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Request for Paid Leave (Form- 23)

What is the Request for Paid Leave Form (Form-23) designed to accomplish?

The Request for Paid Leave Form (Form-23) allows an employee who has been injured on the job and is unable to work as a result of the injury to elect to remain on the payroll and use some or all of his or her accrued leave in lieu of receiving weekly payments from The University of Texas System Workers' Compensation Insurance (WCI). The employer is prohibited from requiring the use of paid leave to cover time lost. Therefore, the Request for Paid Leave form is used to verify whether the employee has chosen to use paid leave or to receive weekly WCI benefits.

When is the Request for Paid Leave Form (Form-23) required?

The Request for Paid Leave Form should be completed as soon as the injured employee begins to lose time from work.

What are the employee's options?

When the employee is presented with the Request for Paid Leave Form for decision and signature, the department should be sure all options have been clearly explained. If the employee elects to use paid leave, the employee must first exhaust sick leave. Once sick leave has been exhausted, the employee may choose to use one or more weeks of other paid leave in lieu of receiving TIBs (Temporary income benefits which accrue from the eighth day of disability and are paid weekly.) Prior to making an election concerning the use of other paid leave, please be advised that although there is a seven day waiting period where TIBs are not payable, should disability extend to the fourteenth day after the first day of disability, the carrier will then issue a TIBs payment for the waiting period. TIBs are never payable as long as you are using paid leave.

What if the employee chooses workers' compensation weekly benefits?

Workers' compensation weekly benefits are calculated at 70% of the employee's average weekly wage (75% of the employee's weekly wage for employees earning less than $8.50 per hour for up to 26 weeks; 60% for part-time employees). The maximum weekly benefit amount changes annually. Currently, the maximum benefit rate is $712, therefore, the higher the employee's salary or wage, the less attractive workers' compensation weekly benefits will be. The employee might elect to continue to use his or her accrued leave until it is exhausted or until he or she is able to return to work simply to avoid reducing income and to preserve benefits.

What if the employee chooses to save accrued leave?

If the employee elects to save accrued leave, or if the employee has no accrued leave to utilize, the employee will be placed on leave without pay and workers' compensation benefits will begin following the seven day waiting period (provided the inability to work is medically substantiated). The employee should understand that being on leave without pay for any reason means one is not eligible for the state's contribution towards insurance premiums (unless the employee continues to participate by paying the required premiums or is granted Family Medical Leave). The employee's credit toward Teacher Retirement System of Texas and longevity may also be affected depending upon how long the disability lasts and whether or not the employee returns to work.

What is the process of completing and filing the Request for Paid Leave Form (Form-23)?

Once the above factors have been explained to the employee and he or she understands how many hours of accrued leave are available, the Request for Paid Leave Form should be completed with the employee's signature. As soon as the form is complete, the original should be forwarded to WCI or the form may be completed electronically through iCE.