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  TIB – Temporary Income Benefit (code as TT)

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  IIB - Impairment Income Benefit (code as PP)

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  SIB – Supplemental Income Benefit (code as TP)

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  LIB – Lifetime Income Benefit (code as PT)

The following chart summarizes the four types of benefits that could cause WC offset.

There is no provision for payment of a lump sum in lieu of any of these benefits, although commutation or acceleration of the IIB is possible.

Lifetime Income Benefits (LIBs) are the only benefits increased by COLAS (per Texas WC law, Section 408.161 (http://www.statutes.legis.state.tx.us/Docs/LA/htm/LA.408.htm#408.161 ). (See chart information in DI 52120.240B in this section.) All other Texas WC benefits are not increased by COLAs. Adjustments to the maximum and minimum benefit amounts occur each fiscal year. The new limits apply to any injury that occurs during that fiscal year.

Attorney fees up to 25 percent allowed.

Texas does not offset its WC for SSA retirement benefits.

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  The commissioner may grant a worker suffering financial hardship advances against the amount of income benefits to which the worker is entitled. Before or after the worker attains maximum medical improvement an advance may be ordered. An insurance carrier pays the advance ordered.

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  A worker must apply to the division for an advance on a form prescribed by the commissioner. The application must describe the hardship that is the grounds for the advance.

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  An advance under this section may not exceed an amount equal to four times the maximum weekly benefit for temporary income benefits. The commissioner may not grant more than three advances to a particular worker based on the same injury.

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  Texas allows employers to elect not to participate in the State's WC system. Injured employees of companies that choose not to participate do not receive WC benefits, but may sue their company for negligence, etc.

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  Some companies create their own plans providing benefits to employees injured on the job. Payments made under such a law or plan is not subject to offset.

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  Do not impose offset if payments are paid under the “opt-out” statute.

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  If you are working a case that appears to involve an employer that has opted-out of the Texas workers' compensation system, obtain verification from the employer.

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  Verification could be a copy of the opt-out plan, copy of correspondence with the employees stating they are not covered by State workers' compensation, or a signed statement from the employee.

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  Also acceptable is an FO precedent on the employer.  

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  State of Texas Insurance Board maintains a list only of those employers who have opted-in and participate in the State’s WC insurance program for the prior two years. Therefore, by default, the employers not listed have opted-out. Online access is provided via TXCOMP's Locate Covered Employers tool. 

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  If you are checking for workers' compensation coverage from a period earlier than the most recent two years, or do not find an employer you believe has coverage, contact the Insurance Coverage Department at (800) 372-7713 or (512) 804-4345.

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  Employers have the freedom to opt-in and opt-out, and some employers exercise this option more than once. If a worker alleges the employer participated in the WC insurance program at the time of injury, the final developmental contact by the FO must be directly with the employer to determine when or if the employer participated and, if applicable, when the employer opted-out.

TIB payments to prisoners are suspended, which means a break in the WC payment. A break in the payment of TIBs could affect eligibility for future triennial redeterminations. For information on Triennial Redetermination of the ACE, see DI 52150.080D.

Effective September 1, 2005, the Texas WC Commission was disbanded and its functions transferred to the newly created Division of Workers' Compensation in the Texas Department of Insurance (TDI).  Despite this reorganization, the process for obtaining WC information is essentially unchanged.  Requests will continue to be made to their Records Center, where employees handle inquiries such as those made by SSA.

NOTE: The information provided by TDI is not proof of WC payments. It is only evidence that payments were made, and additional development should be undertaken to the claimant and/or the insurance carrier to provide the actual proof of the WC payments and periods of payment. The following statement appears on TDI responses to SSA Requests: "The information provided is not a record of money paid to the individual, rather a data report the insurance carrier to DWC which provided the number of weeks the benefit was paid, the number of weeks paid, the weekly amount and the benefit type. The "Estimated Paid to Date" is a calculation based on this information. The "Estimated Paid to Date" does not include reductions in payment to injured employees for attorney fees and other withholdings. For complete benefits payment information, contact the insurance carrier indicated on the worksheet."

If the required information from the claimant or the WC carrier is unknown, .the Division of Workers' Compensation can be contacted. The initial request should be made by fax to (512) 804-4991.   Do not attempt to initially secure the information by phone.  If unable to accomplish a fax transmission, the mailing address is:

The consent of the worker is not required before the Division of Workers' Compensation will release information to SSA, but you should still include a copy of any consent statement that has been obtained.  In order for the Division of Workers' Compensation to verify that the request is from SSA, they ask that it be made using a document with an SSA letterhead.   Any fax cover sheet with the SSA logo may be used, and individual PCs and FOs should create their own local forms for this purpose.  An SSA-1709 should be included as an attachment if deemed appropriate. At a minimum, include the NH’s name, SSN, and the date of the workers’ compensation injury.  The DWC uses the injury date to search for the record, applying a tolerance of 60-90 days from the injury date shown.  If the injury date is unknown, but indications are that the WC payments started at a time close to the onset date established by SSA, show: “Not in SSA records but the Social Security onset date is MM/DD/YYYY.”  If there is an indication that the WC payments did not begin until sometime after DIB was awarded, as would be the case if a DIB beneficiary later returned to work and was injured on the later job, show an injury date slightly prior whatever WC start date is alleged or otherwise indicated on whatever documentation is in file.  To facilitate a response, show your name, title, phone, and fax number on the correspondence.

The Division of WC requests that we wait 60 days before doing a follow-up on the status of a request. If no reply has been received by then, the CA/CTE should do a follow-up phone call to 800–252–7031. Besides providing assistance in determining the status of the prior request, they can also, if needed, help interpret the documents you received.

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  Texas Workers' Compensation Site

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  Texas Workers' Compensation Act