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You are here: Home . wc . news . advisories . ad98-05

Advisory 98-05

NOTIFICATION OF EXPIRATION OF 401 WEEKS

Beginning on September 8, 1998, injured employees will begin reaching the expiration of the 401-week period regarding the payment of temporary income benefits, impairment income benefits, and supplemental income benefits as defined in Texas Labor Code §408.083. Injured employees with a date of injury in 1991 who are still receiving income benefits will be the first employees affected by this statutory provision. Since insurance carriers are responsible for the payment of income benefits, insurance carriers have the most accurate records regarding which injured employees will be affected by this provision.

Effective October 1, 1998, insurance carriers shall send the injured employee advance notification regarding expiration of the 401-week period. This notification shall be sent to all injured employees who are receiving or potentially may receive further income benefits during the six months prior to the expiration of the 401-week period. Insurance carriers shall provide this notification in a letter containing the same content as outlined in the attached example letter, which may be used for this purpose. This notice must include the date on which the injured employee will no longer be entitled to income benefits pursuant to Texas Labor Code §408.083.

For dates of injury before May 1, 1991, this advance notification shall be sent no later than one month prior to the expiration of the 401-week period. For dates of injury on or after May 1, 1991, this advance notification shall be sent both four months prior to the expiration of the 401-week period and one month prior to the expiration of the 401-week period.

Signed this 31st day of August, 1998

Leonard W. Riley, Jr., Executive Director

Distribution:
Austin Carrier Representatives
TWCC Staff
Public Information List

Additional Information for Adjusters


Advanced Notification

[LETTERHEAD]

[DATE OF NOTICE]

NOTIFICATION REGARDING PENDING EXPIRATION OF 401 WEEKS

TO: [NAME OF INJURED EMPLOYEE]
[EMPLOYEE ADDRESS]
[DATE OF INJURY]
[TWCC NUMBER]
[INSURANCE CARRIER]
[CARRIER CLAIM NUMBER]

A review of your claim for workers' compensation benefits indicates the expiration of the 401-week period for entitlement to income benefits is approaching. Eligibility for income benefits ends on the expiration of this time period and you will not be entitled to any income benefits after this date.

Our records show your date of injury as [DATE OF INJURY]. Based on our calculations, your eligibility for income benefits will end on [LAST DAY OF 401-WEEK PERIOD]. This is only a notice. If you are currently receiving income benefits, you will receive another notice when your income benefits have ended.

This notice is in regard to income benefits only. You will continue to be entitled to all health care reasonably required by the nature of your injury as and when needed.

If you have any questions regarding the expiration of 401 weeks and eligibility for income benefits, please contact your adjuster at the telephone number listed below, or call the Texas Workers' Compensation Commission at 1-800-252-7031.

ADJUSTER'S NAME:

ADJUSTER'S LICENSE NO.:

ADJUSTER'S PHONE NO.:

Additional Information for Adjusters


Additional Information for Adjusters

Date Calculation

Dates of Injury before September 1, 1995: 401-week period ends 401 weeks from the date of injury.

Dates of Injury on or after September 1, 1995:

If injury : 401-week period ends 401 weeks from the date of injury.

If occupational disease: 401- week period ends 401 weeks from the date income benefits began to accrue.

Income Benefit Information

Entitlement to all temporary income benefits, impairment income benefits, and supplemental income benefits end on the last day of the 401- week period.

If you are paying supplemental income benefits, process the Statement of Employment Status as required for the last quarter. The payment amount will need to be modified to reflect the expiration of the 401- week period. Calculate the last monthly payment as follows:

Calculate the weekly SIBs rate (the figure before you multiply by 4.34821).

Divide this figure by seven (save "result")

Determine the number of days from the date the last check was due to the end of the 401 week period and add seven (save "days left +7").

Multiply "days left +7" with the "result" calculated previously

This is the amount that will be due for the last monthly payment.

EXAMPLE

Jim Jones is receiving supplemental income benefits and the end of the 401-week period ends during the second month of his ninth quarter. He was injured on 1/12/91 and his 401-week period ends on 9/19/98. He has not returned to work and has no earnings (pre-injury average weekly wage is $500.00.) With no earnings, his normal monthly amount for SIBs is $1,304.46. The carrier has accepted that he is entitled to supplemental income benefits for the ninth quarter which covers the period from 7/29/98 through 10/27/97, inclusive. Under the rules, payments are due on 8/4/98 (seventh day), 9/3/98 (37 th day) and 10/3/98 (67 th day - except that this is after the 401-week period). Accordingly, the last payment will be on 9/3/98. The monthly amount would be:

Weekly SIBs rate is $300.00 (maximum rate for SIBs)

$300.00/7 = $42.86.

Last check (9/3) to end of 401-week period (9/19) = 16 days + 7 = 23

($42.86) times (23) = $985.78

The last payment will be made on 9/3/98 in the amount of $985.78. The carrier would also send the A-2 suspension notice on this date with the last check.



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