Texas Workers' Compensation

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§ 122.5. Employee’s Multiple Employment Wage Statement

(a) Definitions. The following words and terms, when used in this subchapter, will have the following meanings, unless the context clearly indicates otherwise.

(1) Claim Employer–Employer with whom the claimant filed a claim for workers’ compensation benefits and for whom the injured employee (employee) was working at the time of the on-the-job injury.

(2) Non-Claim Employers–Employers other than the claim employer by whom the employee was employed at the time of the on-the-job injury.

(b) For an injury which occurs on or after July 1, 2002, a claimant may file a Multiple Employment Wage Statement for each employer the employee was working for on the date of injury.

(c) If a claimant who is permitted by subsection (b) of this section chooses to file a Multiple Employment Wage Statement, it is the claimant’s responsibility to obtain the required wage information from the Non-Claim Employer(s), providing any necessary corrections to the wage information, and filing the information on the Multiple Employment Wage Statement with the insurance carrier and commission. The carrier is not required to make an adjustment to AWW until the employee provides a complete Multiple Employment Wage Statement as described in subsections (d) and (e) of this section.

(d) The Multiple Employment Wage Statement shall include:

(1) the employee’s name, address, and social security number;

(2) the date of the Non-Claim Employer’s hire of the employee;

(3) the date of injury;

(4) the Non-Claim Employer’s name, address, and federal tax identification number;

(5) the name and phone number of a person at the Non-Claim Employer who can be contacted to verify the wage information (unless the wage information was not provided by a person at the Non-Claim Employer–such as if the wage information came from the Texas Workforce Commission or the employee’s pay stubs);

(6) the wage information required by subsection (e) of this section with documentation that supports the wage information being reported; and

(7) a certification that the wage information provided includes all wage information required by subsection (e) of this section and that the information is complete and accurate.

(e) The wage information required to be provided in a Multiple Employment Wage Statement includes the employee’s Non-Claim Employer wages, as defined in § 128.1 of this title (relating to Average Weekly Wage: General Provisions), earned during the 13 weeks immediately preceding the date of injury and the number of hours the employee worked to earn the wages being reported. The wages are limited to those reportable for federal income tax purposes.

(1) If the employee is paid by the Non-Claim Employer:

(A) on a monthly or a semi-monthly basis, the claimant may provide the wages earned in the three months immediately preceding the injury;

(B) on a biweekly basis, the claimant may provide the wages earned in the 14 weeks immediately preceding the injury;

(C) on other than a monthly, semi-monthly, or biweekly basis, the claimant shall provide the wages earned in the 13 weeks immediately preceding the injury.

(2) If the employee was not employed for 13 continuous weeks before the date of injury:

(A) the claimant shall report the wages of a similar employee performing similar services, as those terms are defined in § 128.3 of this title (relating to Average Weekly Wage Calculation For Full-Time Employees, and For Temporary Income Benefits For All Employees); or

(B) if the Non-Claim Employer does not have a similar employee who has been employed for 13 continuous weeks prior to the employee’s date of injury (or the claimant is unable to obtain the wage information on a similar employee), the claimant shall provide the wages earned by the employee during the period the employee was employed.

(f) Employees who file Multiple Employment Wage Statements are required to report all changes in employment status and/or earnings at the Non-Claim Employer to the carrier until the employee reaches Maximum Medical Improvement.

(1) The employee shall report all changes in employment status at the Non-Claim Employer including termination or resignation within 7 days of the date the change takes place.

(2) The employee shall report within 7 days of the end of the pay period in which a change in earnings at the Non-Claim Employer related to the compensable injury took place. This would include both reductions and increases in wages as compared to the prior week as long as the difference was caused by the compensable injury such as because the employee’s ability to work changed or the employer was more or less able to provide work that met the employee’s work restrictions.

The provisions of this § 122.5 adopted to be effective May 16, 2002, 27 TexReg 4032.

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At a Glance:

Title:

§ 122.5. Employee’s Multiple Employment Wage Statement

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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