In Texas Workers’ Compensation claims there are medical and indemnity (money) benefits. Each of these benefits are governed by the Texas Department of Insurance (TDI) through the Division of Workers’ Compensation (DWC).
Indemnity benefits are cash payments paid directly to the claimant (injured worker). They are paid for disability (TIBs or SIBs); for the claimant’s whole body impairment (IIBs); payment to claimant’s who qualify for life time income benefits (LIBs); and benefits to beneficiaries of a deceased claimant.
Medical benefits are requested by a medical provider and approved or denied by the insurance carrier. If approved, the medical provider receives payment for the medical care directly from the insurance carrier. If they are denied, it can be for a number of different reasons (i.e. compensability, improper treatment, etc.).
To dispute adverse determinations of indemnity or medical benefits by an insurance carrier, the DWC allows the parties to resolve disputes through a hearing process at a field office of the DWC.
Daniel L Morris, The Morris Law Firm, firstname.lastname@example.org, (214)357-1782