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 August 25, 2025, in (city), Texas, with (administrative law judge) presiding as the administrative law judge (ALJ). The ALJ resolved the disputed issues by deciding that: (1) the respondent/cross-appellant (claimant) is entitled to supplemental income benefits (SIBs) for the first quarter, April 2, 2025, through July 1, 2025; and (2) the claimant is not entitled to SIBs for the second quarter, July 2, 2025, through September 30, 2025.
The appellant/cross-respondent (carrier) appealed the ALJ’s determination that the claimant is entitled to SIBs for the first quarter. The claimant responded, urging affirmance of the first quarter SIBs determination. The claimant appealed the ALJ’s determination that the claimant is not entitled to SIBs for the second quarter. The carrier responded to the claimant’s cross-appeal, urging affirmance of the second quarter SIBs determination.
DECISION
Affirmed in part and reversed and rendered in part.
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 December 19, 2024, through March 19, 2025; (4) the qualifying period for the second quarter of SIBs was from March 20, 2025, through June 18, 2025; and (5) the claimant resides in (County), Texas, and per the Texas Workforce Commission, is required to perform three active work search efforts per week. The claimant, a maintenance engineer, was injured on (date of injury), when his left hand was caught in a machine.
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 130.102(b) provides the eligibility criteria for SIBs and states that an injured employee who has an IR of 15% or greater, who has not commuted any impairment income benefits, who has not permanently lost entitlement to SIBs and who has completed and filed an Application for SIBs in accordance with this subchapter is eligible to receive SIBs if, during the qualifying period, the injured employee:
(1)has earned less than 80% of the injured employee’s average weekly wage (AWW) as a direct result of the impairment from the compensable injury; and
In Finding of Fact No. 3, which was not appealed, the ALJ found that during the first and second quarter qualifying periods: the claimant had some ability to work; the claimant was underemployed; and the claimant’s underemployment was not a direct result of his impairment from the compensable injury. As noted above, in order to be eligible for SIBs, the claimant must have earned less than 80% of his AWW as a direct result of the compensable injury. As the ALJ found that the claimant did not meet the direct result requirement for both quarters in dispute in an unappealed finding, we reverse the ALJ’s determination that the claimant is entitled to SIBs for the first quarter, April 2, 2025, through July 1, 2025, and we render a new decision that the claimant is not entitled to SIBs for the first quarter.
The ALJ’s determination that the claimant is not entitled to SIBs for the second quarter, July 2, 2025, through September 30, 2025, is supported by sufficient evidence and is affirmed.
The true corporate name of the insurance carrier is HARTFORD LLOYD’S INSURANCE COMPANY and the name and address of its registered agent for service of process is
CT CORPORATION SYSTEM
1999 BRYAN STREET, SUITE 900
DALLAS, TEXAS 75201.
Cristina Beceiro
Appeals Judge
CONCUR:
Carisa Space-Beam
Appeals Judge
Margaret L. Turner
Appeals Judge