If you are injured on the job while employed in the state of Texas, you may be eligible to file a workers’ compensation claim to cover the expenses associated with your injury. Not all Texas employers are required to carry workers’ compensation insurance, and it is important to understand your options.
According to the most recent statistics from the U.S. Bureau of Labor Statistics, there were 2.8 million nonfatal workplace injuries and illnesses across the U.S. in 2018.
What Is Workers’ Compensation?
Workers’ compensation is a type of insurance that provides benefits to employees who have suffered a work-related injury or illness.
Depending on the nature of your claim, workers’ comp payout amounts can vary.
Texas Workers’ Compensation
Not all Texas employers are required to carry workers’ comp insurance. The Texas Division of Workers’ Compensation (DWC) reported that 28% of private companies in the state do not carry workers’ compensation insurance.
If your employer does not carry workers’ comp insurance, you may consider filing a personal injury claim to receive relief for your injury.
If your employer does have workers’ comp insurance, there are steps you should take immediately after you are injured or after you realize your injuries are associated with work:
- Report the injury directly to your employer, and
- File a DWC Form 041 with the Texas Department of Insurance.
The insurance company will reach out to your employer and review your claim after the form is submitted.
Will I Get a Settlement for Workers’ Comp?
Most insurance claims can be classified as settlements. You are not actually suing your employer. You are basically filing an insurance claim, similar to what you would do with your own health or auto insurance.
According to Texas Labor Code Sec. 408.005, a settlement may not provide for payment of benefits in a lump sum except in specific cases. For a settlement to be approved, both you and the insurance company must come to a clear agreement on the terms of the settlement for workers’ comp.
Once an agreement is reached and the settlement is approved, either party can still withdraw if they change their mind as long as it is before the effective date of the settlement.
How Much Does Workers’ Compensation Pay in Texas?
Workers’ compensation payout amounts vary depending on your wages and your injuries. Each claim is different. When answering the question, How much does workers’ compensation pay in Texas? you must take into account the relief you need and the methods of calculation used by the state.
One important number to know is your average weekly wage (AWW). This is the amount your workers’ compensation income benefits will be based on. In Texas, your AWW is the average wage you earned during the 13 weeks prior to your injury.
This includes bonuses and other forms of income including:
- Car allowance,
- Health benefits, and
- Dry cleaning.
If you have not been employed for 13 weeks prior to your injury, your AWW will be calculated using that of an employee with the same or a similar job.
What are Potential Workers’ Comp Payouts?
The severity of your injuries, paired with your AWW will be the biggest factors that determine how much workers’ compensation pays in Texas. Insurance companies will likely try to minimize both your injuries and AWW. An experienced workers’ compensation attorney can ensure that you are getting what you are owed.
Workers’ compensation payouts should cover all medical expenses related to your condition.
This includes all hospitalization, treatment, medications, and follow up care approved by your doctor. Your employer may require you to see an “in-network” doctor, depending on their insurance plan.
Temporary Income Benefits
Injuries and illnesses can prevent you from performing your job in your previous capacity while you heal. Temporary income benefits make up for the difference in your income while you cannot perform your duties. Texas calculates temporary income benefits as 70% of the difference between the wages you are able to earn after injury and the wages you earned before the injury.
This number increases to 75% if you were making under $10 per hour. Workers’ comp payout amounts for temporary income can last for 104 weeks from injury, or until you can return to work.
Impairment Income Benefits
If permanent bodily damage occurs as a result of your work injury, you may be eligible for impairment income benefits.
These are equal to 70% of your average wage and could continue even after you go back to work. A doctor assigns an impairment percentage point to your condition which reflects severity. Each point equals three weeks of impairment income benefits.
Supplemental Income Benefits
Like impairment income benefits, your impairment rating has an impact on workers’ compensation payouts for supplemental income benefits.
If you have significant permanent damage and receive an impairment rating of 15% or higher, you may receive supplemental income benefits. To be eligible, you must be earning less than 80% of your pre-injury wages, demonstrate you are looking for work, and have not accepted a lump sum payment for your injuries.
You also have to re-apply for these benefits every three months.
Death and Burial Benefits
According to the U.S. Bureau of Labor Statistics, there were 5,333 fatal work injuries recorded in the United States in 2019. This is a 2% increase from the 5,250 in 2018. Eligible family members of employees who die on the job can receive 75% of lost income. Burial and funeral benefits may include up to $10,000.
Lifetime Income Benefits for Disability
In severe circumstances, workers’ compensation payouts may include benefits for permanent disability. These benefits are equal to 75% of your average wages before the injury plus a 3% cost-of-living increase each year.
Lifetime income benefits for disability may apply under these circumstances:
- A spinal injury that causes paralysis in at least one arm or leg;
- Third-degree burns that cover at least 40% of the body and require a skin graft;
- Traumatic brain injury resulting in mental impairment;
- Complete blindness; or
- Amputation or total loss of use of one or more limb, such as a hand or foot.
Workers’ comp payouts for lifetime disability do not have a time limit.
Should I Hire a Texas Workers’ Comp Attorney?
If you have a simple workers’ compensation claim for an injury with a simple prognosis, you may be just fine on your own. There are lots of situations where a workers’ comp attorney could be important to ensuring you get what you deserve for your injuries.
If your employer denies your claim or fails to pay, the experienced attorneys at The Zimmerman Law Firm, P.C., can help you navigate the complexities of workers’ compensation law. Workers’ comp claims deal heavily with insurance companies, and insurance companies will often try to offer you less than what you need to care for your situation.