Workers’ compensation provides a lifeline for employees who are injured or become ill as a result of their job duties. Workers’ compensation benefits in Texas cover medical expenses and provide financial support during recovery. However, filing a claim and receiving benefits can be complex, and not all workers are sure about their eligibility or the types of benefits they might receive.
At Ascend Disability, we understand the intricacies of the Texas workers’ compensation system. This blog will cover everything you need to know about workers’ compensation benefits and how we can help with your Texas workers’ comp claim.
Who Can File a Workers’ Compensation Claim in Texas?
Texas operates a unique system when it comes to workers’ compensation. Unlike most states, Texas does not require employers to carry workers’ compensation insurance, although many still choose to provide coverage. If your employer offers workers’ compensation, you are likely eligible to file a claim if:
You Are an Employee
To qualify for workers’ compensation benefits, you must be an employee of the company. Independent contractors are generally not eligible, but the distinction between an employee and a contractor can sometimes be unclear. A lawyer can help determine your classification if there’s confusion.
You Suffered a Work-Related Injury or Illness
Workers’ compensation covers injuries and illnesses that arise out of and in the course of employment. This includes accidents at work, repetitive motion injuries, or illnesses caused by exposure to hazardous substances on the job.
Your Employer Has Workers’ Compensation Insurance
If your employer has opted into the workers’ compensation system, you are eligible to file a claim. However, if your employer is a non-subscriber (i.e., does not provide workers’ compensation), you may have to file a personal injury lawsuit instead. In this case, you can still recover compensation, but the process and legal rights differ significantly.
Workers’ Compensation Benefits in Texas
In Texas, workers’ compensation benefits support injured workers financially while they recover. These benefits cover various aspects, including medical care, wage replacement, and disability compensation. Here’s a breakdown of the benefits you may be entitled to:
Medical Benefits
Medical benefits cover all necessary medical treatments related to your work injury or illness. These include doctor visits, surgeries, physical therapy, medications, diagnostic tests, and hospital stays. Workers’ compensation also covers the cost of travel to and from medical appointments if they are more than 30 miles away from your home.
There is no cap on medical benefits in Texas, meaning you will continue to receive coverage for all necessary and reasonable treatments as long as they are directly related to your work injury.
Income Benefits
Income benefits are designed to replace a portion of the wages lost while you recover from your work-related injury. There are four types of income benefits available under Texas workers’ compensation law.
Temporary Income Benefits (TIBs)
These benefits are available if you lose income because of your injury and cannot work for at least seven days. TIBs are calculated as 70% of the difference between your average weekly wage (AWW) before the injury and your current earnings (if you are working in a reduced capacity).
TIBs continue until you reach maximum medical improvement (MMI), which is the point at which you are considered medically stable, or for up to 104 weeks, whichever comes first.
Impairment Income Benefits (IIBs)
If your injury results in permanent impairment, you may be eligible for IIBs. After reaching MMI, your doctor will assign an impairment rating, expressed as a percentage, that reflects the level of permanent damage. For each percentage point, you are entitled to three weeks of benefits, calculated at 70% of your AWW.
These benefits are typically awarded for permanent injuries such as the loss of a limb, organ, or other serious physical impairments.
Supplemental Income Benefits (SIBs)
If your impairment rating is 15% or higher and you are unable to return to work or cannot earn at least 80% of your pre-injury wage, you may qualify for SIBs. These benefits are designed to help workers with long-term disabilities. They are paid out monthly and calculated as 80% of the difference between 80% of your pre-injury wage and your current earnings. SIBs may last for up to 401 weeks after your injury.
Lifetime Income Benefits (LIBs)
For the most severe injuries, such as total blindness, loss of limbs, or paralysis, workers may qualify for LIBs. These benefits pay 75% of your AWW and include a 3% annual cost-of-living increase. LIBs continue for the rest of your life and are reserved for catastrophic injuries.
Death Benefits
If a work-related injury or illness results in death, the worker’s surviving spouse, children, or dependents may be entitled to death benefits. These benefits cover a portion of the deceased worker’s wages (up to 75% of their AWW) and may also include funeral expenses, up to $10,000.
Surviving family members can receive death benefits for varying periods depending on their relationship to the deceased and their age or student status.
How to File a Workers’ Compensation Claim in Texas
Filing a workers’ compensation claim in Texas involves several steps, and it’s important to follow them closely to avoid delays or potential claim denial. Here’s what you need to do:
Report Your Injury to Your Employer
The first step in the process is to report your injury to your employer. In Texas, you must notify your employer within 30 days of the injury or the date you became aware of the work-related illness. Failing to report the injury within this time frame could result in the loss of your right to file a claim.
Seek Medical Treatment
Even if your injury seems minor, seek medical attention as soon as possible. A doctor will document your injury and provide treatment recommendations. It’s important to follow all medical advice and keep records of your treatment, as this documentation will play a crucial role in your claim.
File a Claim
To officially start your workers’ compensation claim, you must file Form DWC-041 with the Texas Department of Insurance, Division of Workers’ Compensation (DWC). You have one year from the date of your injury or illness diagnosis to file this form. Missing this deadline could result in your claim being denied.
After your claim is filed, your employer’s workers’ compensation insurance company will review your claim. Be prepared to provide additional documentation and answer questions.
A workers’ compensation attorney can ensure your claim is submitted correctly, communicate with the insurance company, and protect your rights.
Attend a Workers’ Compensation Hearing, if Necessary
If your claim is denied, or if there is a dispute over your benefits, you may need to attend a workers’ compensation hearing. This hearing will take place before a judge, who will review the evidence and make a decision on your claim. An attorney can represent you during the hearing to ensure your rights are protected and that you receive the benefits you deserve.
Why You Need a Workers’ Compensation Lawyer
While it is possible to file a workers’ compensation claim on your own, hiring a lawyer can greatly increase your chances of success and ensure that you receive the maximum benefits available. Here are some reasons why hiring a lawyer is essential.
Navigating the Complex Legal Process
Workers’ compensation laws in Texas can be complex, and the claims process can be confusing, especially if you are dealing with a serious injury or a claim denial. A lawyer from Ascend Disability can help you navigate the process, file the necessary paperwork, and ensure that you meet all deadlines.
Maximizing Your Benefits
A skilled workers’ compensation lawyer will ensure that you receive all the benefits you are entitled to, including medical care, wage replacement, and long-term disability compensation. They will also negotiate with the insurance company on your behalf to secure a fair settlement.
Appealing a Denied Workers’ Comp Claim
If your claim is denied, a lawyer can help you file an appeal and represent you during hearings. They will gather additional evidence, such as medical records and expert testimony, to support your case and advocate for your rights in front of the workers’ compensation judge.
Ensuring Fair Treatment
Insurance companies often try to minimize payouts, and your employer may challenge your claim. Having a lawyer on your side ensures that you are treated fairly throughout the process and that your legal rights are protected.
Contact a Texas Workers’ Compensation Lawyer Today
If you’ve been injured at work in Texas, workers’ compensation benefits can provide crucial financial support while you recover. However, the process of filing a claim and receiving benefits can be challenging. Ascend Disability in Fort Worth, Texas, is here to help you navigate the workers’ compensation system, ensure your claim is handled properly, and fight for the benefits you deserve.
Contact Ascend Disability today for a consultation and let us help you secure the compensation you need to recover and move forward.