Your Benefits | Your Guide to Workers’ Comp

Your Benefits | Your Guide to Workers’ Comp


Hi, my name is Kelly and I’m with the Texas Department of Insurance, Division of Workers’ Compensation. There are many kinds of benefits within the workers’ compensation system. You may be able to get income and medical benefits if your injury happened while you were doing work that is part of your job,
and when the employer has workers’ compensation insurance. First let’s look at income benefits. Income benefits replace some of the money you lost because of your work-related injury or illness. The amount of income benefits you get is based on the Average Weekly Wage. The Average Weekly Wage is the average amount of money that your employer said you got each week from your work in the 13 weeks before you were hurt. That average may also include any other things your employer pays for, like health insurance, or money for a car, or dry cleaning. Your employer reports all your weekly earnings to their insurance company on a form called a wage statement. Your employer reports wages to the insurance company because the insurance company is the one who will pay you your income benefits. If you have money you get from other jobs
and want that amount to be included in your benefits, you must fill out DWC form 003ME, called the Employee’s Multiple Employment Wage Statement. The form can be found at the employee forms link at tdi.texas.gov/wc/employee. You need to fill out this form and return
it to the insurance carrier and the Division. The first kind of income benefits that you
might be able to get are Temporary Income Benefits. You are able to get these benefits when you have lost money from a job for more than 7 days because of your injury. Those days don’t have to all be in the same week. You could miss 4 days of work one week, come back to work for a short time, and miss another 4 days of work the next week. The total number of missed days would still be more than 7 days of missed work, which makes you able to get benefits. Benefits begin on the 8th day of missed work. You are paid Temporary Income Benefits each week. These benefits equal to 70 or 75 percent of what you were paid each week before your injury, depending on what you were paid an hour. After you are hurt, your doctor may let you
return to work if your employer can make changes to your regular job. Your employer may give you different work, or may find a temporary job for you. You are still able to get Temporary Income Benefits if your employer gives you different work to do but pays you less money than you made before you were hurt. Temporary Income Benefits have maximum and minimum benefit amounts. To learn about maximum and minimum benefit amounts under the Texas Workers’ Compensation Act, go to tdi.texas.gov/wc/employee. Temporary Income Benefits end when one of two things happens. These benefits end on the date when you return to work and the money you get from your job equals the money you were paid before your injury. Or your benefits will end on the date when
you reach Maximum Medical Improvement. There are two types of Maximum Medical Improvement:
Clinical Maximum Medical Improvement and Statutory Maximum Medical Improvement. Clinical Maximum Medical Improvement is the date when a doctor says no further healing or recovery from your injury expected. That date is based on examining you and looking at the treatments you have had. Statutory Maximum Medical Improvement is 104 weeks from the date you started getting Temporary Income Benefits. By law, you are only able to get Temporary
Income Benefits for up to 104 weeks. Your Temporary Income Benefits will end on whichever of those dates comes first. The next kind of income benefit that you could be able to get is Impairment Income Benefits. These benefits are paid if you have permanent damage to your body because of your injury. Impairment Income Benefits will be 70 percent of the money you were paid each week before your injury. These benefits do not depend on whether you are able to work. In fact, you could get these benefits even
if you have gone back to work. They are based on the amount of permanent damage that was done to your body. Once a doctor examines you and finds that no further healing from your injury is expected, the doctor may give you an impairment rating. This is a percentage of permanent physical damage done to your whole body because of your injury. For each percentage point of your impairment rating you get 3 weeks of Impairment Income Benefits. For example, if you have an impairment rating of 3 percent, you will get a total of 9 weeks of Impairment Income Benefits. The next kind of income benefit you could
get once Impairment Income Benefits end is Supplemental Income Benefits. These benefits are paid if you have a lot
of permanent damage to your body because of your injury and you still haven’t gone back
to work after your Impairment Income Benefits end. They are also paid if you’ve gone back to
work and are paid less than 80 percent of what you made before your injury. To get Supplemental Income Benefits, you have to: Have an impairment rating of 15 percent or higher. You also have to choose not to get your Impairment Income Benefits in one large payment. You would also have to be out of work or earning less than 80 percent of the amount of money you were able to make before your injury. You have to meet job search requirements each week or agree to be in a program that helps people with disabilities find or keep a job. This is a called a vocational rehabilitative
program. The Division or your insurance company can help you find a program in your area. To get Supplemental Income Benefits, you must turn in an application every three months. The Division reviews your first application. The insurance company reviews future applications. These benefits are paid monthly, not weekly. The amount you get is 80 percent of the difference between 80 percent of the amount your employer said you got each week from your job and what you get paid weekly after your injury. The last income benefit that you could get
is the Lifetime Income Benefit. Lifetime Income Benefits are paid when you have certain serious injuries. Examples of these are complete blindness, serious injuries to the brain, or the loss of two limbs. The benefits are 75 percent of what you made each week before your injury, with a 3 percent cost of living increase each year. The only income benefit that does not have a time limit is the Lifetime Income Benefit. With most income benefits there are limits. Most benefits end at 401 weeks from the date you were hurt, which is about 8 years from the date of your injury or illness. The other type of benefit you could get within the workers’ compensation system is medical benefits. Medical benefits pay for the cost of treating your work-related injury. Your employer’s workers’ compensation
insurance company pays your medical benefits to the health care provider who treats you. Your employer must tell you if your claim
is in a health care network so you can use a doctor in that network if you are hurt. If you are in a health care network and you get treatment from a doctor who is not in the network, without getting approval, you
could have to pay for the cost of the treatment. A doctor or health care provider should not send a bill to you for treating your work-related injury or illness. If you get a bill from a health care provider, please contact our customer service department or your insurance company. We will talk to them and let them know the right way to get payment for those services. Medical treatment is paid for when it is both reasonable and necessary. For more information on the types of benefits you may be eligible for, go to go to tdi.texas.gov/wc/employee, or call our customer service number for more information at 800-252-7031, option 1.

Author:

Leave a Reply

Your email address will not be published. Required fields are marked *