Brian White | March 30, 2021 | Workers Comp
Texas does not require employers to obtain workers’ compensation insurance. But for those that do, the workers’ comp carrier can provide compensation to injured employees.
The compensation paid for a workers’ comp claim covers medical costs and provides temporary income replacement. For workers whose workplace injuries have caused permanent disabilities, workers’ comp insurance will also pay impairment or lifetime income benefits.
Here are some things you should know about how much a workers’ compensation case might be worth and the factors that a lawyer will use to evaluate your claim.
Workers’ Compensation Insurance in Texas
Most states require employers to buy workers’ compensation insurance. Texas does not. Texas law refers to employers that do not buy workers’ compensation insurance as “non-subscribers.”
Injured employees may sue non-subscribing employers for on-the-job injuries since they cannot file a workers’ comp claim.
Employers who subscribe to the workers’ compensation system are immune from lawsuits for workplace injuries. Instead, an injured employee’s exclusive remedy comes from the workers’ compensation carrier for the employer.
Employers have three options for obtaining workers’ compensation coverage, which include:
- A commercial workers’ compensation policy from an insurance company
- Self-insurance, in which the employer sets up a program that pays claims in compliance with the workers’ comp regulations
- A self-insurance group, in which several employers share the program costs and pay claims for any of the member businesses
Regardless of which option an employer chooses, the insurer must pay benefits to injured employees specified under Texas’s Workers’ Compensation Act.
Benefits Paid for a Workers’ Compensation Claim
Under certain circumstances, the insurer will not pay workers’ compensation claims.
Employees do not receive workers’ comp if they were injured due to:
- A deliberate act of harm toward the employee or another person
- A fight that was not due to the employee’s employment
- Off-duty activities, unless the activity was expected or required by the employer
The insurer must cover all other injuries incurred in the course and scope of employment, including injuries that occur due to a single accident, ongoing exposure to repetitive stress, or occupational hazards.
The medical benefits are the most expansive and generous of the benefits paid in a workers’ comp case.
The benefits cover the expenses of all treatment and therapy needed to:
- Cure or relieve the symptoms of the injury
- Promote recovery
- Enhance the employee’s ability to return to work
Medical benefits cover doctor and emergency room visits, hospital stays, diagnostic tests, imaging, medication, and physical therapy. However, you will need to prove that the medical expenses were incurred for medically necessary purposes.
Texas does not cap medical benefits. Texas also prevents workers’ comp insurers from limiting or terminating medical benefits in a workers’ comp settlement.
Texas requires insurers to cover part of your income while you are unable to work. If your work-related injury disables you permanently, insurers must provide additional compensation to make up for your inability to return to your job.
Income benefits fall into a few categories, which we’ll cover below.
Temporary Income Benefits
Temporary income benefits cover part of your wages for as long as your injury impacts your ability to earn money. These benefits begin on the eighth day after your injury. You do not receive temporary income benefits if you can return to your normal work duties at your normal wage within one week. But if you cannot, you will become eligible for temporary income benefits.
The insurer calculates the benefit based on the difference between your average weekly wage before the injury and your average weekly wage after the injury:
- If you earn less than $10 per hour, you receive 75% of the difference.
- If you earn more than $10 per hour, you receive 70% of the difference.
For example, suppose you earned $15 per hour before your work-related injury. You cannot return to your old job, but you can work on modified duty at $10.50 per hour. Your temporary income benefit would be 70% of the difference between $15 per hour and $10.50 per hour. This equals $3.15 per hour.
Added to your reduced wage of $10.50 per hour, you would make $13.65 per hour.
This coverage supports Texas’s strong policy that favors employees who return to work as quickly as possible. While returning to work does not maximize your benefits, it does maximize the amount of money in your pocket.
Temporary income benefits last until:
- You return to your pre-accident average weekly wage
- Your health care provider determines that you cannot expect any further recovery from your injury
- You receive 104 weeks of temporary income benefits
The insurer will end your temporary income benefits upon the earliest of these events.
Impairment Income Benefits
Insurers only pay impairment income benefits when you suffer permanent damage to your body due to a work-related injury. The insurer will pay 70% of your average weekly wage for impairment income benefits.
The duration of this benefit is based on your disability percentage. Your health care provider will calculate the percentage of your body that was permanently damaged in the accident. The insurer must pay this benefit for three weeks for each percentage.
For example, if you receive a 30% disability rating, you will receive 90 weeks of impairment income benefits.
Supplemental Income Benefits
The insurer can pay supplemental income benefits if your impairment income benefits run out before you can return to work.
Texas law caps supplemental income benefits at 80% of the difference between 80% of your average weekly wage and the wages you earned while recovering from your injury. This means that your supplemental income benefit cannot exceed 64% of your average weekly wage.
Lifetime Income Benefits
Insurers pay lifetime income benefits when you have a serious bodily injury, such as:
- large third-degree burns
- permanent blindness in both eyes
- the loss of two or more extremities
- a permanent traumatic brain injury
Lifetime income benefits equal 75% of your average weekly wage with 3% annual increases. The benefit is paid for the remainder of your life.
How Much is Your Workers’ Comp Case Worth?
The value of your workers’ comp case will equal the sum of your medical benefits and income benefits. To evaluate your case, your attorney will need to know about your wage history and the extent of your injuries.
Based on this information, a workers’ comp attorney can estimate the value of your case so that you can try to settle with the insurer instead of waiting for weeks or years before you receive all of your benefits.