Texas Workers' Compensation

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§ 137.48. Return-to-Work Reimbursement Program Administrator Determinations

(a) The administrator shall make determinations regarding the following:

(1) the employer’s eligibility to participate in the program;

(2) the appropriateness of the workplace modification in facilitating the injured employee’s return to work based on doctor-identified restrictions;

(3) the effectiveness of the workplace modification in facilitating the injured employee’s early and sustained return to work;

(4) the cost of the workplace modification in relation to usual and customary costs of the same or similar modification; and

(5) the appropriateness of other costs incurred or to be incurred by the employer to return the injured employee to work in a modified or alternative duty capacity.

(b) The administrator or designee may make an on-site evaluation or request information from the employer or providers of a workplace modification in order to verify that:

(1) the workplace modification was or will be provided;

(2) the workplace modification was or will be a reasonable modification and expenditure; and

(3) the injured employee returned to work as a result of the workplace modification.

(c) The administrator may utilize the National Institute of Health’s “Searchable Online Accommodation Resource,” U.S. Department of Labor resources, Texas Department of Assistive and Rehabilitative Services resources, or similar resources in evaluating and verifying workplace modifications and associated costs. The administrator may consult with a rehabilitation counselor or specialist when verifying the appropriateness of workplace modifications and costs.

(d) The administrator may approve or deny in whole or in part the employer’s request for funds from the program pursuant to § 137.44 of this title (relating to the Return-to-Work Reimbursement Program for Employers), § 137.45 of this title (relating to Employer Eligibility for Disbursements from the Return-to-Work Reimbursement Program), § 137.46 of this title (relating to the Application for Funds from the Return-to-Work Reimbursement Program), and § 137.47 of this title (relating to the Criteria for Return-to-Work Reimbursement Program Applications).

(e) Decisions regarding approval or denial of applications, the reason for approval or denial of an application, and the amount to be disbursed from the program are final, may not be appealed, and are the discretion of the administrator.

(f) Upon completion of the application evaluation, the employer will be notified in writing of the approval or denial of the application by the administrator.

The provisions of this §137.48 adopted to be effective February 22, 2006, 31 TexReg 1037; amended to be effective April 25, 2010, 35 TexReg 3061.

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At a Glance:

Title:

§ 137.48. Return-to-Work Reimbursement Program Administrator Determinations

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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