Texas Workers’ Compensation: Maximum Benefit Amount

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If you have been injured in a work related accident in Texas and are now unable to work, how are you compensated?

If your employer is a subscriber to the Texas Workers’ Compensation system, you are entitled to Temporary Income Benefits (TIBs) if you are disabled due to your compensable injury up until you are returned to work or found to be at Maximum Medical Improvement (MMI).

But, how is the amount of your disability (TIBs) check determined.  The insurance carrier pays you according to your Average Weekly Wage (AWW).  We provide a video on how the AWW is determined.

However, some injured workers’ pre-injury wage exceeds the maximum amount a party can receive for TIBs.  The maximum amount of TIBs can not exceed the State Average Weekly Wage (SAWW).

The State Average Weekly Wage is is equal to 88% of the average weekly wage in covered employment computed by the Texas Workforce Commission. The amount is adjusted beginning on October 1st and running till the end of the following September.

Benfit rates are paid according the the SAWW on the date the injury occurred.

Temporary Income Benefits are paid up to 100% of the SAWW

Impairment Income Benefits are paid up to 70% of the SAWW

Supplemental Income Benefits are paid up to 70% of the SAWW

Lifetime Income Benefits are paid at 100% of the SAWW for the first year the injured worker qualifies for LIBs

Death Benefits are paid at a rate up to 100% of SAWW.

The SAWW for October 2016 through September 2017, is $913.00.

The Morris Firm, PLLC, info@themorrisfirm.net, (214)357-1782

Texas Workers’ Compensation: Disability

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After a work injury in Texas, many workers are entitled to benefits through the Texas Workers’ Compensation system.  These benefits include medical benefits and indemnity benefits (money).

From the date of injury, up to the day after an injured worker is found to be at Maximum Medical Improvement, an injured worker may receive Temporary Income Benefits (TIBs), if they are disabled due to the compensable injury.

The Texas labor Code defines disability as the inability because of a compensable injury to obtain and retain employment at wages equivalent to the preinjury wage.

The medical providers fill out DWC-73 forms providing the restrictions to the injured workers’ ability to return to work.  If the restrictions prohibit the injured worker from working their normal hours or duties, they are disabled.

Even if the injured worker is working, they are entitled to TIBs if they are not making their pre-injury wage.  This can be due to reduced hours or a lower weekly wage due to their injury.

Workers may go in and out of disability up until the date that they are found to be at Maximum Medical Improvement.

The Morris Firm, PLLC, info@themorrisfirm.net, (214)357-1782

Texas Workers’ Compensation: What is muscle guarding?

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When a Worker in Texas has a neck or back injury that is being handled through the Division of Workers’ Compensation, they will receive a Whole Body Impairment Rating.  To determine that Impairment Rating, the medical provider will typically use a DRE Category (Diagnosis Related Estimate) that best suits the claimant’s (injured worker) condition.

To avoid a DRE Category I, which means no impairment at all, there must be clinical findings of injury, observed or documented muscle guarding or documented neurological impairment.

Many cases deal with the observed or documented muscle guarding.  The Fourth Ed. of the AMA Guides to Permanent Impairment define Guarding under Table 71 Pg. 3/109 of the Guides as: paravertebral muscle guarding or spasm or nonuniform loss of range of motion, dysmetria, is present or has been documented by a physician.  Radicular components that follow anatomic pathways but cannot be verified by neurologic findings belong with this type of differentiator.

The Morris Firm, info@themorrisfirm.net (214)357-1782

Texas Workers’ Compensation: Impairment Rating DRE Category IV

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If a worker in Texas suffers an injury to their neck or back and receives a Impairment Rating which includes a DRE Category IV, it will be for “Loss of Motion Segment Integrity or Multiple Neurologic  Compromise.”

Loss of Motion Segment Integrity:  Translation of one vertebra on another segment that is 11 degrees more that the angular motion at an adjacent motion segment; along with documented history of muscle guarding and pain.

Multiple Neurologic Compromise:  There must be bilateral radiculopathy or radiculopathy at multiple levels per the requirements of a DRE Category III.  This must include a documented history of muscle guarding and pain.

If a claimant receives a DRE Category IV for a cervical injury, they will receive a 25% whole body impairment rating for that condition. If the claimant receives a DRE Category IV for a thoracic or a lumbar injury, they will receive a 20% whole body impairment rating for that condition.

The Morris Law Firm, info@themorrisfirm.net (214)357-1782

 

 

Texas Workers’ Compensation: Accident Resulting in Death

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In Texas when an employer subscribes to the Texas Workers’ Compensation system, the Texas Labor Code states that the exclusive remedy (for the injury) is the recovery of the Workers’ Compensation benefits.  The only exception to this statute are claims against the employer for gross negligence resulting in death.

When an employee dies as the result of a workers’ compensation accident, their spouse, dependent children and possibly parents may be entitled death benefits as the result of being a beneficiary of the deceased worker.  If the accident resulting in the workers’ death resulted from the gross negligence of the employer, the surviving spouse or heirs the body have a cause of action against the employer.

You first must establish that the worker was in the “Course and Scope” of their employment when the accident occurred.  Next, for the workers’ compensation claim, the person seeking benefits must establish that they are a legal beneficiary of the deceased worker.  To have a separate “Cause of Action”, the surviving spouse or heir’s the body of the deceased must show that the death was caused by an intentional act or omission of the employer or by the employer’s gross negligence.

Gross negligence is an act or omission “which when viewed objectively from the standpoint of the actor at the time of its occurrence involves an extreme degree of risk, considering the probability and magnitude of the potential harm to others; and of which the actor has actual, subjective awareness of the risk involved, but nevertheless proceeds with conscious indifference to the rights, safety, or welfare of others.  What lifts ordinary negligence into gross negligence is the mental attitude of the defendant . . . The plaintiff must show that the defendant was consciously, i.e., knowingly, indifferent to his rights, welfare and safety.

If one of your family members has died as the result of a Texas Workers’ Compensation accident, make sure that you do not make any agreements with the insurance company or the employer before you consult with a licensed attorney.  If you have any questions about a Texas Workers’ Compensation claim, contact the Dallas office of the Morris Law Firm at (214)357-1782 or via email at info@themorrisfirm.net.

TEXAS WORKERS COMPENSATION INJURIES FROM THERAPY

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Many workers injured at work in Texas go through extensive physical therapy.  What happens when a patient is treating for a workers compensation injury and suffers another injury going through therapy?

In a Texas Workers’ Compensation claim, the injury is not limited to the conditions affected at the time of the injury.  But, includes any conditions naturally arising out of the compensable injury.  This includes medical treatment for the compensable injury which causes damage to the physical structure of the body.

If you are injured during physical therapy, or while receiving medical treatment for your compensable injury, your insurance carrier is liable for the treatment to relieve the effects of the injury.  Additionally, if this portion of your injury creates a permanent impairment, make sure it is included in your impairment rating.

If you have any questions about your workers compensation claim, contact the Dallas office of the Morris Law Firm at (214)357-1782 or via email at info@themorrisfirm.net.

Texas Workers’ Compensation: DRE Category III (Radiculopathy)

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Spinal injuries for cervical, thoracic and lumbar which in radiculopathy may be eligible for a DRE Category III.  Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve.

To qualify a person must have an ongoing minor neurologic impairment low the lower extremity related to cervical, thoracic or lumbar injury.  This is documented through examination of reflexes and findings of unilateral atrophy above or below the knee related to no other condition, and it may be verified by electrodiagnostic testing.  The injured worker must have one of the two following findings:

  1. Decreased circumference (atrophy)  Spine-injury-related circumferential measurements show loss of girth of 2 cm or more above or below the elbow or knee.  The atrophy cannot be explained by non-spine-related problems or contralateral sypertrophy, as might occur with a dominatnt limb or greatly increased use of a limb.  The neurologic impairment may be verified by differentiator 4 below.

2. Electrodiagnostic evidence Unequivocal electrodiagnostic evidence exists of acute nerve root compromise, such as multiple positive sharp waves or fibrillation potentials; or H-wave absence or delay greater than 3 mm/sec; or chronic changes such as polyphasic waves in peripheral muscles.

If a person receives a DRE Category III, that is equal to a 15% Impairment Rating for the Cervical spine and a 10% Impairment Rating for the Thoracic or Lumbar spine.