Crime Victims Compensation Program in Texas

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Tracy Morales

Ricky Sanchez

Crime Victim Services Division

Views expressed are those of the presenters, do not constitute legal advice,

and are not official opinions of the Office of the Texas Attorney General.

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

Please turn off cell phones and pagers or place in a silent

mode.



Questions can be answered in the presentation

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To assist in the compassionate and effective

delivery of crime victim services by offering

information resources, and financial assistance

to crime victims and the organizations

assisting them.



Texas Code of Criminal Procedure



Article 56 subchapter B



Article 56.31 through 56.64



Crime Victims’ Compensation Act

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

Office of the Attorney General (OAG) administers Crime

Victims’ Compensation Program (CVC)



Dedicated to ensuring that victims of violent crime are

provided financial assistance for crime related expenses



Statutorily defined reimbursement



State law requires reimbursement first be sought from other

sources

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

Received a total of 34,706 applications and sexual

assault exam reimbursement claims

•

 24,465 were victim compensation applications

•

 10,241 were sexual assault reimbursement claims



$ 67.4  million in payments

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It is not a tax based or general revenue-funded program.

      No tax dollars are used.



Sources of funding in FY 2018 were:

•

Court fees

•

Federal VOCA grant

•

Restitution

•

Subrogation

•

Other receipts

•

Gifts

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The goal of CVC is to 

reimburse

victims of crime for certain

out of pocket expenses not reimbursed by other sources.

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OAG website for Crime Victims’ Compensation

www.texasattorneygeneral.gov/cvs/crime-victims-compensation

What is available on the CVC website?

•

General program information

•

Basic qualification requirements

•

Reimbursable expenses

•

How to apply

•

Forms and applications

•

Appealing a denial

•

CVMS Webportal

•

Information for service providers

•

Publications and materials order

•

Training

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

The CVC application (English and Spanish) is available on our

web page.



The application is always reviewed after a legislative session

to assure it meets statutory requirements.

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      An application is considered complete and will be processed

when it:



Is filled out in its 

entirety



Is signed by a victim or a valid adult claimant



Provides law enforcement information



Provides any other information requested by the OAG

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

Regular (via mail)



Priority Processing Request (via fax)



Presumptive Eligibility (via fax)

Emergency Medical Care

(EMC) application (via mail)

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Who is a Victim?



An individual who suffers 

physical or mental harm or death

as a result of criminally injurious conduct



Note that every application has to have one victim, and

only one victim



Includes peace officers, firefighters or individuals whose

employment duty is to protect the public

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       Who is a Claimant?



An authorized individual acting on behalf of a victim



An individual who legally or voluntarily assumes the

obligation to pay expenses



A dependent of a deceased victim



An immediate family or household member who requires

psychiatric care or counseling



An application can have multiple claimants, 

but only one

victim.

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      Who is eligible to receive CVC?



A Texas or U.S. RESIDENT who becomes a victim of crime in

Texas



A Texas resident who becomes a victim in a country with no

benefits



A Texas resident who becomes a victim of a crime defined as

an act of terrorism committed outside the United States (as of

September 1, 1997)

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

A Social Security Number is not required for a

      victim to 

apply and be eligible

 for the CVC Program.



A tax ID or Social Security Number is a requirement

to receive a payment

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       “Criminally injurious conduct” refers to crimes that:

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Are attempted or occur

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Pose a substantial threat of personal injury

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Would be punishable by fine or imprisonment

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

Criminal injurious conduct (CIC) crimes are violent crimes

against persons.



CIC crimes range from simple assault to homicide, and

include such crimes as family violence and child sexual

assault.



CIC vehicular-related crimes are:

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Crimes of 

intentional

 injury with an automobile, boat, or

plane

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Failure to stop and render aid (Hit and Run)

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Vehicular crimes involving drugs or alcohol

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Intoxication-related crimes (assault, manslaughter, or

criminally negligent homicide

)

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Assault / Aggravated Assault

   48.9 %



Sexual Abuse of a Child

   14.3 %



Sexual Assault

     9.8 %



Robbery

     5.0 %



Homicide

     5.1 %



DWI

     3.1 %



Failure to stop and render aid

     3.1 %



All other types of crime 

     10.7 %



Examples of other types of crime include:

Stalking

Human Trafficking

Kidnapping 

Physical Abuse of a Child

Arson

Criminally Negligent Homicide

Vehicular Assault

Vehicular Manslaughter

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If the person

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Was engaged in illegal activity (deny or reduce)

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Shares in the responsibility for the crime (deny or reduce)

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Fails to cooperate with law enforcement and prosecution

efforts (deny)



Possible factors



Entire situation is reviewed

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There is no requirement that a suspect be

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Identified

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Apprehended

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Charged

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Convicted

…for a victim to apply for and be awarded compensation.



There is a requirement for the victim to cooperate

throughout the criminal justice process.

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Reporting the crime to law enforcement

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72 hours prior to September 1, 1997

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On or after September 1, 1997, a reasonable period of time

but not so late as to interfere with or hamper the investigation

and prosecution



The program has the discretion

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The victim is a child.

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Extraordinary circumstances hampered the reporting

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Filing requirements to CVC Program

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Prior to September 1, 1997, one year

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On or after September 1,1997, three years



Exceptions

•

Good cause

•

Child victim through age 18 (pre-1997)

•

Child victim age 18 to 21 (1997-present)

•

Victim physically incapacitated



An Emergency Medical Care(EMC) application is for a

victim of an alleged sexual assault who received medical

care at a hospital associated to a sexual assault exam after

August 31, 2015.



The examination must be performed in accordance with

Texas Health and Safety Code Section 323.004 (Minimum

Standards for Emergency Services)



To receive compensation for these costs, you do not need

to meet CVC eligibility requirements such as reporting to law

enforcement or continuing with the investigation.



Victims may choose to seek the full range of CVC benefits

available at a later time

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Examples of medical care costs associated with the exam

•

EMS Transport, if necessary, to the facility where exam

was conducted

•

Emergency Room Facility Fee

•

Physician's Fees

•

Discharge Medication(Ex: HIV Prophylaxis)



Victim is not required to utilize private insurance but does

need to use Medicaid, Medicare of CHIP is available



EMC does not cover other CVC benefits such as:

•

Follow up care

•

Mental Health Counseling

•

Lost wages

•

Relocation

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Up to:

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$25,000 for crimes prior to September 1, 1997

•

$50,000 for crimes on or after September 1,1997



For reimbursement of medical costs, counseling, lost wages,

funeral costs, and other costs resulting from the crime



Does not include property loss or damage

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

Assault / Aggravated Assault

57.1%



Sexual Abuse of a Child

  2.7%



Sexual Assault

  2.0%



Robbery

  8.1%



Homicide

12.7%



DWI

  5.4%



Failure to stop and render aid

  7.9%



All other types of crime are less than 

  4.1%

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Medical

(Includes psychiatric care/counseling and dental)



Loss of earnings



Loss of support



Funeral and burial



Relocation and rental



Child or dependent care



Crime scene clean-up



Property seized as evidence



Travel

By law, CVC is considered the payor of last resort, and all

available collateral resources must be utilized first

Examples of collateral resources include:



Medicaid and Medicare



Health insurance



Texas Workers’ Compensation



Auto insurance



Civil Settlements

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      Some examples of medical expenses which may be covered by

CVC include, but are not limited to:



Hospital Bills



Physician bills



Prescription medication



In-patient and outpatient psychiatric bills



Durable medical equipment(

Ex: 

Wheelchairs, prosthetics)



Glasses replacement



Ambulance



Rehabilitation



Nursing home



Dental

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Medical expenses are paid according to the Division of

Worker’s Compensation medical fee guidelines(MFG) and

are based on the CPT procedure code, location, and year

services were rendered.



By law, the victim is not responsible for the difference,

unless

 victim had benefits reduced or the claim is found to

be a “med max”, then the victim is only responsible up to

the MFG.



Services must be rendered before the bill can be

considered for payment.



Reimbursements for medical expenses must be submitted

within three years of the date of service, unless

extenuating circumstances exist.



In order for CVC to process a medical bill for payment, a

complete billing form or statement is required along with an

explanation of benefits(EOB) if insurance is available.



Some examples of complete bills include:

•

CMS-1500  - standardized billing form used by physicians

or clinics

•

UB-04 - standardized billing form used by

hospitals(required for payment on hospital bills)

•

ADA - standardized billing form used by dental providers

•

Prescription Label or Pharmacy Printout – for prescription

reimbursements

•

“Super Bill” – an itemized, detailed billing statement which

includes all the necessary information needed to process

a bill

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A complete bill should contain the following information:

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Patient Information(Name, Date of Birth, Claim Number)

•

Date of Service(s)

•

CPT Procedure Codes

•

ICD10 Diagnosis Codes

•

Fee Billed for each procedure

•

Total Amount Billed and Balance Due

•

Any payments, discounts or adjustments

•

Physician's Name

•

Provider’s Billing Address

•

Provider’s Tax Identification Number

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CVC is considered a payor of last resort so an explanation

of benefits(EOB) from the insurance should be provided for

processing all medical expenses when a collateral source is

readily available.



EOB must indicate a patient responsibility.  CVC will only

consider payment up to the patient responsibility on the

EOB.



Payments to a provider will be processed at the patient

responsibility or MFG, which ever is less.



In special circumstances, an out of network request may be

granted upon review and approval by CVC.

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Providers may request an estimate of payment for Dental and

DME services.



Pre-estimates are not performed for any other medical

procedures.



If provider agrees to the allowed fee, a complete bills must be

submitted once services are rendered, along with a copy of

the estimate.



The estimate provided by CVC is not a guarantee of payment

but an estimate of CVC allowed rates. CVC does not pre-

authorize services.



All available collateral sources should be utilized and an

Explanation of Benefits should be provided when the patient

has insurance.

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The counseling limit for each victim and/or eligible claimant is

60 sessions.



Mental health counselors will be asked to complete an update

on the victim and/or claimant’s progress.  This Mental Health

Form (MHF) will be mailed to the provider every six months.



In certain circumstances, exceptions may be made to the 60

session limit



Compensation is generally limited to one session per week. 



Missed appointments will not be paid by CVC



Telehealth sessions are eligible for reimbursement if

appropriately billed

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

CVC currently covers mental health counseling provided by:

•

Psychiatrist, and other M.D.

•

Clinical Psychologist

•

Clinical Nurse Specialists in Psychiatry (CNS)

•

Licensed Professional Counselor (LPC)

•

Licensed Marriage and Family Therapist (LMFT)

•

Licensed Clinical Social Worker (LCSW)



List of eligible providers is maintained and located on the

CVC website.



CVC does not make referrals to victims seeking treatment;

they are referred to their local resources.



In-patient hospital treatment, residential treatment center care,

including partial day programs or intensive outpatient

programs are available only for victims and for a maximum of

30 days, unless good cause is shown.



Inpatient and Intensive Psychiatric Care expenses are paid

according to the Division of Worker’s Compensation medical

fee guidelines(MFG)

I

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C

a

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e



CVC reimburses for the forensic costs related to a sexual

assault exam of an alleged victim.



Reimbursement for reasonable costs associated with a forensic

medical examination of a victim is as follows:

•

Not to exceed $1,000 for dates of crime on or after 7/15/16

•

Not to exceed $700 for dates of crime before 7/15/16.



Must be requested by law enforcement in connection with the

investigation



CVC can reimburse for the forensic costs related to a sexual

assault exam of an alleged adult victim that was not reported to

law enforcement if:

•

Victim arrived at the facility within 120 hours of the assault

•

Victim consents to the examination

S

e

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a

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A

s

s

a

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l

t

R

e

i

m

b

u

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m

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n

t



CVC will reimburse for costs such as:

•

Examiner fees

•

Place of service fee

•

Exam fees

•

Sexual assault kit

•

Laboratory procedures

For a full list of reimbursable costs and limits, please see

the OAG Website.



Victim cannot be billed for any of the forensic costs related

to the sexual assault exam

S

e

x

u

a

l

A

s

s

a

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l

t

R

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i

m

b

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t



House Bill 616 - amends Chapter 56 of the Code of Criminal

Procedure to allow the Office of the Attorney General (OAG)

to compensate health care facilities, sexual assault

examiners, and sexual assault nurse examiners directly for

the forensic portion of a sexual assault medical exam.



Exams before to 9/1/19

•

Medical providers bill Law Enforcement Agency(LEA) for

the costs of the forensic medical exam

•

LEA pays the medical provider

•

LEA mails an paper application for reimbursement from

OAG

•

Includes copies of the bills and proof of payment

S

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x

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a

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A

s

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R

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b

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n

t



Exams after 8/31/19

•

Medical provider bills OAG for the costs of the forensic

medical exam and the OAG reimburses provider directly

•

Provider submits an online application via CVC online

portal.

•

Requests for reimbursement must include the forensic

bill(s) and copy of the LEA Request for Sexual Assault

Exam form



Does not cover medical costs. Expenses other than the

forensic costs such as medical treatment are not reimbursed

under this program but may eligible under CVC or

Emergency Medical application.

S

e

x

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a

l

A

s

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a

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R

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i

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b

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t



Loss of earnings related to 

medical

•

Physical or emotional disability

•

While seeking medical treatment for crime-related injury

•

Care for a medically incapacitated adult/minor child by

claimant



Loss of earnings related to the 

criminal justice system

•

Police investigation appointments

•

Protective order court appointment

•

Criminal proceedings

•

Post-convictions

•

Post-adjudication proceedings (executions)



Loss of earnings related to victim’s 

funeral

L

o

s

s

o

f

E

a

r

n

i

n

g

s

(

S

l

i

d

e

1

o

f

2

)

L

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E

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n

i

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s

(

S

l

i

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f

2

)



If employed

, weekly net earnings multiplied by the disability

period.



Limited to $700 per week



If unemployed, will 

consider

 situations that demonstrate the

victim would have been employable. Benefit would be based on

anticipated loss of future earnings.



Name and address of employer



Printout of federal income tax return directly from IRS for all

self-employed

 victims



Name and address of treating physician



If for time off work for medical/criminal justice appointments, a

completely Travel / Appointment Verification Form



Verification of all collateral sources:

•

Social Security, workers’ compensation, short/long-term

disability benefits, settlements

L

o

s

s

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f

E

a

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s



To 

dependents

 of a murder victim

•

Up to $50,000



To 

dependents

 of surviving victims

•

Usually family violence

•

Limited to 90 days



To 

dependents

 of a medically disabled victim

•

During disability period



Limited to $700 per week 

L

o

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f

S

u

p

p

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

Verification of dependency



A person who is dependent, within the meaning of the IRS

code:

•

Income tax return

•

Court order

•

Marriage license

•

Proof of informal marriage

•

Divorce decree

•

Birth certificate



Verification of support lost



Verification of all collateral sources

L

o

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f

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p

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d

B

u

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i

a

l

(

S

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i

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o

f

2

)



Funeral and burial expenses 

maximum

 of $6,500



Additional funds available to 

transport

 the body

•

Burial transit permit / apostille issued by the Texas

Secretary of State

•

Air bill

•

Copies of bills for services paid to other funeral homes for

transporting the body

F

u

n

e

r

a

l

a

n

d

B

u

r

i

a

l

(

S

l

i

d

e

2

o

f

2

)

      What is covered:



 Funeral services



 Casket, urn



 Graveside services



 Cemetery expenses



 Marker/headstone



 Cremation charges



 Additional costs: flowers, musician fees, burial

 clothing for the deceased victim, exhumation

 and reburial



Signed

 funeral purchase agreement



  Cemetery bills



  Receipts for payment



  Death certificate (only if we need to relate death to crime)



  Verification of collateral sources



  Tax ID of the funeral home

F

u

n

e

r

a

l

P

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

F

o

r

v

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c

t

i

m

s

o

f

:

•

Family violence (June 19, 1999)

•

Sexual assault in their residence (September 1, 2001)

•

Human trafficking (September 1, 2013)

•

Stalking (September 1, 2015)



$3,800 Total Benefit

•

Up to $2,000 for applicable relocation cost



Transportation



Deposits and fees



Moving van and storage

•

3 Months rent up to $1800



One time award



3 year time limit to apply for relocation



Completed / 

signed

 CVC Relocation Expense Worksheet



Completed / 

signed

 CVC Relocation Acknowledgment Form



C

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

Completed / 

signed

 Payment Affirmation Form (if

victim/claimant is requesting the landlord to be paid directly for

the deposit or the first month’s rent)



Estimates from professional moving company or car/van

rental if used



Tax ID for landlord if paid directly

R

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

O

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

Children (14 years and under) or dependent adults



Care must be provided by 

licensed or registered provider



$300 per week per child or dependent

•

Crime dates after May 7, 2005 child care is limited to 90 days

•

Crime dates on or after July 15, 2016 child care is limited to 1

year

•

90 day child care exception for dependents of deceased

victims



Itemized

 bill



A written statement from the victim/claimant explaining the need

for childcare as a result of the crime.



Copy of the daycare license



Copy of the daycare fee schedule



Proof of child/dependent care need may be requested

•

Employment verification

•

School enrollment verification

•

Medical statement

C

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

Reasonable and necessary costs of cleaning the crime scene



$2,250 limit



Commercial cleaning company



Will reimburse for cleaning supplies when work is done by

volunteers



What is required?

•

Itemized

 bill for cleanup from the commercial cleaning

company and receipt if paid by claimant

•

Receipts

 for payment of cleaning supplies

•

Verification of collateral sources (home owners’ insurance)

P

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

Reasonable replacement costs for clothing, bedding, or

property of the victim seized as evidence or rendered

unusable as a result of the criminal investigation



$1,000 limit



This is the only property for which reimbursement can be paid

by CVC.



What is required?

•

List of clothing, bedding or property taken

•

Reasonable replacement cost of items

•

Law enforcement verification of items seized

T

r

a

v

e

l

(

S

l

i

d

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1

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f

2

)



Travel expenses due to participation in or attendance at:

•

The investigation prosecution, or judicial processes; also

post-conviction and post-adjudication-involvement

•

The execution of the perpetrator

•

Seeking necessary medical treatment and counseling

services

•

The funeral of the victim for immediate family and

household members



Traveling distance must be more than 20 miles one way.

T

r

a

v

e

l

(

S

l

i

d

e

2

o

f

2

)



Exceeds 20 miles (one way)

•

Necessary and reasonable transportation

•

Commercial transportation

•

Personal vehicle/state mileage reimbursement rate



Exceeds 60 miles (one way)

•

Meals ($36 per day)

•

Lodging expenses ($85 per night)

•

Meals and lodging are per diem state rate

•

Commercial transportation

•

Personal vehicle/state mileage reimbursement rate 



Different travel rates apply for different years and are based on

the state rate at the time.



Travel reimbursements are for crimes on or after September 1,

1997



A completed/signed CVC Travel/Appointment Verification

Form



Receipts for lodging/airfare (if 60 miles or more one way)

T

r

a

v

e

l

R

e

q

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s



Applications with medical bills greater than $50,000



Identified in system as “Med Max”



60 days to submit bills from initial request (checklist)



30-day letter requesting all bills



Long timeline to process these payments as CVC awaits

receipt of all bills from all service providers

M

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d

i

c

a

l

M

a

x

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p

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l

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)

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s

(

S

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f

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)



Bills are or pro-rated based on their share of the total CVC

money available in the claim.



Since bills have not been paid at full fee guideline amount,

victim does owe balance up to the medical fee guideline

(MFG).

E

x

t

r

a

o

r

d

i

n

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y

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s



 Injury is a 

total and permanent disability.



Above the base award, Extraordinary Pecuniary Loss benefits

are:

•

Additional $25,000 (for crimes occurring September

1995-97)

•

Additional $50,000 (for crimes on or after September 1,

1997 to August 31, 2001)

•

Additional $75,000 (for crimes occurring on or after

September 1, 2001)

E

x

t

r

a

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d

i

n

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P

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D

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

Durable medical equipment (September 1, 2001)



Rehabilitation technology (September 1, 2001)



Long-term medical expenses (September 1, 2001)



Home and vehicle wheelchair accessible



Rehabilitation



Loss of earnings



Job training



Home health care



Training in the use of special appliances



$1,500 maximum



Must be paid from an existing or anticipated benefit, 

it is not a

“free award”



May be considered for situations that pose an undue hardship



Decision made by CVC staff based on “best interest of the

victim”

E

m

e

r

g

e

n

c

y

A

w

a

r

d



All funds distributed by the State of Texas flow from the

Comptroller’s Office.



The Comptroller maintains a database of payees and payee

information.

•

Necessary to gather and collect an audit trail for payments

•

Also the method for determining 1099 / tax situation for

payees



It takes two business days to set up a new payee or a new

mailing address for an old payee.

V

e

n

d

o

r

/

P

a

y

m

e

n

t

S

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t

u

p

(

S

l

i

d

e

1

o

f

3

)



The Comptroller can issue a temporary tax ID.



Businesses must have a federal tax ID.

•

Sole proprietors and limited partnerships must supply each

owner’s SSN.

•

Corporations must provide their charter number.

V

e

n

d

o

r

/

P

a

y

m

e

n

t

S

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u

p

(

S

l

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d

e

2

o

f

3

)



Once a payee account is set up, a warrant (check) request is

made.



It takes two business days to receive a warrant (check) once

a request is made if no holds are present.  After that, it takes

two to three business days to be mailed

.

V

e

n

d

o

r

/

P

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m

e

n

t

S

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p

(

S

l

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d

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3

o

f

3

)



The Comptroller’s warrant (check) hold program is a tool that

allows all state agencies to collect outstanding debts.



52 agencies currently participate.



An agency sends the Comptroller’s office a request to

participate in the program.



The Comptroller’s Claim Division requests the agency to

identify the source of debt owed to the State and sets the hold.



As the Comptroller’s office prepares warrants (checks), the

debtors’ identification numbers are electronically checked

against the prepared warrants (checks).

H

o

l

d

s

(

S

l

i

d

e

1

o

f

3

)



The OAG has no control over the hold process – it is

completely managed by the Comptroller and the agency to

which the state debt is owed.



Frequent reasons for hold:

•

Delinquent child support

•

Delinquent student loans

•

Overpayment of unemployment compensation benefits

•

Sales tax due from a business owner

•

Unemployment insurance taxes due

H

o

l

d

s

(

S

l

i

d

e

2

o

f

3

)



Victims and claimants can contact the agency that requested

the hold to make arrangements.



Usually a resolution can be reached that will allow the

warrant (check) to go through, but it must be worked out by

the victim or claimant.



CVC will provide the payee with appropriate phone numbers

to contact the debt-holding agency.

H

o

l

d

s

(

S

l

i

d

e

3

o

f

3

)

A

p

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s

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s

(

S

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f

4

)



The victim or claimant has the right to appeal a decision

(eligibility or awards)

•

Reconsideration

•

Final ruling hearing

•

District court

A

p

p

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a

l

s

P

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s

s

(

S

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)



R

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i

d

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r

a

t

i

o

n

•

First step in appeals process

•

30 days to appeal a denial of benefits

•

Victim or claimant is asked to send CVC all documentation

to prove claim

A

p

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l

s

P

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s

(

S

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)



F

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l

r

u

l

i

n

g

•

30 days to appeal Reconsideration denial

•

Last opportunity to prove compensable claim

•

Victim or claimant requested to send CVC all

documentation to prove claim

•

Victim or claimant speaks personally with a CVS

attorney (hearings officer) about their application

A

p

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s

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(

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)



D

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c

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c

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u

r

t

•

Victim or claimant has 40 days to send CVC letter of

dissatisfaction with Final Ruling Decision.

•

Victim or claimant has 40 days after letter of dissatisfaction

to file suit against CVC in district court.

C

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The Attorney General may investigate an application.

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4

7

(

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The Attorney General, on the Attorney General’s own

motion, or on request of a claimant or victim, may

reconsider;



(1) a decision to make or deny an award; or



(2) the amount of the award

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g

s

:

•

Victim was awarded loss of earnings.

•

CVC received information that victim submitted two false

employment verification documents and also forged HR

Director’s signature to falsely show they were employed.

•

Victim was charged and arrested with Tampering with a

Governmental Record.

•

Victim submitted false medical documentation in order to

continuing receiving loss of earnings.

•

Victim, a nurse, had been terminated from their job due

to felony forgery convictions but falsely indicated that it

was due to a crime related injury.

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n

:

•

Victim awarded relocation but claimed she never received

the check.

•

CVC processed a stop payment and issued a second

check.

•

Comptroller’s records revealed both checks had been

cashed.

•

Victim was charged with Theft.

•

Victim submitted a falsified lease.

•

CVC called apartment complex and was advised victim

was not approved.

•

Victim was charged with Tampering with a Governmental

Record.

Office of the Attorney General

Crime Victim Services Division

CVC Program

P.O. Box 12198

Austin, TX 78711-2198

Main Number: (512) 936-1200 or (800) 983-9933 

Priority Application Fax: (512) 370-9837

Presumptive Eligibility Fax: (512) 370-9995

www.texasattorneygeneral.gov

ITServices@oag.texas.gov

Voice: (512) 936-1768

Fax: (512) 370-3959

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