FAQ
Supplemental income benefits (SIBs) application

Where do I send this form?

• For the first quarter, send this form and supporting documentation to the Texas Department of Insurance,Division of Workers’ Compensation (DWC) by the filing due date on the SIBs notification letter.

Fax: 512-804-4378
Mail: Texas Department of Insurance, Division of Workers’ Compensation
Claims and Customer Services, Mail Code CCS
PO Box 12050
Austin, TX 78711

• For all other quarters, send application and supporting documentation to the insurance carrier by fax, mail, or email.

What is needed to meet the work search requirements?
For each week during the qualifying period, you must:

1. show active participation in a vocational rehabilitation program provided by the Texas Workforce Commission(TWC) or a private vocational rehabilitation provider;
2. show active participation in work search efforts conducted through TWC; or
3. show you were actively looking for a job by attaching job applications or other documents showing you have applied or asked for a job.

You may use the attached work search log to track the applications you’ve submitted each week. You can attach more work search pages if needed.
The number of weekly work searches is based on the county you live in. Contact DWC or visit www.twc.texas.gov/jobseekers/required-number-work-search-activities-county for the number of work searches your county requires. If out of state, contact your local unemployment office to find out how many work searches you must do.

What if I’m unable to perform any type of work in any capacity?
You must provide a narrative report from a doctor which specifically explains how your injury causes a total inability to work, and no other records show that you are able to return to work.

Can I still apply if I’m working?
Yes, if you are earning less than 80% of your average weekly wage due to permanent impairment from your injury. You can document this with pay stubs or wage statements. You must meet work search requirements for any weeks during the qualifying period you are not working.

What if my application is denied?
You can ask for a benefit review conference. At the conference, someone from DWC will listen to you and the insurance carrier and try to help you reach an agreement. An injured employee who is not represented by an attorney may also get help by contacting the Office of Injured Employee Counsel at 866-393-6432.

Questions?
Call 800-252-7031, Monday to Friday, 8 a.m. to 5 p.m., Central time. Go to www.tdi.texas.gov/wc to learn more about workers’ compensation.

Note: With few exceptions, on your request, you are entitled to:

• Be informed about the information DWC collects about you.
• Receive and review the information (Government Code Sections 552.021 and 552.023).
• Have DWC correct information that is incorrect (Government Code Section 559.004).For more information, contact [email protected] or go to the Corrections Procedure section at www.tdi.texas.gov.

For more information, contact [email protected] or go to the Corrections Procedure section at www.tdi.texas.gov.