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RULE §126.4 Advance of Benefits Based on Financial Hardship

Published: 2015

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(a) An injured employee seeking an advance of income benefits
based on financial hardship shall submit a written application to the Commission
in the form and manner prescribed by the Commission that states the basis
for the hardship The application must state the employee understands that
if an advance is granted the amount of future weekly benefit payments will
be reduced as directed by the Commission.
(b) The Commission shall forward a copy of the employee's application
to the insurance carrier and shall consider the employee's application and
may order an advance if it determines that both a hardship exists for the
employee and the employee is likely to be entitled to income benefits sufficient
to cover the amount of the advance.
(c) An advance will not be granted to an employee whose combined
post-injury earnings, as defined by §129.2 of this title (relating to
Entitlement to Temporary Income Benefits), and income benefits under this
Act equals or exceeds 90% of the employee's net pre-injury wage. In the absence
of specific evidence to the contrary, the net pre-injury wage of an employee
shall be presumed to be 80% of the average weekly wage, for this section.

(d) The Commission shall notify the carrier and the employee
in writing when an advance is ordered. The notice shall include the amount
of the advance to be paid; this amount shall not exceed four times the maximum
weekly benefit for temporary income benefits as computed under the Act, §408.061(a).
The carrier shall pay an advance ordered by the Commission within seven days
of the receipt of notice from the Commission by the carrier's Austin representative.

(e) After the carrier has paid an advance, it shall reduce
the amount of the weekly income benefits in an amount set by the Commission,
which takes into account the amount advanced and the number of weeks that
benefits are likely to be paid in the future. The weekly benefits may be paid
in this reduced amount until the carrier has recouped the amount advanced.

(f) The total amount of benefits paid to the employee through
weekly payments and advances based on hardship shall not exceed the amount
the employee would have received under a normal payment schedule. No more
than three advances shall be granted based on the same injury.

Source Note: The provisions of this §126.4 adopted to be effective January 30, 1991, 16 TexReg 313; amended to be effective December 26, 1999, 24 TexReg 11399