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 February 7, 2003. The hearing officer resolved the disputed issue by deciding that the respondent (claimant) was entitled to supplemental income benefits (SIBs) for the first quarter, September 26 through December 25, 2002. The appellant (carrier) appealed, arguing that the claimant failed to meet the requirements of Tex. W.C. Comm’n, 28 TEX. ADMIN. CODE §130.102 (Rule 130.102). The appeal file did not contain a response from the claimant.
DECISION
Reversed and a new decision rendered that the claimant is not entitled to SIBs for the first quarter.
Eligibility criteria for SIBs entitlement are set forth in Section 408.142(a) and Rule 130.102. At issue are the requirements in Section 408.142(a)(4) and Rule 130.102(b)(2) that the claimant make a good faith effort to obtain employment commensurate with her ability to work. The parties stipulated that the applicable qualifying period was from June 14 through September 12, 2002.
Rule 130.102(d)(2) 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 enrolled in, and satisfactorily participated in, a full-time vocational rehabilitation program sponsored by the Texas Rehabilitation Commission (TRC) during the qualifying period. The hearing officer specifically found that the claimant was enrolled in and satisfactorily participating in a full time vocational rehabilitation program sponsored by the TRC. The hearing officer noted that the claimant testified she followed the four steps set out in her individualized plan of employment (IPE) from the TRC. The IPE was in evidence and listed the following steps as necessary to achieve the claimant’s employment goal: obtain degree, stabilize living arrangements, increase physical stamina, and complete registration with the Texas Workforce Commission. Although the claimant testified that she worked with TRC in an attempt to attend school to complete her degree, she further testified that she was unable to do so because her loans were in default and therefore she could not qualify for additional financial aid. Therefore, the claimant testified that she did not have enough money to attend classes even with the aid provided by TRC. The claimant testified that the plan was for her to attend classes in the spring semester of 2002 but that she did not do so. There was no evidence from the TRC which indicated the claimant was satisfactorily participating in a program. The hearing officer’s finding that the claimant was enrolled and satisfactorily participating in a full-time TRC-sponsored vocational rehabilitation program is against the great weight and preponderance of the evidence and is reversed.
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 as 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 the September 16, 2002, report from Dr. R specifically explains how the claimant’s injury causes a total inability to work. In evidence was a record from Dr. B which showed that the claimant had an ability to work. However, the hearing officer did not find the record from Dr. B credible because Dr. B attributed the claimant’s condition to previous injuries. We note that the record was dated October 18, 2001, more than eight months outside of the qualifying period. There was sufficient evidence to support the hearing officer’s finding that Dr. B’s report was not an “other record” that showed the claimant is able to return to work.
We have reviewed the narrative dated September 16, 2002, from Dr. R, which the hearing officer found specifically explained how the claimant’s injury causes a total inability to work. The record does no more than generally describe her condition and proposed treatment and then pronounces that she cannot work. The record mentions that the claimant injured her neck, back, and left shoulder, noting that another doctor is treating the claimant for those conditions, and concentrates on the condition of the claimant’s right knee. Dr. R concludes his comments on the claimant’s knee condition stating: “The patient is currently not fit to work” without further explanation. Rule 130.102(d)(4) requires that the narrative specifically explain how the injury causes a total inability to work, including sedentary and part-time work. A recitation of medical conditions and treatment followed by a simple statement that the claimant could not work is inadequate under Rule 130.102(d)(4). Texas Workers Compensation Commission Appeal No. 002724, decided January 5, 2001.
The hearing officer’s determination that the claimant is entitled to SIBs for the first quarter is reversed and a new decision rendered that she is not entitled to those benefits.
The true corporate name of the insurance carrier is LIBERTY MUTUAL FIRE INSURANCE COMPANY and the name and address of its registered agent for service of process is
CT CORPORATION SYSTEMS
350 NORTH ST. PAUL STREET, SUITE 2900
DALLAS, TEXAS 75201.
Thomas A. Knapp
CONCUR:
Daniel R. Barry – Appeals Judge
Michael B. McShane
Appeals Panel
Manager/Judge