If you’re injured at work while doing your job, a Houston workers’ compensation lawyer can help. You shouldn’t have to bear the burden of healthcare costs and lost income. That’s where workers’ compensation insurance comes in. Sandoval Waldman represents injured workers so they can get the benefits they are legally entitled to receive.
Work-related injuries, illnesses, and deaths are all too common in Texas. There were about 230,500 non-fatal occupational injuries and illnesses in the state in 2017 and 534 fatalities, according to the U.S. Bureau of Labor Statistics. These numbers illustrate why workers’ compensation exists.
What is Workers’ Compensation?
Workers’ compensation is an insurance program created by state law that pays your medical bills and replaces some of the income lost due to your work-related injury or illness. It’s the responsibility of the Division of Workers’ Compensation Insurance of the Texas Department of Insurance.
In Texas, employers do not need to carry workers’ compensation insurance unless they are certain private employers or part of a government or educational system. Those who don’t are known as non-subscribers.
For employers with workers’ compensation insurance coverage, that insurance company pays any income or medical benefits to you or your beneficiaries if you are injured or suffer a work-related illness. If this happens to you, you have the right to receive medical and income benefits if you meet certain requirements.
Your Rights and Responsibilities Under Texas Workers’ Compensation Law
You have the right to:
- Hire a workers’ compensation lawyer at any time
- Receive reasonable and necessary medical care
- Keep your claim private and choose the doctor who will treat you
- Know from your employer whether your claim is in a health care network, so that you can use a doctor in that network. If you are treated by a physician who is outside the network without getting approval from your employer, you might need to pay for your treatment.
- Legal review of any disputes on your claim
You also have responsibilities. You must:
- Inform your employer within 30 days about your work-related injury or illness
- Report your injury or illness to the Division of Workers’ Compensation Insurance (the “Division”) within one year
- Inform your doctor how you were hurt and if it was work-related
- Inform the Division and the insurance carrier about any changes in your pay, in the work you do or to your address and telephone number
There are many benefits from the workers’ compensation system. You may obtain income and medical benefits if your injury or illness is work-related and your employer has workers’ compensation insurance.
Income benefits replace some of your lost income based on your average weekly wage, the average amount of money that your employer states you received each week in the 13 weeks before your injury or illness. The insurance company, not your employer, pays the income benefits.
1. Temporary Income Benefits
You may receive temporary income benefits if you lost money from your job for more than seven days due to your injury or illness. These days need not be in the same week. If you work part-time, your benefits would be to help cover the days and hours you miss. Temporary income benefits are paid each week and are 70% or 75% of your pre-injury income, depending on your hourly rate.
After your injury or illness, your doctor may release you to return to work if your employer can make changes to your job. Your employer may provide different or temporary work. You’re still eligible for temporary income benefits if your employer gives you different work but you earn less money than before your injury.
Temporary income benefits end on the date you return to work and the money you earn is the same as your pay before your injury or when you reach maximum medical improvement (MMI). There is clinical MMI and statutory MMI. Clinical MMI is the date a physician decides no further healing or recovery is expected. Statutory MMI is 104 weeks from the date you started receiving temporary income benefits. Your income benefits end on whichever date comes first.
2. Impairment Income Benefits
They are paid if you suffer permanent harm because of your work-related illness or injury. They will be 70% of your weekly income before your injury, whether or not you’re able to work. They may continue after returning to your job. They are based on how much permanent damage was done to your body.
If a doctor finds no further healing from your injury is expected, he or she may give you an impairment rating. This is a percentage of permanent physical harm you suffered because of your injury. For each percentage point of your impairment rating, you get 3 weeks of impairment income benefits.
3. Supplemental Income Benefits
These benefits start after impairment income benefits end. They are paid if you have suffered serious harm to your body and you haven’t been able to return to work after your impairment income benefits ended. You would need to meet job search requirements each week or agree to be in a program that helps those with disabilities find or keep a job, known as a vocational rehabilitative program.
4. Lifetime Income Benefits
Lifetime income benefits are paid if you sustained certain serious injuries, including complete blindness, serious brain injuries, or the loss of two or more limbs. The benefits are 75% of what you made each week before your injury, with a 3% cost of living increase each year. There is no time limit to these benefits.
5. Medical Benefits
Medical benefits pay for the cost of treating your work-related injury, including medications, testing, physical therapy, and surgeries. Medical treatment must be reasonable and necessary for it to be paid.
What Happens if Your Employer is a Non-Subscriber
If your employer hasn’t purchased an insurance policy to cover work-related injuries or illnesses, and your injury was caused by your employer’s negligence, they could be sued to compensate you for the harm you suffered. Your employer may be self-insured for workers’ comp, with its own insurance plan that provides benefits and covers injuries to employees while on the job. Or, your employer may have other policies that are designed to help with these types of claims. Also, you may be able to recover from other assets of your employer, depending on the legal entity/entities owning the business.
Documents and Evidence that Can Help Your Claim
Being proactive and taking steps to document your injury and why it happened could save a lot of time in the process, and solid evidence may prevent your claim from being denied.
- Accident reports: If you or your employer made one, keep a copy. It can establish what happened, when, why, how, and who witnessed the accident.
- Medical records: Get copies of all the records of your treatment. They can provide a timeline of your treatment, progress, symptoms, and their severity, as well as the results of tests, scans, and X-rays.
- Employment records: Copies of your employment records can show you worked for your employer at the time of the injury and were hurt in the course of your employment.
- Witness testimony: Get the names of accident witnesses and ask them to write down what they saw, what led to the accident, and what happened afterward.
- Photos: If you can, take pictures of the accident scene immediately afterward. If you cannot, ask a co-worker to do so for you. Photos of your injuries could also be helpful.
- Personal diary/journal: Create a journal of your medical care, pain levels, your costs, and your recovery.
How a Houston Workers’ Compensation Lawyer Can Help
Sandoval Waldman provides representation to people injured or made ill because of their job. Workers’ compensation law and procedures can be complex. Going it alone could allow an employer or insurance company to walk away from their responsibilities to you.
After putting your employer on notice of your work-related injury or illness, if your workers’ compensation claim is denied, or your employer has no coverage at all, a work injury lawyer can contact your employer’s insurance adjuster to see if there is missing, incorrect, or inaccurate information or documentation causing the problem. If so, we can provide what’s needed so your claim will be accepted.
If your claim is denied and you can’t work out a resolution with the insurance company, you can appeal the decision with the Division. Workers’ comp lawyers can represent you at a dispute resolution conference called a Benefit Review Conference. If the issues are still not resolved, your claim may go to arbitration or to a contested case hearing. This is a formal, legal process where a Division hearing officer presides and writes a decision on the matter.
If that decision goes against you and there are legal grounds to challenge it, you can appeal it to the Division’s Appeals Panel. It will review legal briefs and the evidence from the contested case hearing and issue a decision. No new evidence can be presented. Their decision may affirm, change, or reverse the hearing officer’s decision. If there are grounds to appeal this decision, one can be filed in the state court system.
Even if your claim is accepted, while receiving benefits there could be dozens of ways an insurance company can try to short-change you with your income and medical benefits. We try to help our clients get all the benefits they deserve and are entitled to under the law. We understand how the Texas’ workers compensation laws and system work. Sandoval Waldman won’t tolerate an employer or insurance company trying to avoid its responsibilities and cheat one of our clients.
Depending on the circumstances and cause of your work injury or illness, other parties may be legally responsible. There could be a “third party” lawsuit against a non-employer whose negligence or defective product contributed to the harm you suffered. This can happen in many work-injury situations, including a motor vehicle accident while on the job or an injury caused by a defective tool or piece of equipment. These legal claims may result in compensation not available under workers’ compensation, including pain, suffering, mental anguish, and even punitive damages.
Take the Next Step: Talk to a Workers’ Compensation Lawyer
We are dedicated to representing injured workers and their families. There are specific time requirements that must be met when filing workers’ compensation claims. Consult with an experienced work-injury attorney as soon as possible after a work-related injury. Call us today at 713-688-4878 (HURT) for your free workplace injury consultation. Remember, your initial consultation is free and you don’t pay us a fee unless you win.