This appeal arises pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 401.001 et seq. (1989 Act). A contested case hearing (CCH) was held on April 30, 2025, with the record closing on May 19, 2025, in (city), Texas, with (administrative law judge) presiding as the administrative law judge (ALJ). The ALJ resolved the disputed issue by deciding that the respondent (claimant) is entitled to supplemental income benefits (SIBs) for the first quarter, January 15, 2025, through April 15, 2025.
The appellant (carrier) appealed the ALJ’s determination. The claimant responded, urging affirmance of the decision.
DECISION
Reversed and remanded.
The parties stipulated in part that: (1) on (date of injury), the claimant sustained a compensable injury which resulted in an impairment rating (IR) of 15% or greater; (2) the claimant has not commuted any portion of his impairment income benefits; (3) the qualifying period for the first quarter of SIBs was from October 3, 2024, through January 1, 2025; (4) during the qualifying period for the first quarter of SIBs, the claimant resided in (county) County, Texas; and (5) during the qualifying period for the first quarter of SIBs, the number of minimum weekly work search efforts in (county) County, Texas was three. The claimant, a truck driver, was injured on (date of injury), when he fell off a trailer and hurt his shoulder.
Eligibility criteria for SIBs entitlement are set forth in Section 408.142. Section 408.142 as amended by the 79th Legislature, effective September 1, 2005, references the requirements of Section 408.1415 regarding work search compliance standards. Section 408.1415(a) states, in part, that the Texas Department of Insurance, Division of Workers’ Compensation (Division) commissioner by rule shall adopt compliance standards for SIBs recipients. 28 Tex. Admin. Code §§ 130.100-130.109 (Rules 130.100-130.109), effective July 1, 2009, govern the eligibility of SIBs. Rule 130.101(4) provides, in part, that a qualifying period that begins on or after July 1, 2009, is subject to the provisions of this subchapter, and a qualifying period that begins prior to July 1, 2009, remains subject to the rules in effect on the date the qualifying period begins.
Rule 130.102(d)(1) provides that an injured employee demonstrates an active effort to obtain employment by meeting at least one or any combination of the following work search requirements each week during the entire qualifying period:
(A) has returned to work in a position which is commensurate with the injured employee’s ability to work;
(B) has actively participated in a vocational rehabilitation program as defined in [Rule] 130.101 of this title (relating to [d]efinitions);
(C) has actively participated in work search efforts conducted through the Texas Workforce Commission [TWC];
(D) has performed active work search efforts documented by job applications; or
(E) 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 claimant’s theory for entitlement to SIBs for the first quarter was based on returning to work in a position which is commensurate with the injured employee’s ability to work. The ALJ found that the claimant’s underemployment was a direct result of his impairment from the compensable injury based on the fact that the claimant is permanently restricted from repetitive lifting or continuous lifting more than 25 pounds. This finding is supported by sufficient evidence. The ALJ also stated that the evidence was sufficient to show the claimant was employed every week of the qualifying period; however, the evidence in the record and the claimant’s testimony indicate that the claimant did not work during the last week of the qualifying period due to taking time off and due to holiday closures. As such, the claimant did not demonstrate an active effort to obtain employment under Rule 130.102(d)(1). Accordingly, we reverse the ALJ’s determination that the claimant is entitled to SIBs for the first quarter, January 15, 2025, through April 15, 2025.
Rule 130.102(d)(2) provides that an injured employee who has not met at least one of the work search requirements in any week during the qualifying period is not entitled to SIBs unless the injured employee can demonstrate that he or she had reasonable grounds for failing to comply with the work search requirements under this section. The ALJ made no finding in her decision as to whether the claimant had reasonable grounds under the evidence presented for failing to comply with work search requirements during the last week of the qualifying period. Accordingly, we remand the issue of whether the claimant is entitled to SIBs for the first quarter, January 15, 2025, through April 15, 2025, to the ALJ for further action consistent with this decision. See Appeals Panel Decision (APD) 220632, decided June 13, 2022.
SUMMARY
We reverse the ALJ’s determination that the claimant is entitled to SIBs for the first quarter, January 15, 2025, through April 15, 2025, and we remand the issue of whether the claimant is entitled to SIBs for the first quarter, January 15, 2025, through April 15, 2025, to the ALJ for further action consistent with this decision.
REMAND INSTRUCTIONS
On remand the ALJ is to consider all of the evidence, make findings of fact regarding whether the claimant has demonstrated reasonable grounds for failing to comply with the work search requirements during the last week of the qualifying period, and render conclusions of law and a decision regarding whether the claimant is entitled to SIBs for the first quarter, January 15, 2025, through April 15, 2025.
Pending resolution of the remand, a final decision has not been made in this case. However, since reversal and remand necessitate the issuance of a new decision and order by the ALJ, a party who wishes to appeal from such new decision must file a request for review not later than 15 days after the date on which such new decision is received from the Division, pursuant to Section 410.202 which was amended June 17, 2001, to exclude Saturdays and Sundays and holidays listed in Section 662.003 of the Texas Government Code in the computation of the 15-day appeal and response periods. See APD 060721, decided June 12, 2006.
The true corporate name of the insurance carrier is GREAT WEST CASUALTY COMPANY and the name and address of its registered agent for service of process is
CSC-LAWYERS INCORPORATING SERVICES CO.
211 EAST 7TH STREET, SUITE 620
AUSTIN, TEXAS 78701-3218.
Cristina Beceiro
Appeals Judge
CONCUR:
Carisa Space-Beam
Appeals Judge
Margaret L. Turner
Appeals Judge