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Advisory 99-02

Notification of New TWCC-52
Application for Supplemental Income Benefits

Effective April 13, 1999, the Commission has adopted a new Form TWCC-52, Application for Supplemental Income Benefits, to meet the requirements of the new Rules 130.100 - 130.108 pertaining to supplemental income benefits (SIBs). The new form includes designated space for data elements that must be completed by insurance carriers when the form is mailed to injured employees. Rule 130.104 requires insurance carriers to provide the quarter number, date of the quarter, dates of the qualifying period and the filing deadline.

Information has been incorporated throughout the form to help the injured employee gather the appropriate information to document wages earned during the qualifying period and to thoroughly document job search efforts during this period. Emphasis has been placed on the employee's responsibility to obtain current medical reports supporting any inability to work.

There is no requirement in new rules 130.100 - 130.108 for the insurance carrier to file a copy of Form TWCC-52 with the Commission after a determination of entitlement or non-entitlement is made. The carrier must file Form TWCC-45, Request for a Benefit Review Conference, if it disagrees with the Commission's determination for the first quarter or when it makes a finding of non-entitlement for a subsequent quarter and has previously been paying SIBs. The carrier is not required to request a benefit review conference if it finds non-entitlement and did not pay SIBs in the quarter that immediately preceded the quarter for which Form TWCC-52 was filed.

The new rules are available on the Commission's web site at Also included on the web site is the February 8, 1999 FYI Bulletin, New Rules on Supplemental Income Benefits Adopted, regarding the effective dates for qualifying periods and new eligibility requirements. These documents may also be ordered from TWCC Publications, (512)440-3618.

Adopted this 13th day of April, 1999

Leonard W. Riley, Jr., Executive Director