TITLE 28.INSURANCE

Part 1. TEXAS DEPARTMENT OF INSURANCE

Chapter 5. PROPERTY AND CASUALTY INSURANCE

Subchapter U. USE OF CREDIT INFORMATION OR CREDIT SCORES

28 TAC §5.9941

The Texas Department of Insurance proposes amendments to §5.9941, regarding the allowable differences in rates charged by insurers due solely to differences in credit scores. In general, Insurance Code Article 21.49-2U provides certain requirements pertaining to the use of credit information and credit scoring by insurers in Texas for underwriting or rating certain personal insurance policies. Article 21.49-2U applies to insurers authorized to write property and casualty insurance in this state that write certain types of personal insurance coverage and use credit information or credit reports for the underwriting or rating of that coverage. However, Article 21.49-2U does not apply to farm mutual insurance companies.

Article 21.49-2U, Section 13(b) requires the commissioner to adopt rules regarding the allowable differences in rates charged by insurers due solely to differences in credit scores. The proposed amendments to §5.9941 establish an allowable percentage difference in rates an insurer may charge due solely to credit scoring if the difference in rates is based on sound actuarial principles and fully supported by data filed with the department. Section 5.9941 was adopted on November 10, 2003 and became effective on November 30, 2003. Prior to the adoption of §5.9941, the Texas Department of Insurance received numerous comments from members of the legislature, the public and insurers on proposed §5.9941. Many comments were received concerning the appropriate allowable differences in rates charged by insurers due solely to differences in credit scores. Some commenters suggested that the allowable difference be a dollar amount; most other commenters requested that a percentage amount be set by the Commissioner. The department proposed an amendment to §5.9941 on December 12, 2003. A public hearing was held on January 7, 2004 where many comments were received from insurers, legislators, and members of the public. That proposed credit scoring amendment was withdrawn by operation of law on June 12, 2004 in accordance with TEX. GOV’T CODE §2001.027. After further evaluation of that proposed amendment, the department believes substantive changes need to be made to include additional requirements regarding the use of rates charged by insurers due solely to differences in credit scores.

After further consideration of the statute, comments received and legislative history, the department is proposing an amendment to establish a rate difference due solely to the use of credit scoring that cannot be greater than +/- 10% from what would have been charged had credit scoring not been used. The amendment further provides that if an insurer proposes to use credit scoring to rate personal insurance policies and if the rate difference due solely to credit scoring is greater than +/-10%, the insurer must request and justify an allowable difference in rates and may not use the proposed rate difference until it is permitted by the department. The insurer’s request must include actuarial support and information required by the Commissioner. An insurer can reference the Filings Made Easy Guide for information on actuarial support. The proposed amendments to §5.9941 are necessary to ensure that insurance consumers are charged premiums that are reasonable, fair, and related to their risk profiles while minimizing market disruption. The proposed amendments will further promote stability in the market and promote an increase in consumer choices while promoting a competitive environment. The department believes that it is good public policy to set some type of limitation on the allowable differences in rates. The department further believes that to minimize market disruption and to provide stability, insurers must request and justify a difference in rates that exceeds the +/-10% limitation and this must be permitted by the department before an insurer may charge such a rate. This would assure that any rate increases due to a difference in rates greater than +/-10% are fully supported and justified.

Marilyn Hamilton, Associate Commissioner, Property and Casualty Group, has determined that for each year of the first five years the proposed section will be in effect, there will be no fiscal impact to state and local governments as a result of the enforcement or administration of the rule. There will be no measurable effect on local employment or the local economy as a result of the proposal.

Ms. Hamilton has determined that for each year of the first five years the proposed section is in effect, the public benefit anticipated as a result of the proposed section will be that consumers will not be charged rates, due solely to the use of credit scoring, that vary more than +/-10% unless they are fully supported by actuarial information that is reasonably related to actual or anticipated loss experience and are permitted by the department. Requiring insurers to request and justify differences in rates charged due to the use of credit scoring minimizes the possibility that consumers will realize unjustified rate increases and minimizes market disruption. The costs of compliance with the proposed section for large, small and micro-businesses result entirely from the legislative enactment of Senate Bill 14, 78th Legislature, Regular Session, and not as a result of the administration or enforcement of the rules. Based upon the cost of labor per hour, there will be no difference in the cost of compliance between a large and small business as a result of the proposal. There is no disproportionate economic impact on small or micro-businesses. The proposed section may not be waived for insurers that qualify as small or micro-businesses because the requirements of the section are prescribed by statute, and the statute does not provide for an exemption.

To be considered, written comments on the proposal must be submitted no later than 5:00 p.m. on August 2, 2004, to Gene C. Jarmon, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comment must be simultaneously submitted to Marilyn Hamilton, Associate Commissioner, Property & Casualty Group, MC 104-PC, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. Any request for a public hearing should be submitted separately to the Office of the Chief Clerk.

The amendments are proposed under Insurance Code Article 21.49-2U and §36.001. The 78th Legislature, Regular Session, enacted Senate Bill 14, which added Article 21.49-2U. Article 21.49-2U, Section 13(a) authorizes the commissioner to adopt rules as necessary to implement the article. Article 21.49-2U, Section 13(b) requires the commissioner to adopt rules regarding the allowable differences in rates charged by insurers due solely to differences in credit scores. Section 36.001 provides that the Commissioner of Insurance may adopt any rules necessary and appropriate to implement the powers and duties of the Texas Department of Insurance under the Insurance Code and other laws of this state.

The following statute is affected by this proposal: Rule Statute §5.9941 Insurance Code Article 21.49-2U

§5.9941.Differences in Rates Charged Due Solely to Difference in Credit Scores.

(a) An insurer may vary its rates charged to applicants or insureds for personal insurance policies due solely to credit scoring. The differences in rates charged due solely to credit scoring shall be based on sound actuarial principles and supported by data filed with the department and must meet the following requirements: [ . ]

(1) The rate differences due solely to the use of credit scoring cannot be greater than +/- 10% from what would have been charged had credit scoring not been used.

(2) Notwithstanding paragraph (1) of this subsection, if an insurer proposes a credit scoring rating structure for rating personal insurance policies in Texas that has a rate differential greater than +/-10%, the insurer must request and justify an allowable difference in rates for its proposed credit scoring rating structure. The request for a rate differential shall include actuarial support and any information required by the Commissioner, including the numbers of policyholders and associated premiums that would be affected by the rate differential. For a definition of "actuarial support," insurers may refer to the Filings Made Easy Guide. The Filings Made Easy Guide may be obtained from the TDI website at www.tdi.state.tx.us or by request from the Texas Department of Insurance, Property and Casualty Intake Unit, Mail Code 104-3B, P.O. Box 14910, Austin, TX 78714-9104.

(3) An insurer may not use a rate differential greater than +/-10% until it is permitted by the department.

(4) An insurer that proposes a rate differential that is not greater than +/-10% is subject to the filing requirements of article 5.13-2, 5.101 or 5.142 of the Insurance Code, whichever is applicable.

(b) A request for a rate differential greater than +/-10% filed [ Filings ] under this section must be submitted to the Texas Department of Insurance, [ no later than March 1, 2004 to the ] Property & Casualty Intake Unit, Mail Code 104-3B, P.O. Box 149104, Austin, Texas 78714-9104 or to the Texas Department of Insurance, Property & Casualty Intake Unit, 333 Guadalupe, Austin, Texas 78701.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 21, 2004.

TRD-200404069

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Earliest possible date of adoption: August 1, 2004

For further information, please call: (512) 463-6327


Chapter 19. AGENTS' LICENSING

Subchapter H. LICENSING OF PUBLIC INSURANCE ADJUSTERS

28 TAC §19.713

The Texas Department of Insurance proposes new §19.713, concerning the Public Insurance Adjusters’ Rules of Professional Conduct and Ethics. This proposal is required by Texas Insurance Code Article 21.07-5, §18(1). Article 21.07-5 was adopted pursuant to Senate Bill 127, during the 78th Legislature’s Regular Session. The proposed rule concisely states certain legal and ethical requirements that are of prime importance for public insurance adjusters’ professional conduct. Many additional laws, however, govern public insurance adjusters' conduct, including laws relating to matters of licensure, as well as those defining specific obligations of public insurance adjusters. Accordingly, while this proposal states certain requirements for the legal and ethical professional conduct of public insurance adjusters, it does not exhaust the legal or ethical requirements that govern their actions.

Proposed §19.713 is necessary to implement Article 21.07-5, §18(1) and further effective regulation of public insurance adjusters by providing public insurance adjusters with a statement of certain legal and ethical requirements that are of prime importance in the conduct of their business. This proposed rule is based upon the recommendations of the public insurance adjusters’ advisory committee, appointed by the commissioner pursuant to Insurance Code Article 21.07-5, §18(1), and reflects requirements found in existing law, as well as the National Association of Public Insurance Adjusters’ Rules of Professional Conduct and Ethics. The statement of these legal and ethical requirements in proposed §19.713 should result in enhanced protection for consumers and others interacting with public insurance adjusters by providing a concise point of reference for judging the conduct of public insurance adjusters.

Matt Ray, deputy commissioner, licensing division, has determined that for each year of the first five years the proposed section will be in effect there will be no fiscal impact to state and local governments as a result of the enforcement or administration of the proposed rule. There will be no anticipated effect on local employment or the local economy as a result of the proposal.

Mr. Ray has determined that for each year of the first five years the proposed rule is in effect, the anticipated public benefit will be enhanced consumer protection, as well as improved public understanding of the role that public insurance adjusters play in the state’s insurance industry. Any economic costs to comply with the proposed rule result from the enactment of Insurance Code Article 21.07-5, §18(1), which requires the commissioner to adopt a code of ethics for public insurance adjusters, as well as the other provisions of Article 21.07-5 upon which the requirements of this proposed section are based and not as a result of the adoption, enforcement, or administration of the proposed section. There will be no difference in the cost of compliance between a large and small business as a result of the proposed rule. Based upon the cost of labor per hour, there is no disproportionate economic impact on small or micro businesses. Even if the proposed rule would have an adverse effect on small or micro businesses, it is neither legal nor feasible to waive the provisions of the proposed section for small or micro businesses, when the Insurance Code requires equal application of these provisions to all affected persons.

To be considered, written comments on the proposal must be submitted no later than 5 p.m. on August 2, 2004 to Gene C. Jarmon, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P. O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comments must be simultaneously submitted to Matt Ray, Deputy Commissioner, Licensing Division, Mail Code 107-1A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. Any requests for a public hearing should be submitted separately to the Office of the Chief Clerk.

This section is proposed under the Insurance Code Article 21.07-5, §18(1) and §36.001. Article 21.07-5, §18(1) directs the commissioner to adopt a code of ethics for public insurance adjusters that governs their conduct. This proposal is based upon the following Insurance Code statutes relating to the conduct of public insurance adjusters. Article 21.07-5, §5(a)(4) requires that public insurance adjusters conduct their business "fairly and in good faith without detriment to the public." Article 21.07-5, §23(j) requires that public insurance adjusters refrain from improper solicitation. Article 21.07-5, §23(m)(1) requires that public insurance adjusters refrain from using misrepresentations in the conduct of their business. Article 21.07-5, §22 sets forth the fees and commissions that public insurance adjusters may charge. Article 21.07-5, §21(a) requires that public insurance adjusters complete continuing education. Article 21.07-5, §§5(8) and 15(a)(8) require that public insurance adjusters possess adequate knowledge and experience to handle their work appropriately. Article 21.07-5, §2 prohibits public insurance adjusters from engaging in the unauthorized practice of law. Article 21.07-5, §23(l) prohibits public insurance adjusters from engaging in activities that may be construed as presenting a conflict of interest or obtaining a financial interest in salvaged property that is the subject of a claim. Article 21.07-5, §§28 and 29 prohibit public insurance adjusters from using advertisements that violate the Insurance Code. Article 21.07-5, §23(d) requires that public insurance adjusters use contract forms that are approved by the commissioner. Finally, §36.001 provides that the commissioner may adopt any rules necessary and appropriate to implement the powers and duties of the Texas Department of Insurance under the Insurance Code and other laws of this state.

The following statute is affected by the proposal: Insurance Code Article 21.07-5

§19.713.Public Insurance Adjuster Rules of Professional Conduct and Ethics.

(a) This section states certain legal and ethical requirements that are of prime importance for public insurance adjusters’ professional conduct. This section does not exhaust the legal or ethical requirements that govern public insurance adjusters.

(b) All public insurance adjuster licensees shall comply with the following requirements:

(1) Licensees shall conduct business with their clients, insurance companies, and the public, in a spirit of fairness and justice.

(2) Licensees shall not employ any improper solicitation which would violate Insurance Code Article 21.07-5 or this subchapter.

(3) Licensees shall not make a misrepresentation, in violation of Insurance Code Article 21.07-5, §23(m)(1), to an insured or to an insurance company in the conduct of their actions as a public insurance adjuster.

(4) Licensees shall charge only commissions and fees which are in compliance with the requirements set forth in Insurance Code Article 21.07-5 and this subchapter.

(5) Licensees shall complete continuing education as required by Insurance Code Article 21.07-5 and this subchapter.

(6) Licensees shall have appropriate knowledge and experience for the work they undertake and should obtain competent technical assistance, when necessary, to help handle claims and losses outside their area of expertise.

(7) Licensees shall not engage in the unauthorized practice of law.

(8) Licensees shall avoid situations of conflict of interest, including acquiring any interest in salvaged property or participating in any way, directly or indirectly in the reconstruction, repair or restoration of damaged property that is the subject of a claim adjusted by the licensee, except as allowed in Insurance Code Article 21.07-5 and this subchapter.

(9) Licensees shall not disseminate or use any form of agreement, advertising, or other communication, regardless of format or medium, in this state that is harmful to the profession of public insurance adjusting and that does not comply with Insurance Code Article 21.07-5, this subchapter or other provisions of the Insurance Code.

(10) Licensees shall use only contracts that comply with Insurance Code Article 21.07-5 and this subchapter.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 21, 2004.

TRD-200404050

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Earliest possible date of adoption: August 1, 2004

For further information, please call: (512) 463-6327


Part 2. TEXAS WORKERS' COMPENSATION COMMISSION

Chapter 122. COMPENSATION PROCEDURE--CLAIMANTS

The Texas Workers' Compensation Commission (commission) proposes amendments to §122.2, concerning Injured Employee's Claim for Compensation, and §122.100, concerning Claim for Death Benefits.

The Texas Register published text shows words proposed to be added to or deleted from the current text, and should be read to determine all proposed changes.

The proposed amendments to §122.2 are to allow submission of an injured employee's claim for compensation in an electronic format and delete the requirement for the injured employee's signature. The proposed amendments to §122.100 are to allow submission of a claim for death benefits in an electronic format and provide the manner of filing subsequent filings of all additional evidence that establishes that the claimant is a legal beneficiary. The electronic filing options provided by the proposed amendments are part of an overriding goal of the commission, in its Business Process Improvement (BPI) project, to improve and streamline agency processes and applications through the use of advanced technology and tools, as appropriate, to increase agency effectiveness, efficiency, and accountability.

Currently, §122.2 specifies the form that must be used by injured employees to file a claim for compensation. In order to achieve standardization with existing rule 102.5, General Rules for Written Communication to and from the Commission, which allows electronic submission of information, the commission proposes to amend subsection (c) to allow reporting of a claim for compensation to the commission either on paper or via electronic transmission, in the form, format, and manner prescribed by the commission.

The commission proposes to amend subsection (c)(6) by adding language to clarify that, if the injury claimed is an occupational disease, the claim must include the name and location of the employer at the time of the last injurious exposure to the hazards of the occupational disease. As a result of this clarification, the commission proposes to delete subsection (d) because it is redundant of subsection (c)(6) as amended.

The commission proposes to delete current subsection (e), which requires the prescribed form TWCC-41 or other written claim for compensation must be signed by the person filing it and change the reference to "no later than" one year to "within" one year. As a result of deleting subsections (d) and (e), the commission proposes to re-designate subsection (f) as subsection (d).

Currently, §122.100 specifies the form that must be used by claimants to file a claim for death benefits. In order to achieve standardization with existing rule 102.5, General Rules for Written Communication to and from the Commission, which allows electronic submission of information, the commission proposes to amend subsection (b) to allow reporting of a claim for death benefits to the commission either on paper or via electronic transmission, in the form, format, and manner prescribed by the commission.

The commission also proposes to amend subsection (c) to clarify that a claimant is required to submit not only a copy of the deceased employee's death certificate but also and any additional evidence that establishes that the claimant is a legal beneficiary of the deceased employee. In subsection (c), paragraphs (1) and (2) are added to address how the additional evidence regarding legal beneficiary status should be submitted depending on whether the claim is filed on paper or electronically. The commission also proposes to amend subsection (c) by deleting certain unnecessary language.

Stacey Jefferson, Director of the commission's Business and Information Technology Services Division, has determined that, for the first five-year period the proposed rules are in effect, the proposed amendments will result in minimal, if any, fiscal impact on state or local governments as a result of enforcing or administering the amended rules. The commission may experience minimal costs associated with staff time involved with any necessary modifications to the instructions, or the potential development of educational materials, associated with the use of the electronic interface referred to in the amended rules. No other state or local governments will be involved in enforcing or administering the amended rules.

Local governments and state governments as covered regulated entities will be impacted in the same manner as described later in this preamble for persons required to comply with the rules as proposed.

Ms. Jefferson has also determined that for each year of the first five years the rules as proposed are in effect the public benefits anticipated as a result of enforcing the rules will include easier access by claimants to TWCC for purposes of reporting incident details because, in addition to filing standard paper claims, claimants will be able to file the forms either from a computer at home, office, or a TWCC field office; and ultimately allowing access to the filing by associated claim participants, thereby eliminating some requests for copies of claim file information.

There will be no anticipated economic costs to persons required to comply with the rules as proposed because the rule allows, but does not require, electronic filing. There will be no economic costs to injured employees, as these proposed amendments remove a signature requirement and allow easier and greater access to the commission.

There will be no costs of compliance for small businesses and no adverse economic impact on small businesses or micro-businesses as a result of the proposed amendments.

Comments on the proposal must be received by 5:00 p.m., August 2, 2004. You may comment via the Internet by accessing the commission's website at www.twcc.state.tx.us and then clicking on "Proposed Rules." This medium for commenting will help you organize your comments by rule chapter. You may also comment by emailing your comments to RuleComments@ twcc.state.tx.us or by mailing or delivering your comments to Linda Velásquez at the Office of the General Counsel, Mailstop #4-D, Texas Workers' Compensation Commission, 7551 Metro Center Drive, Ste. 100, Austin, TX 78744.

Commenters are requested to clearly identify by number the specific rule and paragraph commented upon. The commission may not be able to respond to comments that cannot be linked to a particular proposed rule. Along with your comment, it is suggested that you include the reasoning for the comment in order for commission staff to fully evaluate your recommendations.

Based upon various considerations, including comments received and the staff's or commissioners' review of those comments, or based upon the commissioners' action at the public meeting, the rule as adopted may be revised from the rule as proposed in whole or in part. Persons in support of the rule as proposed, in whole or in part, may wish to comment to that effect.

Subchapter A. CLAIMS PROCEDURE FOR INJURED EMPLOYEES

28 TAC §122.2

The amendments are proposed pursuant to Texas Labor Code §402.042, which authorizes the Executive Director to enter orders as authorized by the statute as well as to prescribe the form, manner and procedure for transmission of information to the commission; Texas Labor Code §402.061, which authorizes the commission to adopt rules necessary to administer the Act; Texas Labor Code §409.003, which sets forth the requirements for an injured employee or person acting on their behalf to file a claim for compensation with the commission; and Texas Labor Code §409.007, which sets forth the requirements for a legal beneficiary or person acting on their behalf to file a claim for death benefits with the commission.

The amendments are proposed under Texas Labor Code §§402.042, 402.061, 409.003, and 409.007.

The previously sited sections of the Texas Labor Code are affected by this proposed rule action. No other code, statute, or article is affected by this rule action.

§122.2.Injured Employee's Claim for Compensation.

(a) An injured employee, or a person acting on the injured employee's behalf, shall file with the commission a written claim for compensation within one year after the date of the injury's occurrence, except as provided in subsection (b) of this section.

(b) An employee whose injury results from an occupational disease, or a person acting on that employee's behalf, shall file with the commission a written claim for compensation within one year after the date the employee knew or should have known that the disease was related to the employment.

(c) The claim should be submitted to the commission either on paper or via electronic transmission, in the form, format, and manner prescribed by the commission, [ on a Form TWCC 41 prescribed by the commission ] and should include the following:

(1) the name, address, telephone number (if any), occupation, wage, and social security number of the injured employee;

(2) the length of time the employee worked for the employer prior to the date of injury;

(3) the date, time, and location the injury occurred (or the date the employee knew or should have known that the occupational disease was related to the employment);

(4) a description of the circumstances and nature of the injury;

(5) the names of witnesses (if any);

(6) the name and location of the employer at the time of the injury (or , if the injury claimed is an occupational disease, the name and location of the employer at the time of the last injurious exposure to the hazards of the occupational disease);

(7) the name of the employee's immediate supervisor;

(8) the name and address of at least one health care provider that has treated the employee for the injury; and

(9) the identity of the person (if any) acting on behalf of the injured employee.

[ (d) If the injury claimed is an occupational disease, the claim shall list the name and location of the employer at the time of the last injurious exposure to the hazards of the disease if known.]

[ (e) The prescribed Form TWCC-41 or other written claim for compensation must be signed by the person filing it.]

(d) [ (f) ] Failure to file a claim for compensation with the commission no later than one year from the incident shall relieve the employer and the employer's insurance carrier from liability under the Act unless:

(1) good cause exists for failure to file a claim in a timely manner; or

(2) the employer or insurance carrier does not contest the claim.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 21, 2004.

TRD-200404054

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Earliest possible date of adoption: August 1, 2004

For further information, please call: (512) 804-4287


Subchapter B. CLAIMS PROCEDURE FOR BENEFICIARIES OF INJURED EMPLOYEES

28 TAC §122.100

The amendments are proposed pursuant to Texas Labor Code §402.042, which authorizes the Executive Director to enter orders as authorized by the statute as well as to prescribe the form, manner and procedure for transmission of information to the commission; Texas Labor Code §402.061, which authorizes the commission to adopt rules necessary to administer the Act; Texas Labor Code §409.003, which sets forth the requirements for an injured employee or person acting on their behalf to file a claim for compensation with the commission; and Texas Labor Code §409.007, which sets forth the requirements for a legal beneficiary or person acting on their behalf to file a claim for death benefits with the commission.

The amendments are proposed under Texas Labor Code §§402.042, 402.061, 409.003, and 409.007.

The previously sited sections of the Texas Labor Code are affected by this proposed rule action. No other code, statute, or article is affected by this rule action.

§122.100.Claim for Death Benefits.

(a) In order for a legal beneficiary, other than the subsequent injury fund, to receive the benefits available as a consequence of the death of an employee which results from a compensable injury, a person shall file a written claim for compensation with the commission within one year after the date of the employee's death.

(b) The claim should be submitted to the commission either on paper or via electronic transmission, in the form, format, and manner prescribed by the commission, [ on a Form TWCC 42 prescribed by the commission ] and should include the following:

(1) the claimant's name, address, telephone number (if any), social security number, and relationship to the deceased employee;

(2) the deceased employee's name, last address, social security number (if known)[ , ] and workers' compensation claim number (if any); and

(3) other information, as follows:

(A) a description of the circumstances and nature of the injury (if known);

(B) the name and location of the employer at the time of the injury;

(C) the date of the compensable injury, and date of death; and

(D) other known legal beneficiaries.

(c) A claimant shall file with the commission [ Each claim shall be accompanied by ] a copy of the deceased employee's death certificate and any additional documentation or other [ . In addition, each claimant shall file ] evidence that establishes that the claimant is a legal beneficiary of the deceased employee. [ under the Act, §4.42. (See §§132.2-132.6 of this title (relating to Determination of Facts of Dependent Status; Eligibility of Spouse To Receive Death Benefits; Eligibility of a Child To Receive Death Benefits; Eligibility of a Grandchild To Receive Death Benefits; and Eligibility of Other Surviving Dependent's To Receive Death Benefits) for required proof of eligibility.) ]

(1) If the claim is filed with the commission in paper format, the additional evidence regarding legal beneficiary status shall be filed at the same time as the claim.

(2) If the claim is filed via electronic transmission, the additional evidence regarding legal beneficiary status may be filed separately in paper format and sent either by mail, facsimile, or hand delivery.

(d) Each person must file a separate claim for death benefits, unless the claim expressly includes or is made on behalf of another person.

(e) Failure to file a claim for death benefits within one year after the date of the employee's death shall bar the claim of a legal beneficiary, other than the subsequent injury fund, unless:

(1) that legal beneficiary is a minor or otherwise legally incompetent; or

(2) good cause exists for failure to file the claim in a timely manner.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 23, 2004.

TRD-200404214

Susan Cory

General Counsel

Texas Workers' Compensation Commission

Earliest possible date of adoption: August 1, 2004

For further information, please call: (512) 804-4287