GQ Corner

Q. Just wanted to run deducting TIBs overpayment from current TIBs. We started paying claimant TIBs based upon his report of lost time.  We then received information from the employer that he had actually worked during that timeframe and was not off work.  I sent the claimant a letter requesting his approval to deduct the overpayment from his TIBs and discussed it with him.  He agreed and did sign the form to deduct 25% from his weekly benefits.

A. Yes, I think this would be a situation to follow the recoupment procedures set out in Rule 126.16. Be sure to adhere to the notice (and other) requirements and note that you must wait until at least the second benefit payment after written notice to begin recoupment.

Q. Extraterritorial coverage? Insured states the claimant was hired in Texas and he works in different states; however he has never worked in Texas.  He has worked in Colorado, Nebraska, Kansas and Ohio. The accident occurred in Ohio. We need to determine if the claimant would still be covered under Texas jurisdiction? See below.

P: TX
W: Multiple states
A: OH (monopolistic state)
L: TX
S: NC
H: Texas

The claimant has only worked for the insured for 4 months.

A. Texas Labor Code Section 406.071 provides that an employee injured while working in another jurisdiction (outside of Texas) or legal beneficiary of the employee may pursue benefits and taxes if (1) the injury would be compensable if it had occurred in Texas, and (2) the employee has significant contacts with Texas or the employment is principally located in Texas. The statute defines “significant contacts” as being hired or recruited in Texas and either being injured within one year of the hire date, or working in Texas for at least 10 working days during that 12 months preceding the injury.

Based on your facts, it seems to me that it could be a Texas claim because the claimant was hired in Texas and injured within a year.