If you have a work-related injury or illness, you may be entitled to Texas workers compensation benefits. These benefits can provide financial support and medical coverage while you are recovering from your injuries or illness.
However, Texas workers compensation is a voluntary system. (Most other states require workers comp coverage.) If your employer has opted out of workers compensation insurance, you have the right to file a personal injury lawsuit.
If your Texas employer does have workers’ compensation insurance, you have specific rights and duties under the law. It is important that you understand Texas’ workers compensation system before you file a claim for benefits.
How Do I File a Workers Compensation Claim in Texas?
Most Texas employers carry workers compensation insurance. If you suffer a work-related injury or illness, you should notify your employer of your condition and request benefits. If you do not notify your employer within 30 days of your injury, you may be denied from receiving workers comp benefits.
You also must file a Claim for Compensation with the Texas Division of Workers Compensation (DWC) within a year of your injury. Again, you may lose your right to benefits if you do not file a claim with the DWC in a timely manner.
Once you have made a claim for benefits, your employer’s insurance company will investigate your claim. Typically, the insurance company will review your medical records, accident reports, and other information. If the company approves your claim, you should start receiving benefits.
If your claim is denied, you have the right to appeal. Because appeals frequently require a detailed understanding of medical and legal issues, you may want to speak with a workers comp lawyer before appealing your claim.
What Does Workers Compensation Cover?
Workers compensation benefits are paid to workers who have suffered work-related injuries and illnesses. In order to be work-related, you must show that your injury or illness arose out your employment.
Pre-existing conditions may also be covered, if you can show that your work activities significantly aggravated the condition. Workers’ comp will not be paid if you only experienced an increase in pain from a pre-existing condition. Instead, you will need medical evidence showing that your condition was aggravated or accelerated by work.
Can I Recover Any Damages Along with Workers Compensation?
Typically, workers compensation is an employee’s exclusive remedy. This means that you cannot sue your employer for negligence or request compensation for pain and suffering.
However, there are some exceptions to Texas’ exclusive remedy rule. You may file a negligence lawsuit if:
- Your employer did not have workers compensation insurance, or
- A third party was responsible for your injuries.
- A fellow employee is typically not a third party. Third parties claims may involve auto accidents, product liability, or premises liability.
A truck driver is injured when a negligent driver sideswiped his vehicle. The truck driver may receive workers compensation and file a personal injury lawsuit against the negligent driver.
What Type of Workers Compensation Benefits Can I Qualify For?
An injured worker’s benefits may include coverage of:
- Reasonable and necessary medical treatment,
- Income benefits
- Burial benefits, and
- Death benefits.
Every Texas workers compensation claim is different. Your benefits may vary, depending on the severity of your medical condition and your ability to return to work.
There are four types of income benefits available in Texas. These benefits include temporary, impairment, supplemental, and lifetime benefits. Texas sets a maximum income benefit each year. Additionally, there is a minimum benefit for temporary, impairment, and lifetime benefits.
Temporary Income Benefits (TIB)
Temporary income benefits are paid if you are fully or partially disabled for more than seven days. Typically, TIB benefits are 70% of the difference between your average weekly wage and your pre-injury wages. However, low wage earners may be entitled to larger benefit. TIB is paid for no more than 104 weeks.
A worker’s pre-injury average weekly wage was $500. After a back injury, she cannot work. Her weekly TIB payment will be $350 (70% of $500).
Another worker suffers a broken finger at work. His pre-injury average weekly wage was $500. While recovering, he earns $400 per week. His weekly TIB will be $70 (70% of $100).
Impairment Income Benefits (IIB)
Impairment benefits are paid when you have reached maximum medical improvement (MMI) and have a permanent impairment. Your doctor will set your impairment rating once you reach MMI. For every percentage point, you will receive three weeks of IIB benefits. IIB benefits are 70% of your average weekly wage.
A worker is assigned a 25% impairment rating. His average weekly wage was $500. He is entitled to 75 weeks of IIB benefits with a weekly rate of $350.
Supplemental Income Benefits (SIB)
Supplemental benefits are an additional monthly benefit paid to injured workers who:
- Have at least a 15% impairment rating,
- Have not returned to work or now earn less than 80% of their pre-injury average weekly wage,
- Are doing a legitimate job search, and
- Did not take their IIB benefits in a lump sum payment.
- SIB payments are 80% of the difference between 80% of your average weekly wage and your post-injury weekly wages.
An eligible worker’s pre-injury average weekly wage was $500. Post-injury, she earns $350 per week. Her SIB benefits will be $160 per month.
80% of pre-injury weekly wage = $400
$400-350 (post-injury earning) = $50
80% of $50 = $40 per week (or $160 monthly).
Lifetime Income Benefits (LIB)
Lifetime income benefits are paid when you suffer a catastrophic injury, including:
- Loss of vision in both eyes,
- Loss of both feet,
- Loss of both hands,
- Loss of one hand and one foot,
- Paralysis of two limbs,
- Permanent insanity or imbecility,
- Third degree burns over 40% of your body that require grafting, or
- Third degree burns on both hands or on one hand and your face.
LIB payments are 75% of your average weekly wage with a 3% annual increase in benefits.
Do I Need a Texas Lawyer?
If your workers comp claim is disputed, you should probably speak with a Texas workers compensation lawyer. A workers’ comp lawyer can evaluate your claim and maximize your benefits.