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
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 firstname.lastname@example.org.
As explained last time, Texas Workers’ Compensation neck and back injuries that receive a DRE category I for impairment are considered to have no impairment at all. The DRE category II is for minor impairments to the neck or back.
To qualify for a DRE category II, the injured worker should have a clinical history and examination findings that are compatible with a specific injury or illness. The findings may include significant intermittent or continuous muscle guarding that has been observed and documented by a physician, non-uniform loss of range of motion, or nonverifiable radicular complaints. There is no objective sign of radiculopathy and no loss of structural integrity.
Under the Texas Workers’ Compensation system, a DRE category II entitles an injured worker to a 5% whole body impairment. This translates to 15 weeks of impairment income benefits.
Morris Law Firm, (214)357-1782, email at email@example.com.
Texas uses the Fourth Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment to determine Impairment Ratings for injured workers. The Guide is to only apply to permanent impairments, defined as adverse conditions that are stable and unlikely to change.
The Guides require that a doctor performing an evaluation must first gather through and complete historical information on the medical condition(s) and then carry out a medical evaluation supported by appropriate tests and diagnostic procedures.
The doctor should determine the condition that seems to be of the most concern to the injured worker. That condition needs to be assessed and given a whole body impairment. Each of the unrelated conditions must be assessed and given a whole body impairment. Then all the conditions are combined using the Combined Values Chart.
The Guides find the impairment by DREs (Diagnosis Related Estimates), ROM (Range of Motion) and specific Diagnosis ratings. The Guides determine if the methods are combined or one method is to be used with the exclusion of the others.
The Morris Firm, firstname.lastname@example.org, (214)357-1782
I know that most of the Texas Workers’ Compensation news seems to limit benefits and injured workers’ rights within the system. However, once in a while a ray of light shines in and gives us a glimmer of hope. One of these recent rays was provided by the Texas Workers’ Compensation Appeals Panel.
In Appeal No. 110670, the Division of Workers’ Compensation found that “it is impossible for a claimant to have reached MMI, since he has only had a minimal trial of post-operative care.” In this case, the Appeals Panel overturned the findings of a designated doctor in finding maximum medical improvement, prior to the injured worker attending a pre-authorized chronic pain management program. This allowed the injured worker to continue to receive Temporary Income Benefits (TIBs), while off work.
It is nice to see that in spite of all the forces trying to push injured workers out of the system prior to substantial recovery, there are still avenues for the injured worker to claim the statutory benefits for which his labor paid the insurance premiums.
Daniel L Morris, The Morris Firm, email@example.com, (214)357-1782
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