March 17, 2020
Workers’ Comp May Pay Part of Lost Wages
If you live in Texas and are hurt on the job, you may wonder: Does workers’ comp pay for lost wages? As an injured worker, you not only have to endure the pain of your injuries and focus your attention on recovery. You may also be worried about a sudden loss of income — money you need to pay your bills, feed your family, and cover your suddenly increased medical expenses, at a time you are unable to work. While in some situations, you may receive compensation for a percentage of your lost wages through workers’ comp, whether or not you actually can get it depends on several factors and your individual situation.
Workers’ compensation in Texas is a state-regulated insurance program that pays medical bills and replaces some lost wages for covered employees who are injured at work or contract work-related illnesses, and it provides benefits for dependents of workers who die as a result of job-related injuries. However, insurance companies are out for profit and want to pay out as little as possible, so they will try to find reasons to deny even legitimate claims. As a result, injured workers often run into problems trying to navigate the workers’ comp system, and they never receive the lost wage payments and other benefits they deserve.
For this reason, if you have suffered a work-related injury or illness, it’s important to contact an experienced workers’ comp lawyer to make sure you know your rights and don’t leave money owed to you on the table.
Does Workers’ Compensation Pay for Lost Wages in Texas?
How to Determine if You Are Eligible
If you work in the state of Texas and your employer carries workers’ compensation insurance, you may be eligible for benefits if you suffer an injury or illness due to your job. Workers’ comp is designed to compensate you for medical expenses and a portion of your lost wages if you meet certain criteria. You must have suffered injury or illness on the job and must report your injuries in a timely manner. However, not every employer participates in the program.
In order to be eligible for benefits, your employer must carry workers’ compensation insurance coverage under the Texas Workers’ Compensation Act. The Division of Workers’ Compensation (DWC) is the state agency that regulates the delivery of workers’ compensation benefits to injured employees and to eligible family members of employees killed on the job, but it does not pay benefits. Benefits are paid by workers’ compensation insurance companies (if employers participate), by employers certified by this agency to self-insure, or by self-insured governmental entities.
Does Workers’ Comp Cover Lost Wages in Texas?
Workers’ compensation will replace a portion of your lost wages if:
- Your employer has workers’ compensation insurance coverage under the Texas Workers’ Compensation Act; and
- Your injury or illness occurs at work or is related to your job; and
- Your work-related injury or illness causes you to lose all or some of your wages for more than seven (7) days from one or more jobs.
If you are an employee of a company that carries workers’ comp insurance, you may be eligible for lost wages payments if . . .
- Your injuries fall into one of the following categories to qualify for benefits:
- On-the-job injuries and injuries you receive while doing work-related tasks
- Repetitive stress injuries, such as carpal tunnel syndrome, from work-related activities
- Occupational illnesses from exposure at work to toxins and chemicals.
- You meet the various deadlines and requirements for reporting your injury to the necessary parties and filing a claim. The following are deadlines and requirements:
- You must inform your employer about your work-related injury and other requirements within 30 days of the accident.
- You must report your injury to the Texas Department of Insurance Division of Workers’ Compensation within a year. You must tell them, as well as the insurance company, about how the injury affected your pay and the work you’re able to do.
- You must tell your doctor how you were hurt and specify that it was work-related.
- In some cases, employers require that you use a doctor in a certain network or clear your doctor with them beforehand.
Workers’ Compensation and Lost Wages
Depending on the type of injury and illness and its effect on your income, workers’ comp may pay you compensation for a percentage of your lost wages. There are 5 main categories of benefits you may receive:
Temporary Income Benefits (TIBs)
Temporary income benefits may be paid if you lose wages for more than seven days due to your illness or injury. Benefits are typically 70% or 75% of your income and end on the date you are able to return to work for your pre-injury salary or after the end of your TIBs benefits period, which is 104 weeks. In some situations, your doctor may allow you to go back to work on modified duty, which might be a change to your regular job or a temporary or different work task. You may still get TIBs if you are on modified duty at lower wages.
Impairment Income Benefits (IIBs)
Impairment income benefits are paid if your work-related injury or illness causes you permanent harm and affects your body as a whole. The amount you may be able to get is based on an impairment rating (IR) given by a healthcare provider after an exam. This exam generally happens when you reach maximum medical improvement (MMI) and you are not expected to improve further. If you are eligible, you get three weeks of IIBs for each percentage of impairment and are paid 70% of your pre-injury income.
Supplemental Income Benefits (SIBs)
Supplemental income benefits begin after impairment income benefits end if you are still unable to work and have an impairment rating of 15% or more. SIB amounts are 80% of what you get when you subtract the difference between 80% of your average weekly wage (AWW) and any wages you got after your work-related injury. You may be required to meet job-search requirements or participate in a vocational rehabilitative program.
Lifetime Income Benefits (LIBs)
Lifetime income benefits are paid if you suffer a catastrophic injury that prevents you from working. Benefits are 75% of your previous salary, with annual cost of living increases, and there is no time limit.
You could get lifetime benefits if you have:
- total and permanent loss of sight in both eyes
- loss of both feet at or above the ankle
- loss of both hands at or above the wrist
- loss of one foot at or above the ankle, and loss of one hand, at or above the wrist
- an injury to the spine that causes permanent and complete paralysis of both arms, both legs, or one arm and one leg
- a physically traumatic injury to the brain resulting in incurable insanity or imbecility
- third-degree burns that cover at least 40% of the body and requires grafting
- third-degree burns covering the majority of either both hands or one hand and the face.
Medical benefits pay for reasonable and necessary medical care to treat your work-related injury or illness.
Death and Burial Benefits
Workers’ comp may also pay burial benefits for funeral expenses and death benefits to replace some of the money lost when an employee dies because of a work-related injury or illness.
What if My Employer Doesn’t Carry Workers’ Comp Insurance?
The state of Texas is unique in that it doesn’t require most private employers to carry workers’ comp insurance — only governments, educational systems, or private employers who contract with government entities or meet other specific criteria must carry it. Some employers may purchase their own private insurance policies to cover work-related injuries or illness, but others (non-subscribers) may not have coverage at all.
If you work for a non-subscriber and suffer a job-related injury or illness, you are not completely out of luck. You may be able to sue your employer in a personal injury lawsuit for lost wages, medical bills, and other damages. You may also file a personal injury lawsuit against a third party who caused your injury.
In a Texas personal injury lawsuit, your attorney would have to prove that the defendant in the case was at fault or negligent for causing your injuries. This means showing that the following four elements existed:
- The defendant owed you a duty of care.
- The defendant breached that duty by acting or failing to act.
- This breach was the primary cause of your injuries.
- You suffered damages from the injury.
In a successful Texas lawsuit, you may receive a compensation award that covers both your economic damages and non-economic damages.
Economic damages include those types of damages that have a specific dollar value, such as:
- Medical and rehabilitation expenses
- Lost income from being unable to work
- Lost future earning capacity.
Non-economic damages are not easily quantifiable monetarily, such as:
- Pain and suffering
- Emotional and mental anguish.
In addition, Texas allows for special damages, based on your particular situation, which can be specifically asked for in a lawsuit.
How Our Workers’ Comp Attorney Can Help Get Lost Wages
If you’ve been hurt on the job, it’s important to hire an experienced workers’ comp attorney to help you navigate the system and ensure that you receive the full amount your injuries or illness warrants. Workers’ comp laws are complex and confusing for laypeople, and employers and insurance companies don’t like parting with their money. A workers’ comp lawyer is knowledgeable about the law, knows the process for filing claims, and will protect your rights every step of the way.
Here are specific ways our workers’ compensation attorneys can help you:
- To support your claim, you must submit documentation, including medical records, accident reports, employment records, and more. Our attorney will know what is required and help ensure that you have what you need to maximize the likelihood of approval of your claim.
- We will carefully review all of your expenses and losses due to the incident and make sure that the insurance company doesn’t shortchange you.
- If for some reason your claim is denied, we will work with the insurance adjuster to understand the reason for the denial and get any additional required documentation to them.
- If we aren’t able to work out a reasonable resolution with the insurance company, we will help you take it to the next step: appeal the decision with the Texas Department of Insurance. This will involve representing your interests in a meeting called a “benefit review conference” and possibly taking it to arbitration or a contested case hearing. If that step is unsuccessful, we will help you make an appeal to the division’s appeals panel.
- If your employer does not carry workers’ comp insurance, our lawyer can help you bring a lawsuit to recover the money that you deserve for your losses.
If You’re Worried about Lost Wages, We Can Help
If you or a loved one was harmed due to a work-related injury or illness in Texas, the work injury lawyers at the Waldman Legal Group can examine your individual situation and find the best ways to increase your chances of getting workers’ comp to pay for lost wages and other benefits.
Our experienced and compassionate attorneys will be happy to discuss your case and answer any questions you have — from “Does workers’ comp pay for lost wages?” to “How much is my case worth?” to “How do we get started?” We have years of experience with the Texas workers’ compensation system and will work with you to ensure your claim is handled correctly from the start.
To schedule a free consultation and learn more about workers’ compensation and lost wages in Texas, call our office now at (713) 688-4878.