Wage Payments

Texas

If an authorized treating physician takes you off-work due to your work-injury, you may qualify for weekly workers’ compensation income benefits. In most cases, weekly benefit payments are based on a percentage of your average weekly wage (AWW), which is generally your average weekly earnings for the 13 weeks prior to your accident. The amount of income benefits to which you may be entitled depends on the nature and extent of your injury.

Weekly workers’ compensation income benefits are subject to a seven-day waiting period. This means that you will not be paid indemnity benefits for the first seven days of your claim. However, if the authorized treating physician has taken you off-work for more than 14 days, then you will be paid for the seven-day waiting period, shortly thereafter.

Keep in mind that there is a maximum weekly wage amount mandated by the state, which may affect your AWW. If you have questions about calculation of your AWW and income benefits, please check with your adjustor.

Below are the most common types of income benefits and the methods used to calculate your entitlement to them. If your claim is classified in one of the categories below, your benefits will in most cases be paid as described. Because Texas workers’ comp law provides for many different scenarios, this is not an all-inclusive list. Depending on your situation, your workers’ comp claim may provide you with different benefits.

Temporary Income Benefits

If the authorized treating physician determines that you are unable to work due to your work injury, you may be eligible to receive temporary disability benefits, subject to the seven-day waiting period, as discussed above. These benefits are typically equal to 70 percent of the difference between your AWW and the wages you are able to earn after your work-related injury, subject to maximum and minimum income benefit amounts.

Temporary benefits continue until you return to work or the employer provides you with a bona fide offer of employment at pre-injury earnings; or you reach maximum medical improvement (MMI). MMI means that you are in the best physical state that you can reasonably be expected to reach, given your medical condition. In other words, a determination as to whether you have reached MMI is based on a lack of medical improvement in your condition.  If you have not already reached MMI after 104 weeks from the date that income benefits began to accrue, then you will automatically deemed to have reached MMI; however, this period may be extended if you have spinal surgery. At MMI, a determination may be made as to whether you are entitled to permanent income benefits.

Permanent Income Benefits

After you reach MMI, your authorized treating physician will determine whether you have sustained any permanent impairment as a result of your work injury. If you have any such permanent impairment, then the physician will assess the percentage of permanent impairment (impairment rating) to your body as a whole caused by the work injury (according to the American Medical Association, Guides to Evaluation of Permanent Impairment).

Your permanent income benefits will be calculated using this impairment rating. Three weeks of benefits are paid for each percentage point of your impairment rating. For example, if you receive a 10 percent permanent impairment rating due to your work-injury, you will receive 30 weeks of permanent income benefits. Permanent impairment benefits are generally paid at 70 percent of your AWW.

Lifetime Income Benefits

Certain specific catastrophic injuries, such as complete and permanent vision loss, may result in lifetime income benefits. These weekly benefits are typically paid at 75 percent of your AWW, with a three percent increase each year.

Death Benefits

If a worker dies as a result of a compensable, work-related accident, the worker’s children, spouse, parents, or other dependent family members may receive workers’ comp death benefits, depending on the facts of the case.

A widowed spouse with no dependent children is generally entitled to 75 percent of the deceased worker’s AWW, which is paid until remarriage or death. Upon remarriage, the spouse is entitled to an additional 104 weeks of death benefits.

If the worker had eligible children, the benefits are distrubuted with one half paid to the surviving spouse and the remaining half distributed among the eligible children, or if the child is deceased, to the child’s children (grandchildren of the worker). A child is eligible to receive death benefits until age 18; or until age 25 if the child is enrolled as a full-time student in an accredited educational institution. A child with a physical or mental disability who is a dependent on the date the worker died may receive benefits until the date the child dies or is no longer dependent due to the disability. Other dependent family members may also be entitled to benefits, as listed in Texas statute.

A one-time payment of up to $6,000 may be available for actual reasonable funeral expenses.

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