Understanding Workers’ Compensation Income and Medical Benefits

Workers’ compensation benefits

What are the different types of workers' compensation income benefits?

-Workers' compensation income benefits include Temporary Income Benefits (TIBs)

-Impairment Income Benefits (IIBs)
-Supplemental Income Benefits (SIBs)
-Lifetime Income Benefits (LIBs).

Each type serves a specific purpose, such as providing temporary financial support during recovery (TIBs) or offering lifelong assistance in severe injury cases (LIBs).

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How are medical benefits under workers' compensation determined?

Medical benefits cover the necessary and reasonable medical expenses for treating work-related injuries or illnesses. These benefits are tailored to the specific medical needs resulting from the work-related injury or illness.

What are burial and death benefits in workers' compensation?

Burial benefits assist with funeral expenses in cases where an employee's death is due to work-related causes. Death benefits support the families of deceased employees, providing financial aid following a work-related death.

How can I receive my income or death benefits?

Income or death benefits can be received through traditional checks, Electronic Funds Transfer (EFT), or an Access Card Program. The method chosen depends on personal preference and eligibility criteria, especially for EFT and the Access Card Program.

How is the Average Weekly Wage (AWW) calculated for workers’ compensation?

The Average Weekly Wage is calculated based on the average amount your employer paid you in the 13 weeks before your injury or illness. This calculation includes all earnings during this period and may also consider wages from multiple employers if applicable.

Can multiple jobs affect my workers’ compensation benefits?

Yes, if you had multiple jobs at the time of your injury, wages from all these jobs might be considered in calculating your benefits. This is particularly relevant for determining your Average Weekly Wage, which forms the basis for many benefit calculations.

How are school district employees’ AWW calculated differently?

For school district employees, the AWW is based on wages earned, not just wages paid. This distinction is important as some school employees may receive their salary over different periods (9 months or 12 months). The AWW calculation varies based on contract terms and the nature of the employment agreement.

Maximum Benefit Amount

The maximum weekly benefits an employee can receive. This amount cannot exceed the state average weekly wage (SAWW), rounded to the nearest dollar. The following are the maximum benefit amounts:

Temporary Income Benefits (TIBs) = 100% of SAWW
Impairment Income Benefits (IIBs) = 70% of SAWW
Supplemental Income Benefits (SIBs) = 70% of SAWW
Lifetime Income Benefits (LIBs) = 100% of SAWW for the first year
Death Benefits (DBs) = 100% of SAWW

The Texas Workforce Commission computes the maximum weekly income benefit for each year (October 1 to September 30) no later than October 1 of each year.

Maximum Medical Improvement (MMI)

An injured employee reaches MMI when either of the following occurs:

The work-related injury or illness has improved as much as expected.
104 weeks have passed since the employee became eligible for TIBs.

Minimum Benefit Amount:
The lowest amount of weekly benefits an employee can receive. The minimum benefit amount is 15% of the SAWW, rounded to the nearest dollar. The DWC sets the minimum weekly income benefit for each year (October 1 to September 30) no later than October 1 of each year.

Multiple Employment:
When an employee has more than one employer, wages from all employers may be considered in calculating benefits.

Non-Claim Employer:
An employer that the employee worked for at the time of the injury or illness but is not the claimed employer.

Non-Pecuniary Wages:
Wages that are not paid in money, such as health insurance premiums, allowances for a vehicle or housing, or clothing.

Pecuniary Wages:
Wages paid in money, including salary, commissions, and bonuses. This includes all forms of payment for a given period. Pecuniary wages may also include the market value of room and board, laundry, fuel, and any other benefit that can be estimated in monetary terms.

State Average Weekly Wage:
Equal to 88% of the average weekly wage, as determined by the Texas Workforce Commission under §207.002(c).

Understanding these terms and their implications is crucial when dealing with workers’ compensation benefits. If you have any further questions or need more information, don’t hesitate to seek guidance from a professional or refer to the Texas Labor Code for detailed explanations of each benefit type.

Definitions

Average Weekly Wage (AWW):
The average amount of money your employer paid you each week in the 13 weeks before your injury or illness. Income and death benefit payments are based on your AWW.

Claim Employer:
The employer that the employee was working for at the time of the illness or injury. It is also the employer through whom the employee filed the workers’ compensation claim.

Disability:
When a work-related injury or illness causes you to lose the ability to earn your weekly wages. “Disability” refers to your inability to earn an income, not to a physical handicap.

Impairment Rating:
An impairment rating indicates what percentage of your body is affected by the work-related injury or illness.

We are Americana Injury, our organization is focused on patient’s recovery and wellness by providing a network of providers that is focus on identifying the diagnosis, treatment plan, and resolution of symptoms. Not only do we understand your symptoms, we know what it takes to obtain a great settlement with your case. We understand that car accident and work compensation cases take diligence to manage from the time you first enter our office and to the end. We provided with diagnostic and medical support to communicate to your attorney and carrier for settlement processing. You come to the right place for your injury needs.

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