Unlike most other states, Texas law does not require employers to carry workers’ compensation insurance. However, most employers still opt to carry it to limit their potential liability for on-the-job accidents and injuries. If an employee suffers an injury while working for an employer who carries workers’ compensation insurance, the amount of compensation the employee may receive is subject to limitations from state law.
If the employer does not carry workers’ compensation insurance then the employee may have the option of filing a personal injury lawsuit against the employer. In order to do this, you must speak to a Houston workers compensation lawyer.
What Does Workers’ Compensation Cover in Texas?
Workers’ compensation benefits exist to allay the financial impact of a work-related injury. Generally, workers’ compensation benefits provide medical expense coverage and weekly benefits for the time an injured employee must spend out of work in recovery. The medical expense coverage will pay for all of the medical treatment an injured employee requires as long as he or she visits a physician approved by the insurance carrier.
When an employee files for workers’ compensation in Texas, the employer must provide the employee with the necessary firms and refer the employee to a list of physicians approved by the workers’ compensation insurance carrier. The employee must choose one of these physicians; however, he or she may seek medical care from any available physician in the event of an emergency. Once the emergency passes and the injured employee’s condition stabilizes, he or she must then seek treatment from one of the physicians on the insurer’s list.
Texas uses a formula to calculate weekly workers’ compensation benefits based on the injured employee’s earnings prior to the injury. Generally, an employee can receive benefits up to 70% of his or her average weekly wages before the injury. The temporary income benefits maximum for the fiscal year 2019 is $938, so impairment income benefits and supplemental income benefits max out at $656 per week with a minimum of $141 per week for temporary income benefits and no minimum requirement for supplemental income benefits.
Maximum Medical Improvement and Disability
The term “maximum medical improvement” refers to the upper limits of an injured employee’s recovery potential. For example, a compound fracture in the arm could lead to permanent nerve damage. The victim could recover use of his or her arm but experience diminished sensations or chronic pain following recovery. Once an injured employee reaches maximum medical improvement, the attending workers’ compensation physician will assign the employee an impairment percentage from 1% to 99%.
The impairment rating an injured employee receives after reaching maximum medical improvement will determine the amount of ongoing workers’ compensation benefits the employee will receive and how long those benefit payments will continue. Generally, a higher impairment rating will lead to longer-lasting benefits.
Are There Any Ongoing Benefits?
If the injured employee reaches maximum medical improvement but cannot return to his or her prior position or earn the same amount as he or she earned prior to the injury, the injured employee may qualify for supplemental income benefits to essentially make up the difference. As long as the employee qualifies for supplemental income benefits, he or she may receive those benefits for a maximum of 401 weeks. To calculate supplemental income benefits, start by determining 80% of the injured employee’s pre-injury weekly wages and subtract the weekly wages earned post-injury. The employee will receive 80% of the difference.
It is also possible for an injured employee to qualify for lifetime benefits after a severe work-related injury. However, strict requirements exist, and only certain severe injuries qualify, such as amputation of a limb, complete blindness, a traumatic brain injury that results in a mental impairment, or third-degree burns requiring skin grafts over at least 40% of the body or the hands and face. Lifetime benefits are 75% of the injured employee’s pre-injury wages and increase by 3% each year to account for inflation and cost of living adjustments.