Benefit Review Conference, The New Rules

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Beginning October 1, 2010, The Division of Workers’ Compensation (DWC) will change how they grant Benefit Review Conferences (BRC). Prior to the change, an injured worker could fill out a DWC-45 requesting a BRC along with some information as to their position, and one would be set. Under Rule §141.1, the DWC will now review the DWC-45 for completeness. If the form is found to be incomplete, the hearing will be denied. In a workers’ compensation claim, there are many time sensitive issues. If the DWC-45 is denied, the injured worker may lose the ability to have the issue addressed. The injured worker must show documented evidence as to how they attempted to resolve the issue with the insurance company prior to requesting the hearing. Additionally, the DWC’s position is that if the reviewer feels that the party did not make sufficient efforts to resolve the issue, the request will be denied. The documentation that is relevant to the issue must be exchanged with the insurance carrier and the DWC prior to the BRC. Once the BRC has been set, either party may request that the hearing be rescheduled within ten days of the receipt of the set notice. After the tenth day, the party must show good cause for their continuance to be granted. The DWC is clearly making it harder to get a hearing. Do not attempt to go through the hearing process without an attorney that is experienced in the Texas Workers’ Compensation system. At the Morris Law Firm, PLLC, we have been helping injured workers in the DFW area and all of North Texas, for the last 15 years. Call us at (214)357-1782 or contact us at info@themorrisfirm.net.

Nuevas reglas para las Conferencias de Revisión de Beneficios (BRC)

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A partir del 1ro de octubre de 2010, la División de Compensación para Trabajadores (DWC) cambiará la forma en que concede las Conferencias para Revisión de Beneficios (BRC). Antes del cambio, un trabajador lesionado podía llenar un formulario DWC-45 para solicitar una BRC junto con alguna información acerca de su actividad, y eso era suficiente. Según la Regla §141.1, la DWC revisará exhaustivamente el formulario DWC-45. Si se halla que el formulario se encuentra incompleto, se negará la audiencia. En reclamo por compensación de un trabajador, hay muchos temas sensibles que deben ser tenidos en cuenta para abordar el tema. Si se niega el DWC-45, el trabajador lesionado podría perder la posibilidad de que si caso sea tratado. El trabajador lesionado, previo solicitar la audiencia, debe mostrar evidencia documentada de que la forma en que trató de resolver el problema con la compañía de seguros. Además, la DWC ha adoptado una posición en la que si el revisor considera que las partes no han hecho esfuerzos suficientes por resolver el problema, la solicitud es denegada. La documentación que sea relevante para el tema debe ser intercambiada con la compañía de seguros y la DWC antes de la BRC. Una vez que se ha establecido el BRC, cualquiera de las partes podrá solicitar que la audiencia sea reprogramada dentro de los diez días siguientes a la recepción de la notificación de que el BRC ha sido aprobado. A partir del décimo día, las partes deben demostrar una buena causa para que se le conceda la permanencia. Claramente, la DWC está haciendo más difícil conseguir una audiencia. No trate de pasar por el proceso de la audiencia sin un abogado que tenga experiencia en el sistema de Compensación para Trabajadores de Texas. En la firma de abogados Morris, PLLC, hemos estado ayudando a trabajadores lesionados en el área de DFW y todo el norte de Texas, durante los últimos 15 años. Llámenos al (214)357-1782 o póngase en contacto con nosotros en info@themorrisfirm.net.

Inmigración

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La mayoría de las personas que solicitan aplicar como inmigrantes lo hacen para que algún familiar pueda aplicar para solicitar la inmigración y que de esa manera el familiar pueda solicitar la residencia permanente. La aplicación para migración que debe presentarse se llama petición familiar. Un residente permanente puede solicitarla para su cónyuge, un hijo soltero menor de 21 años o un hijo o hija soltera que tenga 21 años de edad o más. Un ciudadano estadounidense puede solicitarla para su esposo o esposa, hijo o hija soltero menor de 21 años, un hijo o hija soltera de 21 años o más, hermanos o hermanas y padres. Estas peticiones se envían a migraciones y cuando la aplicación es aprobada se envía un recibo de inmigración. Cuando un residente permanente aplica por un familiar, dicho familiar es ingresado al sistema de prioridad y debe que esperar para solicitar una visa de residente permanente. A veces, esta espera puede ser de varios años. Cuando un ciudadano aplica por un pariente directo, el proceso es mucho más rápido. Los parientes directos son esposos, padres o hijos solteros menores de 21 años de edad. Cuando un ciudadano aplica por un hijo o una hija casada mayor de 21 años de edad o un hermano o hermana, dicho pariente es ingresado en el sistema de prioridades y de nuevo la espera puede ser muy larga. Llame a nuestra oficina y podemos ayudarlo a usted y sus familiares a lidiar con este complicado sistema.

Immigration

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Most people who apply for immigrant petitions have a family member who petitions immigration so that the family member can apply for permanent residence. The application that has to be filed with immigration is called a family petition. A permanent resident can apply for a spouse, an unmarried child under age 21, or an unmarried son or daughter who is 21 years of age or older. A US citizen can apply for husband or wife, unmarried son or daughter under age 21, an unmarried son or daughter age 21 or older, brothers or sisters, and parents. These petitions are sent to immigration and when they are approved the petitioner is sent a receipt from immigration. When a permanent resident applies for a relative, that relative is placed in the priority system and has to wait to apply for a permanent resident visa. Sometimes this wait can be several years. When a citizen applies for an immediate relative, the process is much faster. Immediate relatives are spouses, parents, or single children under 21 years of age. When a citizen applies for a married son or daughter age 21 or older or a brother or sister the relative is placed in the priority system and again the wait can be a very long time. Call our office and we can help you and you relatives though this complicated system.

Supplemental Income Benefits (SIBs)

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When it comes to the indemnity side of Workers’ Compensation, no area has had more changes than Supplemental Income Benefits (SIBs). An injured workers is entitled to SIBs when they receive an Impairment Rating (IR) of 15% or greater, their disability is directly resulting from the compensable injury, they are earning less than 80% of their Average Weekly Wage (AWW) and demonstrated an active effort to obtain employment in accordance with Labor Code §408.1415. When the Texas Law changed in 1991, claimants were found entitled to SIBs with a letter from a doctor stating that they can not work or a list of places where they look for work (seeking employment in good faith). Presently entitlement to SIBs is determined under Texas Administrative Code §130.102 (1) An injured employee demonstrates an active effort to obtain employment by meeting at least one or any combination of the following work search requirements each week during the entire qualifying period: (A) has returned to work in a position which is commensurate with the injured employee’s ability to work; (B) has actively participated in a vocational rehabilitation program as defined in §130.101 of this title (relating to Definitions); (C) has actively participated in work search efforts conducted through the Texas Workforce Commission (TWC); (D) has performed active work search efforts documented by job applications; or (E) has been unable to perform any type of work in any capacity, has provided a narrative report from a doctor which specifically explains how the injury causes a total inability to work, and no other records show that the injured employee is able to return to work. Claimants must meet at least one of the criteria of A-E for each week of the qualifying period to be found eligible for the quarter of SIBs. Training programs should be through the Department of Rehabilitative Serves (DARS) or have documentation that the program has been approved by DARS. The Claimant should register with the Texas Workforce Commission (TWC) and if they are seeking employment, should have job contacts each week equal to or greater than the minimum number required by the TWC for the given county to qualify for unemployment benefits. Under the new rules, a designated doctor can be requested for ability to work prior to the second anniversary of the initial determination for entitlement. The designated doctor’s findings carry presumptive weight, but may be overcome by a preponderance of the evidence. SIBs are a difficult area to navigate. The application of the Rules are in constant flux and are evolving as new case law is decided. If your insurance carrier disputes a quarter of SIBs and you prevail on that quarter, the insurance carrier is liable for your attorney’s fees. There is no reason not to have an attorney on your side for SIBs. Call us at our Dallas location, (214)357-1782 or contact us at info@themorrisfirm.net

Beneficios de Ingresos Suplementarios

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Cuando se trata de la parte indemnizable de la Compensación para Trabajadores, ningún otra área ha sufrido más cambios que los Beneficios de Ingresos Suplementarios (SIB). Los trabajadores lesionados tienen derecho a SIB cuando reciben un porcentaje por impedimento (IR) de 15% o mayor, si su discapacidad es el resultado directo de la lesión indemnizable, si están ganando menos del 80% de su salario semanal promedio (AWW) y demostraron un esfuerzo activo para obtener un empleo en conformidad con el Código de trabajo §408.1415. Cuando la Ley de Texas cambió en 1991, se otorgó a los demandantes el derecho a recibir SIB mediante una carta de un médico la cual indique que no pueden trabajar o una lista de lugares en los que buscan trabajo (donde han buscado empleo de buena fe). En la actualidad, el derecho a SIB está determinado por el Código Administrativo de Texas §130.102 (1) Un empleado lesionado demuestra un esfuerzo activo para obtener un empleo mediante el cumplimiento de al menos uno o cualquier combinación de los siguientes requisitos de búsqueda de trabajo, cada semana durante todo el período de calificación: (A) ha vuelto a trabajar en una posición que es acorde con la capacidad laboral del empleado lesionado; (B) ha participado activamente en un programa de rehabilitación vocacional como se define en la §130.101 de este título (Definiciones); (C) ha participado activamente y esforzadamente en la búsqueda de trabajo llevadas a cabo a través de la Comisión de Empleo de Texas (TWC); (D) ha realizado una activa y esforzada búsqueda de trabajo que se encuentre documentada por solicitudes de empleo; o (E) ha sido incapaz de realizar cualquier tipo de trabajo en cualquier condición, ha proporcionado un informe descriptivo, realizado por un médico, que explique específicamente cómo su lesión causa una incapacidad total para trabajar, y no existan otros registros que muestren que el empleado lesionado es capaz de volver al trabajo. Los reclamantes, deben cumplir al menos uno de los criterios enunciados desde A hasta E para cada semana del período de calificación en que son elegibles para el trimestre de SIB. Los programas de capacitación deben ser llevados a cabo a través del Departamento de Servicios de Rehabilitación (DARS) o tener la documentación que pruebe que el programa ha sido aprobado por el DARS. El reclamante debe registrarse en la Comisión Laboral de Texas (TWC) y si está buscando empleo debe tener contactos laborares, cada semana, en un número igual o mayor al número mínimo requerido por la TWC para un determinado condado calificar para los beneficios por desempleo. Bajo las nuevas reglas, se puede solicitar un médico designado para comprobar la capacidad laboral antes del segundo aniversario de la determinación de recibir el derecho. Sin bien las conclusiones del médico designado tienen un peso presuntivo, pueden ser superadas por la preponderancia de la evidencia. Los SIB son un área difícil de navegar. La aplicación de las Normas es de flujo constante y están evolucionando a medida que se genera nueva jurisprudencia. Si su compañía de seguros disputa algún trimestre de SIB y usted gana esa disputa sobre el trimestre, la compañía de seguros debe hacerse responsable de los honorarios de su abogado. Cuando se trata de SIB, hay razón alguna para no tener un abogado a su lado. Llámenos a nuestra oficina en Dallas al (214)357-1782, o póngase en contacto con nosotros en info@themorrisfirm.net

Overcoming an Intoxication Defense

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After an injury, many employers require their employees to have a drug screen performed the day of the injury. The testing is not to help the injured worker recover from his injuries. It is performed to allow the employer and insurance carrier to dispute the compensability of the injured worker’s claim. If an injured workers’ refuses to be tested, this does not mean that he is automatically considered intoxicated. Might as well be fired for refusing the testing, than for a positive test. If an injured worker is found to be intoxicated (does not have the full use of his physical and mental faculties) at the time of the accident, the insurance carrier is not liable for the workers’ compensation claim. (See Tex. Labor Code §406.032(1)(A)). It does not matter that the accident was not the fault of the claimant. The intoxication serves as an absolute exception to liability, regardless of the cause of injury. See Texas Indemnity Insurance Company v. Dill, 42 S.W.2d 1059 (Tex. App.—Eastland 1931), aff’d 63 S.W.2d 1016 (Tex. Comm’n App. 1933). <strong> You are not required to go to the company doctor. The day of your injury, you should be seen by a doctor that will properly note all of your physical complaints from the accident. A doctor providing treatment to someone who is injured should be more concerned about making their patient whole, then building a defense for an insurance company. If the doctor you see tells you to only write down the most serious injuries and they will deal with the others later. Be very weary of the loyalty of the doctor. Do not allow the adjuster or your companies HR department to select your treating doctor. Even if your employer is in a network, you have the ability to select your own doctor. Call us, we can help you to find a doctor that has your interest at heart. Intoxication is defined as the state of not having the normal use of mental or physical faculties resulting from the voluntary introduction into the body of an alcoholic beverage or controlled substance or controlled substance analogue. This does not include medications taken by the injured worker, which were prescribed by a doctor to them. <strong>The question of intoxication must be raised by the insurance company in a timely fashion. If the insurance company fails to timely dispute the claim under the defense of intoxication timely, they are barred from doing so. As the injured worker, you presumed to be sober at the time of the injury. Bender v. Federal Underwriters Exchange, 133 S.W.2d 214, (Tex.Civ.App.—Eastland, 1939, writ dism’d judgm’t correct). However, if the injured worker tests positive for non-prescribed drugs or alcohol content, the burden shifts, as a matter of law, back upon the claimant to establish that he was not intoxicated at the time of the accident. If the insurance carrier presents “probative evidence” of intoxication to rebut the presumption of sobriety, then the claimant has the burden to prove that he was not intoxicated (had the total use of his physical and mental faculties) at the time of the injury. March v. Victoria Lloyds Insurance Co., 773 S.W.2d 785 (Tex. Civ. App.—Fort Worth 1989, writ denied). If the injured worker refuses the testing, the burden does not shift as a matter of law. See Appeals Panel Decision 033057. However, the hearing officer may find that the burden shifts through other evidence. If the insurance carrier shifts the burden to the claimant in regards to intoxication, the claimant must prove by preponderance that he had the full use of his physical and mental faculties at the time of the accident. Although, scientific or medical evidence is not required to establish sobriety, a one line statement that he was not intoxicated does not overcome the presumption. See Appeal Panel Decision 062507-S. The claimant may use the testimony of his co-workers, supervisors and other witnesses to establish sobriety. Even witnesses that may e unwilling to testify as to sobriety may establish the same when they say that the claimant was allowed to operate dangerous machinery or equipment. Testimony as to how long prior to the accident they had worked together that day, and claimant’s actions during that time period. How long after the accident was the test administered? If more than 24 hours has passed, most hearing officers will not consider the test. If the testing was for alcohol, is the carrier trying to extrapolate the testing to shift the burden? Many factors must be taken into consideration (ie weight, age, activity level, food intake…) to perform a proper extrapolation. Who administered the testing? If it was the employer, did they know how to properly administer the test? How can they establish that it was not contaminated? If it was for alcohol, was the machine calibrated properly? It is not unusual that the employer does not have the proper expertise to administer testing after an accident. Intoxication is a tricky area of a workers’ compensation claim. Do not attempt to handle it yourself. Contact an attorney to assist you. You can call the Morris Law Firm to set up an appointment to go over your case at our Dallas location, <strong>(214)357-1782.</strong>