130.104
(a) Subsequent Quarter Determination. After the Division has made a determination of entitlement or non-entitlement for supplemental income benefits for the first quarter, the insurance carrier shall make determinations for subsequent quarters consistent with the provisions contained in §130.102 of this title (relating to Eligibility for Supplemental Income Benefits; Amount). The insurance carrier shall issue […]
130.105
(a) Failure to timely file. An injured employee who does not timely file an Application for Supplemental Income Benefits with the insurance carrier shall not receive supplemental income benefits for the period of time between the beginning date of the quarter and the date on which the form was received by the insurance carrier, unless […]
130.106
(a) 12-Month Provision. Except as provided in §130.109 of this title (relating to Reinstatement of Entitlement if Discharged with Intent to Deprive of Supplemental Income Benefits), an injured employee who is not entitled to supplemental income benefits for a period of four consecutive quarters permanently loses entitlement to such benefits. (b) 401-Week Provision. An injured […]
130.107
(a) First Quarter. After the Division’s initial determination of entitlement, the insurance carrier shall pay supplemental income benefits as follows: (1) the first payment shall be made on or before the tenth day after the day on which the insurance carrier received the Division determination of entitlement or the seventh day of the quarter, whichever […]
130.108
(a) Injured Employee Disputes. An injured employee may contest the determination by the Division or the insurance carrier regarding non-entitlement to, or the amount of, supplemental income benefits by requesting a benefit review conference as provided by Chapter 141 of this title (relating to Dispute Resolution–Benefit Review Conference). (b) Insurance Carrier Dispute; First Quarter. If […]
130.109
(a) An injured employee who has lost entitlement to supplemental income benefits under § 130.106(a) of this title (relating to Loss of Entitlement to Supplemental Income Benefits), and is discharged from employment within 12 months of losing entitlement, will become re-entitled if the employer discharged the injured employee with intent to deprive the injured employee […]
132.9
(a) A grandchild, who is eligible to receive death benefits and is a minor at the time of the employee’s death, is entitled to receive benefits until the earlier of: (1) the date on which the grandchild turns 18; or (2) the date of death of the grandchild. (b) A grandchild, who is eligible to […]
140.6
(a) Applicability. This section is applicable to a subclaim pursued under Labor Code § 409.009, including a subclaim pursued by a health care insurer. (b) Party status. A subclaimant as described in § 409.009 is a party to a claim concerning workers’ compensation benefits. (c) Rights in Relation to the Injured Employee. (1) A subclaimant […]
140.7
(a) Applicability. This section applies only to subclaims by a health care insurer based on information received under Labor Code § 402.084(c-3). (b) Health care insurer. “Health care insurer” means an insurance carrier and an authorized representative of an insurance carrier, as described by Labor Code § 402.084(c-1). (c) Reimbursement of Health Care Insurers. A […]
134.402
(a) Applicability of this rule is as follows: (1) This section applies to facility services provided on or after September 1, 2008 by an ambulatory surgical center (ASC), other than professional medical services. (2) This section does not apply to: (A) professional medical services billed by a health care provider not employed by the ASC, […]