There are many different types of Texas workers’ compensation benefits available to injured workers after filing a claim, but some are more important than others. For instance, most people don’t need to know that a severely injured person might be able to get a wheelchair ramp installed at home because they will need it for the rest of their life. But, everybody needs to know about the 4 most important Texas workers’ compensation benefits that can be paid after a work injury.
Texas Workers’ Compensation Medical Benefits
Every injured worker in Texas is entitled to medical treatment. This is the most basic of the Texas workers’ compensation benefits. Injured employees are entitled to all medical care that cures or relieves the effects of their compensable work injury. The general rule is that the medical treatment has to be both reasonable and necessary care.
According to Texas workers’ compensation law, all medical treatment provided in the workers’ comp system has to be in accordance with the Official Disability Guidelines (ODG). These guidelines discuss the specific treatment options available for each body part and diagnosis. Medical treatment that is listed in the ODG is considered reasonable and necessary. Network status may also affect access to healthcare.
Temporary Income Benefits
The most common monetary benefit paid to Texas injured workers are temporary income benefits (TIBs). These are benefits to replace lost wages. You become entitled to these benefits once you miss eight days from work as a result of your work injury. When you miss days from work as a result of your work injury, the law calls that disability. You will often see “disability” listed as an issue for dispute resolution when cases go before a judge.
All Texas workers’ compensation benefits paid to injured workers are based on your average weekly wage. Temporary income benefits pay out at 70% of your average weekly wage (75% in some cases). However, there is a maximum benefit amount of $1007.00 per week as of this writing.
Impairment Income Benefits
Impairment income benefits (IIBs) are Texas workers’ compensation benefits for injured workers with permanent damage resulting from their work injuries. You must get an impairment rating when you reach maximum medical improvement,. An impairment rating is a measurement of the permanent damage you sustained in your work accident.
A qualified doctor assigns an impairment rating from the AMA Guides To The Evaluation Of Permanent Impairment, 4th Edition. You can get one from your treating doctor, from a state-appointed designated doctor, or from an insurance company doctor. The doctor assigns an Impairment rating as a percentage of loss. As an example, most low back injuries qualify for a 5% impairment rating in the AMA Guides.
The workers’ comp insurance company has to pay Impairment income benefits if you have any permanent impairment. These benefits begin on your maximum medical improvement date. The adjuster must pay you 3 weeks of benefits for every percentage of impairment awarded. So, from the example above, a 5% impairment rating will result in 15 weeks of IIBs. These Texas workers’ compensation benefits also pay at 70% of your average weekly wage. As of this writing, the maximum weekly impairment income benefit is $705.00, regardless of your average weekly wage.
Texas Workers’ Compensation Death Benefits
Death benefits are the Texas workers’ compensation benefits paid to a surviving spouse or child if the employee dies as a result of the work accident. Death benefits pay at the rate of 75% of the employee’s average weekly wage. Currently, the maximum death benefit that can be paid is $1007.00 per week.
Death benefits are paid to a spouse for life, unless there is a remarriage. Check out the link above for more details on these benefits. Children will receive death benefits until they are 18 years old, unless they continue in school. A child who turns 18 and enrolls in full-time continuing education can receive benefits up until the age of 26, depending on their grades.
What If My Texas Workers’ Compensation Benefits Get Denied?
Adjusters deny Texas workers’ compensation benefits all the time. That’s why the legislature created a dispute resolution system. Our workers’ comp system has a benefit review conference as a mediation to try to work out a way for all parties to come to an agreement about unpaid benefits. After that, a contested case hearing in front of a judge is available, if necessary, to get a ruling on a continuing dispute.
Our book, The Ultimate Survival Guide For Texas Injured Workers: Everything You Need To Know To Beat Insurance Companies At Their Games has more info about Texas workers’ compensation benefits. It’s a free download for all injured workers.