Texas Workers Compensation is available to workers injured on-the-job when their company subscribes to a Texas Workers Compensation insurance plan. Texas Workers Compensation is administered by the State of Texas and can be a complex system to maneuver.
Texas Workers Compensation will cover an injury that occurs while an employee is working for his or her employer and furthering the interests of the employer. Unlike a personal injury action, it does not matter who is at fault. Under the law, an injured worker is entitled to reasonable and medically necessary treatment related to the work injury in addition to income benefits.
The Law Firm of Adam Henderson understands that suffering a work injury can be a stressful time, and we are here to guide you through the complex Texas Workers Compensation process and “Fight for your Rights”.
There are three different stages of income benefits throughout a workers compensation claim:
Temporary Income Benefits (TIBS) are lost-income replacement benefits. TIBs are seventy percent of your average weekly wage, which is calculated by averaging your pay from the thirteen weeks immediately prior to the injury. TIBs are based upon gross pay, and the insurance should, though sometimes neglects to, include overtime pay, bonuses, other fringe benefits earned or secondary employment. TIBs start eight days after you begin losing time from work. You are entitled to TIBs for two years or until one of these events occur: you reach clinical maximum medical improvement; you are released to work without restrictions; or you are given a light duty position earning pre-injury wages.
Impairment Income Benefits (IIBs) are calculated in the same way as TIBs and are paid when you reach Maximum Medical Improvement (MMI). When you reach MMI, a doctor will determine what level of permanent damage you have, if any. This is called the Impairment Rating, which is represented by a percentage of your body that is damaged, and three weeks of benefits are paid for each percentage point.
Supplemental Income Benefits (SIBs) are paid after IIBs have expired if (1) you have received at least a 15% Impairment Rating and (2) you are earning less than eighty percent of your pre-injury average weekly wage. Furthermore, if a doctor has determined you have an ability to work, you must make a good-faith effort as outlined by law to search for employment.
Many times, the workers compensation insurance company may dispute part of or the entire claim. These disputes can be broken down into these categories:
- Compensability dispute. This is where the insurance has denied the claim in its entirety. Reasons may include that the insurance states you were not working in the course and scope of employment when an injury occurred or that you are suffering from an ordinary disease or condition of life, not something work-related.
- Disability dispute. The insurance may dispute that your ability to earn pre-injury wages is unrelated to the work injury.
- Extent of injury dispute. The insurance company may accept your claim but try to limit the “extent” of your injury. For example, if you injure your back at work, the insurance may accept a muscle strain when in fact an MRI has positive findings for a disc herniation attributable to your work-injury.
- Maximum Medical Improvement/Impairment Rating dispute. Both the insurance company and the injured worker may dispute a doctor’s certification of MMI and Impairment Rating. An insurance may dispute an Impairment Rating of a doctor because it believes it too high; an injured worker may want to dispute a doctor’s certification of MMI if he has not exhausted all medical treatment such that he has not even reached MMI or to dispute an Impairment Rating that is too low.
- Average Weekly Wage Dispute. There is a formula for determining average weekly wage (AWW). Sometimes, the insurance will base their calculation of your AWW on incomplete information, which may result in a compensation rate lower than you should be receiving.
For all of these disputes, it may be necessary to attend hearings at the Texas Department of Insurance. The Law Firm of Adam Henderson has a great deal of experience taking disputes through the hearings process. In some disputes, there are certain deadlines that apply, and if they are not met, your ability to proceed may be inhibited. Our attorneys are well-versed in all the rules and procedures that surround each of these disputes.