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, firstname.lastname@example.org, (214)357-1782
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, email@example.com (214)357-1782
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:
- 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.
In 1991, Texas changed how workers’ compensation claims are handled by separating the medical treatment and the disability payments to the injured worker. This was done to allow injured workers to receive medical treatment without settlement negotiations affecting the treatment.
However, in 2006, The Texas Division of Workers’ Compensation allowed Insurance companies, certified self-insured employers, groups of certified self-insured employers, and political subdivisions can set up their own networks or contract with certified networks.
When an injured worker seeks medical treatment, it must be be determined if they can treat with a doctor of their choosing or they must find a doctor within the network. Injured workers are limited on how many changes they can make when selecting their treating doctor. Therefore, they should always consult with a person knowledgeable in the Workers’ Compensation system when selecting a treating doctor.
Daniel L Morris, The Morris Firm, firstname.lastname@example.org, (214)357-1782
Up to 80% of disputes in Texas Workers’ Compensation claims include an extent of injury issue. Over the past few years it has become more difficult for injured workers to prevail at the Texas Department of Insurance, Division of Workers’ Compensation when an insurance carrier disputes disputes any conditions beyond a contusion or a sprain/strain injury.
Most conditions beyond a sprain/strain or contusion require a medical provider to present a “letter of causation” to establish the diagnosis as related to the compensable injury.
However, getting a “letter of causation” is not as simple as it sounds. Texas has now allowed employers to elect to be part of a care network. Injured workers whose employers are in a network may only treat with doctors in the network. Most of the networks are very restrictive on which doctors are allowed to enter the network and those who are in the network can be removed at the discretion of the insurance carrier. Therefore, some doctors in the networks refuse to provide “letters of causation” when the insurance carrier has denied a diagnosis.
Even when a worker gets a “letter of causation”, the insurance carrier can have the worker examined by their selection of doctor to rebut the letter. Some insurance carriers even hire doctors to testify at hearings who have never examined the worker; nor have they provided a report which the injured worker may have reviewed by a doctor.
In summary, if you are looking at a dispute of your Texas Workers’ Compensation claim make sure you have the evidence you need to establish the disputed condition.
Daniel L Morris, The Morris Firm, email@example.com, (214)357=1782
Under the Texas Workers’ Compensation system, a worker will reach Maximum Medical Improvement when based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated. Generally this must happen no later than 104 weeks from the date that benefits begin to accrue.
Texas currently uses the 4th Edition of the Guides to the Evaluation of Permanent Impairment. The Guides provide the manner for a doctor to calculate the injured workers’ Impairment Rating. The rating will will be no impairment or a finding from 0% to 100% whole body impairment rating.
To do a proper rating, the doctor must address each compensable condition and provide a rating for that condition. All conditions are added to provide the whole body impairment rating.
Daniel L. Morris, The Morris Law Firm, http://www.themorrisfirm.net, (214)357-1782
Texas work related injuries are very regulated. Disputes over Maximum Medical Improvement are included in the majority of hearings handled at the Division of Workers’ Compensation. Certifications are completed by a doctor who examines the injured worker and completes a DWC-69 form.
The most important thing to understand is that once a worker is found to be at Maximum Medical Improvement, they will no longer be eligible to receive Temporary Income Benefits (TIBs). If the doctor finds a date of Maximum Medical Improvement, the certification will contain either a finding of no impairment or provide an impairment rating from 0 to 100%. The Impairment Rating is multiplied by 3 and the injured worker is paid that number of weeks of Impairment Income Benefits (IIBs).
Once you receive a certification of Maximum Medical Improvement make sure you have it reviewed asap. You have a limited time to dispute the findings of the certification.
Daniel L Morris, The Morris Firm, www.themorrisfirm.net, firstname.lastname@example.org, (214)357-1782