Title: 

APD 012716

Significant Decision

Date: 

December 29, 2001

Issues: 

Unavailable

Table of Contents

APD 012716

This appeal arises pursuant to the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing was held on June 18, 2001. The hearing officer resolved the disputed issues by deciding that the respondent’s (claimant) compensable injury of __________, includes anxiety and depression, and that the claimant is entitled to supplemental income benefits (SIBs) for the second and third quarters. The appellant (carrier) appealed. In Texas Workers’ Compensation Commission Appeal No. 011630, decided September 5, 2001, the Appeals Panel remanded the case to the hearing officer for the purpose of obtaining the insurance carrier’s registered agent information. See Section 410.164(c). On remand, the carrier provided the required information. The hearing officer made the same determinations in the decision on remand as she had in her original decision. The carrier has appealed. No response was received from the claimant.

DECISION

The hearing officer’s decision on remand is affirmed.

EXTENT OF INJURY ISSUE

The hearing officer did not err in determining that the claimant’s compensable injury includes anxiety and depression. Conflicting evidence was presented on this issue. The hearing officer is the sole judge of the weight and credibility of the evidence. Section 410.165(a). As the finder of fact, the hearing officer resolves the conflicts in the evidence and determines what facts have been established. A referral doctor reported in January 2001 that the claimant’s anxiety and depression resulted from the claimant’s work-related injury and subsequent chronic pain. The hearing officer’s determination is supported by sufficient evidence and is not so against the great weight and preponderance of the evidence as to be clearly wrong and unjust. Cain v. Bain, 709 S.W.2d 175 (Tex. 1986).

SECOND AND THIRD QUARTERS SIBS ISSUES

The hearing officer did not err in determining that the claimant is entitled to SIBs for the second and third quarters. Eligibility criteria for SIBs entitlement are set forth in Section 408.142(a) and Tex. W.C. Comm’n, 28 TEX. ADMIN. CODE § 130.102 (Rule 130.102). The SIBs criteria in dispute for the relevant qualifying periods for the second and third quarters are whether the claimant earned less than 80% of his average weekly wage as a direct result of the impairment from his compensable injury, and whether he made a good faith effort to obtain employment commensurate with his ability to work. Rule 130.102(c) provides that an injured employee has earned less than 80% of the employee’s average weekly wage as a direct result of the impairment from the compensable injury if the impairment from the compensable injury is a cause of the reduced earnings. With regard to the good faith criterion, the claimant contended that, as a result of his compensable injury, he had no ability to work during the relevant qualifying periods. Rule 130.102(d)(4) provides that an injured employee has made a good faith effort to obtain employment commensurate with the employee’s ability to work if the employee has been unable to perform any type of work in any capacity, has provided a narrative report from a doctor which specifically explains how the injury causes a total inability to work, and no other records show that the injured employee is able to return to work.

The hearing officer found that during the qualifying periods for the second and third quarters, the claimant was unemployed as a direct result of his impairment, that the claimant was unable to work in any capacity, that the claimant provided a narrative report from a doctor which specifically explained how the injury caused a total inability to work, and that other records did not show that the claimant was able to return to work. A doctor the claimant saw at the request of the Texas Workers’ Compensation Commission provided the required narrative report which specifically explained how the compensable injury caused a total inability to work. A doctor the claimant saw at the carrier’s request wrote that it appeared that the claimant is able to do a light to sedentary job, but stated that a functional capacity evaluation (FCE) would be ordered to determine the claimant’s ability to work, and that doctor completed a work status report which indicated that the claimant’s compensable injury prevents the claimant from returning to work until the completion of an FCE. We conclude that the hearing officer’s findings and determinations on entitlement to second and third quarter SIBs are supported by sufficient evidence and are not so against the great weight and preponderance of the evidence as to be clearly wrong and unjust. Cain, supra.

The hearing officer’s decision and order on remand are affirmed.

The true corporate name of the insurance carrier is AMERICAN MOTORISTS INSURANCE COMPANY and the name and address of its registered agent for service of process is

CORPORATION SERVICE COMPANY

800 BRAZOS STREET

AUSTIN, TEXAS 78701.

Robert W. Potts

CONCUR:

Elaine M. Chaney – Appeals Judge

Robert E. Lang

Appeals Panel

Manager/Judge