GQ Corner

Q: I understand that there has been a change regarding TIBs for employees earning less than $10.00 per hour.  Has this change become effective? If so, when did it take effect?

A: You are referring to Senate Bill 901, which was signed by the Governor on May 21, 2015. The bill increases weekly TIBs benefits for injured workers. The bill raises the low-wage-earner threshold for increased TIBs benefits from $8.50 per hour to $10.00 per hour. Employees who meet that criteria are entitled to 75% of their AWW for up to the first 26 weeks of their disability.

This new law goes into effect September 1, 2015 and is applicable to claims with a date of injury on or after September 1, 2015. A claim based on a compensable injury that occurs before September 1, 2015 continues to be governed by the law in effect on the date the compensable injury occurred, and TIBs are paid according to the law in effect on the claim date of injury.

Q: Does the current statue permit a structured settlement for Death Benefits? What are the requirements for a structured settlement for Death Benefits?

A: Rule 132.16 provides a process by which a Carrier can purchase and annuity to pay DIBS:

(c) The insurance carrier and an eligible beneficiary may enter into a written agreement that the carrier shall purchase an annuity for that beneficiary for weekly or monthly payment of death benefits. An application for payment of death benefits by annuity must be submitted to the Commission for approval in the form, format and manner required by the Commission. If less than the maximum weekly death benefit in effect at the time of death is being paid, a completed Employer’s Wage Statement (Form TWCC-3) must be filed with the application for payment by annuity.
(d) An annuity for the payment of death benefits shall meet the following terms and conditions. 

(1) Monthly death benefit payments shall be initiated no later than the 45th day after the date on in which the written agreement was approved by the Commission. 
(2) The company providing an annuity for the payment of death benefits must be licensed to do business in Texas and must have a current A. M. Best rating of B+ or better or have a Standard & Poor’s rating of claims paying ability of A or better. 
(3) The workers’ compensation insurance carrier must guarantee the payments provided by the annuity company in the event of default. 
(4) When benefits are paid to an eligible spouse of the deceased employee and the spouse subsequently remarries, the annuity contract must address the payment of a lump sum payment equal to 104 weeks of benefits to the eligible spouse and the redistribution of benefits at the end of 104 weeks to the remaining eligible beneficiaries, if any. 
(5) If all beneficiaries become ineligible to receive death benefits and an amount equal to 364 weeks of death benefits has not been paid, the remaining benefits shall be paid by the annuity company without an order from the Commission to the Subsequent Injury Fund not later than 30 days after all beneficiaries’ eligibility ends. 
(6) A beneficiary, or the beneficiary’s guardian if applicable, shall not be allowed to assign the right to receive death benefits from an annuity. All death benefits must be paid to the order of the eligible beneficiary or the legal guardian, if applicable. 
(7) The annuity company shall pay death benefits either weekly or monthly as elected by the beneficiary in the application for payment of death benefits by annuity. 
(8) If monthly payments are elected by the beneficiary, the transition from weekly to monthly benefits paid by annuity shall be the same as that for death benefits paid by the responsible insurance carrier set out in subsection (a) of this section. 

(e) This section applies only to agreements entered into on or after January 1, 2000, for payment of death benefits under the provisions of the Act.

Here is the link to the required form to get DWC approval:  http://www.tdi.texas.gov/forms/dwc/dwc031ppanndb.pdf

Q: I have a fatal comp claimant and today is the one year anniversary. As with most of these death cases, the family has plaintiff attorney. However, we have not heard a thing on a request for payment for the parents. How long do I have before we are required to pay the DWC the 364 weeks? Do we need to have a BRC to confirm the one year is up?

A: Pay the SIF without order from the Division. Your deadline in this case is no later than the 7th day after the anniversary of the claimant’s death. See Rule 132.10(c).