Thousands of people are killed every year on the job, and multitudes of others suffer serious injuries. On-the-job injuries account for huge losses of time and productivity, but if you’re hurt at work, these concerns are secondary to your own. These injuries can prevent you from working, result in lost wages and even land you in bankruptcy thanks to high medical bills. Fortunately, there are workers compensation protections, and this is how you can become eligible.
When you’re injured on the job and you file a workers compensation claim, the first set of income benefits that you should receive is called Temporary Income Benefits (“TIBs’). Once you miss more than 7 days of work due to your injury, then your entitlement to TIBs will begin. They can last up to 104 weeks.
Remember, these income benefits are meant to replace your lost wages from being unable to return to work because of your work-related injury. But often times, you may not begin actually receiving your TIBs because your employer’s insurance carrier doesn’t believe you were injured on the job. The only way to resolve this problem is to take your matter up with the Texas Department of Insurance-Division of Workers Compensation (“Division”). And until you have resolved your nonpayment of benefits with the Division, you won’t receive any of your lost wages.
Hiring legal counsel at this stage in the process is crucial. Without your regular income, bills start to pile up and it’s difficult to make ends meet. With the help of an attorney who is board certified in workers compensation law, you’ll receive the best legal guidance while moving through the workers compensation’s complex system of administrative rules.
Two things happened this week to raise the consciousness of the public towards the inadequacies of workers compensation. First was a major piece of reporting by Pro Publica and NPR that conducted an exhaustive examination of workers compensation benefits, state by state. You can find the articles here:
The reporters chief findings:
- Since 2003, legislators in 33 states have passed workers’ comp laws that reduce benefits or make it more difficult for those with certain injuries and diseases to qualify for them.
- Where a worker gets hurt matters. Because each state has developed its own system, an amputated arm can literally be worth two or three times as much on one side of a state line than the other.
- Many states, Texas among them, have not only shrunk the payments to injured workers, they’ve also cut them off after an arbitrary time limit — even if workers haven’t recovered.
- Employers and insurers increasingly control medical decisions, such as whether an injured worker needs surgery.
As a workers compensation attorney who has been practicing since before 2003, I can attest that changes made to Texas’ system that occurred after 2003 were the second such effort to reduce workers compensation benefits and make them more difficult to obtain.
Even though other states made changes to their workers’ compensation schemes in part due to the success Texas has had reducing benefits, most of those states still did not take the more extreme path of reducing benefits to injured workers to the levels that Texas has done. This graphic is illustrative:
Those of us representing injured workers have complained for a long time that there is a race to the bottom amongst the states in what is being paid to injured workers. That race is on the verge of breaking the system. The only question is will Republicans in safely gerrymandered districts have the courage to fix the system before it breaks?
The second thing to raise some consciousness was a report put out by OSHA which can be found here:
That report states another aspect of workers compensation law that has long been complained about by those of us who represent injured workers:
“The costs of workplace injuries are borne primarily by injured workers, their families, and taxpayer-supported components of the social safety net. Changes in statebased workers’ compensation insurance programs have made it increasingly difficult for injured workers to receive the full benefits (including adequate wagereplacement payments and coverage for medical expenses) to which they are entitled. Employers now provide only a small percentage (about 20%) of the overall financial cost of workplace injuries and illnesses through workers’ compensation. This cost-shift has forced injured workers, their families and taxpayers to subsidize the vast majority of the lost income and medical care costs generated by these conditions.”
That is, the public, not the workers’ compensation insurer and not the business that purchases the insurance, bears the primary burden for the costs of injured workers. This occurs through the cost-shifting of workers onto other forms of payment.
I cannot even begin to count the number of times I have heard adjusters state that a workers isn’t being disenfranchised because the worker can just apply for social security disability. Likewise, we frequently have problems on cases with doctors advising injured workers to just put their injury on medicaid so that the doctor can avoid all the pre-authorization hassles that comes with workers compensation.
One problem is the race to the bottom that impacts all injured workers. The public’s attitude is “As long as it doesn’t affect me, I don’t care. Out of sight, out of mind.” But this report confirms that it does affect the public. When the system finally breaks, remember that.
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Workers’ compensation is a state-regulated insurance program that pays medical expenses and lost wages of employees who are injured at work or suffer from work-related illnesses. Workers’ compensation cases are treated on a case-by-case basis, which means that employees are treated differently based on the nature and severity of their injuries.
In Texas, the agency responsible for regulating the state’s workers’ compensation system is the Texas Department of Insurance (TDI). Within the TDI exists a smaller division, which carries the sole responsibility of processing and monitoring workers’ compensation claims, called the Division of Workers’ Compensation (DWC).
A work-related accident can result in a lifelong injury. It can also leave you drowning in medical bills, lost income, and uncertainty about your future. Injured employees facing this situation are not alone—workers’ compensation attorneys will answer your questions and fight to obtain the benefits you deserve.
With all the discussion over Arizona’s tough stance on undocumented aliens, a renewed interest has been undertaken regarding Texas’ stance on these aliens in a workers’ compensation context.
The new maximum and minimum weekly benefit rates for 2010 have been published. The rates can be found here.
Texas is the only state that doesn’t make workers compensation insurance mandatory for at least some employers. This is a shame, because workers’ compensation insurance is beneficial to both employees and employers as Sally Spooner, a school teacher, and the Cody School District, her employer, recently found out.
The Cody School District is the local school district in Cody, Wyoming. Recently, the district decided to discontinue providing workers compensation insurance for their employees as the superintendent and school board felt that $175,000.00 in annual premiums was not a good way to save money for the district. They couldn’t have been more wrong. One of their teachers, Sally Spooner, slipped and fell and ended up having to have her right let amputated just below the knee after suffering serious injuries. Now, this incident will likely cost the district far in excess of what they would have paid in annual workers’ comp premiums.
This incident illustrates the give and take of the workers’ compensation system. For employers, workers’ compensation insurance protects them from the big money judgments for pain and suffering, loss of future earning capacity, loss of consortium, disfigurement, etc. Typically, workers’ compensation claimants recover their medical expenses, lost wages and some kind of future impairment benefit. They downside for the employer is that workers compensation is no-fault insurance. Thus, even if an employee is injured through no fault of the employer, the insurance compensates the claimant. For the claimant, obviously they receive benefits without having to prove fault–and typically those benefits start being paid very quickly versus the length of time it would take if you had to prove negligence in a court of law. However, the injured claimant gives up the right to sue their employer for their employer’s negligence in causing the injury. Thus, the injured party cannot recover the big money damages that we often hear about in the news. Thus system serves both parties equally. But more importantly, providing workers’ compensation insurance for employees is the right thing to do. Just look at the comments to the hyperlinked article about Ms. Spooner, above, to see what I mean.