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 November 13, 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 (claimant) is entitled to supplemental income benefits (SIBs) for the first quarter, March 29, 2025, through June 27, 2025; (2) the claimant is entitled to SIBs for the second quarter, June 28, 2025, through September 26, 2025; (3) the claimant is entitled to SIBs for the third quarter, September 27, 2025, through December 26, 2025; and (4) the appellant (carrier) did not waive its right to contest the claimant’s entitlement to SIBs for the first quarter by failing to timely request a benefit review conference (BRC). The carrier appealed the ALJ’s determinations of the claimant’s entitlement to the first, second, and third quarter of SIBs. The appeal file does not contain a response from the claimant. The ALJ’s determination that the carrier did not waive its right to contest the claimant’s entitlement to SIBs for the first quarter by failing to timely request a BRC was not appealed and became final pursuant to Section 410.169.
DECISION
Affirmed in part and reversed and rendered in part.
The claimant testified that he injured his right eye when cleaning a pressurized pipe. The claimant had surgery on his right eye on the same date as the compensable injury. The evidence reflects that a prior Decision was issued on July 31, 2025, that determined that the claimant reached maximum medical improvement (MMI) on April 5, 2024, with a 17% impairment rating (IR). The parties stipulated, in part, that the claimant’s county of residence required five active work search efforts documented by job applications during each week of the qualifying period. The parties stipulated that the qualifying period for the first quarter of SIBs was from December 15, 2024, through March 15, 2025, and that the qualifying period for the second quarter of SIBs was from March 16, 2025, through June 14, 2025. The parties stipulated that the qualifying period for the third quarter was from June 15, 2025, through September 13, 2025.
FIRST AND SECOND QUARTER SIBS
The Texas Department of Insurance, Division of Workers’ Compensation (Division) sent the first quarter SIBs application (DWC-52) to the claimant on August 15, 2025. It is undisputed that the claimant did not make five work search efforts documented by job applications during each week of the qualifying period for the first or second quarter. The claimant contended that he had good cause for failing to meet the work search requirements and the ALJ determined that the claimant demonstrated he had reasonable grounds for failing to comply with the work search requirements of Tex. Admin. Code § 130.102(d)(Rule 130.102(d)). The ALJ noted in her discussion of the evidence that the claimant did not receive the decision relating to the IR and the date of MMI until August 6, 2025, after the end of the qualifying period for both the first and second quarters. We note the Division sent the claimant the DWC-52 for the first quarter on August 15, 2025, which was after the qualifying periods for the first and second quarters. Each contention that the claimant had good cause for failing to meet the work search requirements of Rule 130.102(d) must be judged on a case-by-case basis considering the evidence in the record. Under the facts presented in the instant case, the ALJ could determine the claimant had reasonable grounds for failing to comply with the work search requirements for both the first and second quarters.
The ALJ’s determination that the claimant is entitled to SIBs for the first quarter March 29, 2025, through June 27, 2025, is supported by sufficient evidence and is affirmed.
The ALJ’s determination that the claimant is entitled to SIBs for the second quarter, June 28, 2025, through September 26, 2025, is supported by sufficient evidence and is affirmed.
THIRD QUARTER SIBS
As discussed previously, the ALJ noted that the claimant did not receive the decision relating to the claimant’s date of MMI and IR until August 6, 2025, after the qualifying period had already begun on June 15, 2025. In her discussion of the evidence, the ALJ noted that there was no persuasive evidence from the carrier that the application for the third quarter was sent to the claimant. The ALJ found that the claimant is entitled to SIBs for the third quarter based because the claimant demonstrated he had reasonable grounds for failing to comply with the Rule 130.102(d) work search requirements.
The evidence reflects that the claimant listed job searches on the third quarter SIBs application beginning on August 24, 2025, and listed work search efforts for the last three weeks of the qualifying period. However, there were two full weeks after receipt of the ALJ’s prior decision regarding the MMI/IR certification in which the claimant did not perform any work search efforts during the qualifying period for the third SIBs quarter. Under these facts, we cannot agree the claimant established reasonable grounds for failing to comply with Rule 130.102(d) during those weeks. The ALJ notes that there was no persuasive evidence from the carrier that the application for the third quarter was sent to the claimant. We have held that Rule 130.104(b) does not require the carrier to pay for any quarter of SIBs for which it did not provide a DWC-52. Appeals Panel Decision (APD) 032272, decided October 16, 2003, and APD 032218, decided October 14, 2003. Accordingly, we reverse the ALJ’s determination that the claimant is entitled to SIBs for the third quarter, September 27, 2025, through December 26, 2025, and render a new decision that the claimant is not entitled to SIBs for the third quarter, September 27, 2025, through December 26, 2025.
SUMMARY
We affirm the ALJ’s determination that the claimant is entitled to SIBs for the first quarter, March 29, 2025, through June 27, 2025.
We affirm the ALJ’s determination that the claimant is entitled to SIBs for the second quarter, June 28, 2025, through September 26, 2025.
We reverse the ALJ’s determination that the claimant is entitled to SIBs for the third quarter, September 27, 2025, through December 26, 2025, and render a new decision that the claimant is not entitled to SIBs for the third quarter, September 27, 2025, through December 26, 2025.
The true corporate name of the insurance carrier is NEW HAMPSHIRE INSURANCE COMPANY and the name and address of its registered agent for service of process is
CORPORATION SERVICE COMPANY
211 EAST 7TH STREET, SUITE 620
AUSTIN, TEXAS 78701-3218.
Margaret L. Turner
Appeals Judge
CONCUR:
Cristina Beceiro
Appeals Judge
Carisa Space-Beam
Appeals Judge