(a) The administrator shall make determinations regarding the following:
- (1) the employer's eligibility to participate in the program;
- (2) the appropriateness of the workplace modification in facilitating the injured employee's return to work based on doctor-identified restrictions;
- (3) the effectiveness of the workplace modification in facilitating the injured employee's early and sustained return to work;
- (4) the cost of the workplace modification in relation to usual and customary costs of the same or similar modification; and
- (5) the appropriateness of other costs incurred by the employer to return the injured employee to work in a modified or alternate duty capacity.
(b) The administrator or designee may make an on-site evaluation or request information from the employer or providers of a workplace modification in order to verify that:
- (1) the workplace modification was provided;
- (2) the workplace modification was a reasonable modification and expenditure; and
- (3) the injured employee returned to work as a result of the workplace modification.
- (c) The administrator shall utilize the National Institute of Health's "Searchable Online Accommodation Resource," U.S. Department of Labor resources, Texas Department of Assistive and Rehabilitative Services resources, or similar resources in evaluating and verifying workplace modifications and associated costs. The administrator may consult with a rehabilitation counselor or specialist when verifying the appropriateness of workplace modifications and costs.
- (d) The administrator may approve or deny in whole or in part the employer's request for reimbursement from the account.
- (e) Decisions regarding approval or denial of applications, the reason for approval or denial of an application, and the amount to be disbursed from the account may not be appealed and are the sole discretion of the return-to-work account administrator.
Source Note:The provisions of this §137.48 adopted to be effective February 22, 2006, 31 TexReg 1037.