My Workers’ Comp Benefits Stopped. What Can I Do?

It’s been several months since your workplace injury. You’ve been receiving workers’ comp payments. Suddenly, your benefits are cut off. What can you do?

Employers and their insurers may cut off benefits over a technicality. They may point to a provision in your employment agreement or a change in your treatment as the reason for cutting off your benefits, or they may give you no reason. If are seriously injured on the job,  you need a workers’ comp lawyer! Don’t wait for your benefits to be cut off! For a free consultation, call the Waldman Legal Group at 713-688-4878. The attorneys at the Waldman Legal Group will review your case and determine if we can help preserve or restore your benefits.

Is your employer a workers’ comp subscriber?

The type of compensation that you may recover for a work injury will depend on whether your employer carries state-regulated workers’ comp insurance. Texas employers are not required to carry workers’ comp insurance coverage. Employers that don’t participate in the workers’ comp system are commonly known as “non-subscribers.”

Beware: Some employers use the term “workers’ comp” in their claims process when they don’t have “official” state-regulated workers’ compensation insurance. Call the Waldman Legal Group at 713-688-4878. We can research your employer’s coverage and see if their “worker’s comp” is official or not!

If your employer is a non-subscriber, you can sue your employer for damages in court (some employers require you to pursue your claims in arbitration), and if you can prove your injury resulted from the negligence of your employer or a coworker, you can recover all your damages, including medical expenses, pain and suffering, and loss of earnings. If your employer is a subscriber to the workers’ comp system, you can recover worker’s compensation benefits, regardless of negligence, if your injury was sustained on the job.

How do you know if your employer is a “subscriber” or “non-subscriber”? Call our legal team at 713-688-4878 and we will investigate your employer’s workers’ comp status.

If my employer is a “subscriber,” what type of  benefits can I receive through workers’ comp?

If your employer is a subscriber to worker’s comp under Texas law, there are specific benefits to which you are entitled. These benefits come in the form of disability income and medical care.

Income benefits can that be thought of as ongoing money benefits offered to you as a result of being unable to work. However, there is no guarantee that these income benefits will continue indefinitely, with one exception. In Texas, there are generally four types of income benefits that you can receive based on your circumstances.

• Temporary Income Benefits. These “temporary” income benefits are awarded to workers that have been injured on the job and cannot work more than seven days. If your doctor has released you to return to work on a light-duty capacity, you may still be eligible to receive these temporary income benefits. In most cases, you will receive 70% of the difference between your average weekly wage and what you are able to earn after your work-related injury. The maximum benefit you’ll be able to receive per week is $1,007.00. Once you’re able to return to work on a full-capacity basis, your temporary income benefits will come to an end. There are other reasons why your temporary income benefits may come to an end too soon – these are explained later throughout this article.
• Impairment Income Benefits. If your injury has left you permanently impaired, you may be eligible for impairment income benefits. These benefits become available the minute you reach “maximum medical improvement.” What does that mean? Maximum medical improvement refers to the state you reach when there is no curative medical treatment to improve your injuries. At that point, your doctor will assign permanent work restrictions and a permanent impairment rating. The amount of impairment income benefits you receive will be based on that impairment rating. You will receive three weeks of impairment income benefits for each percentage point of impairment. The maximum benefit you can receive weekly is $705.00.
• Supplemental Income Benefits. Supplemental income benefits are somewhat similar to impairment income benefits, but they are only paid when you’ve been assessed with an impairment rating of 15% or more. While determining how to calculate the number of supplemental income benefits you’ll receive is tricky, the important takeaway is that your supplemental income benefits will begin to be paid once your impairment income benefits come to an end. You’ll only be able to receive supplemental income benefits for up to 401 weeks. The maximum benefit you can receive weekly is $705.00.
• Lifetime Income Benefits. You may be eligible for lifetime income benefits if your injuries are severe. What are some examples of severe injuries? Injuries that result in an arm and leg amputation, permanent vision loss and blindness, or a spinal injury resulting in paralysis may place you in a position to receive lifetime income benefits. These benefits will translate to 75% of your average weekly wage. Of all the income benefits, this is the only type of benefit that will be paid out for the remainder of your life. The maximum benefit you’ll be able to receive per week is $1,007.00.

You can learn more about these types of income benefits by visiting the Texas Department of Insurance’s website.

What other type of benefits can I receive through workers comp?

In addition to income benefits, you can receive medical care. These medical benefits may include your regular visits with a physician, physical therapy sessions, and any other treatment recommended by your medical provider. When you go to your medical provider, you will be asked to provide your workers’ comp claim information. The workers’ comp insurer will be billed directly.

Most of the time, you will be able to choose any medical provider that participates in the workers’ comp health care network. Other times your employer may require you to see a particular medical provider for treatment.

Why was the amount on my workers’ comp check suddenly reduced?

When you sustain a serious injury on the job, you will likely not be able to go back to work for some time. You will be required to make frequent visits with the doctor and keep up with your medical treatment.

If your doctor at any point determines that you may return to work on light-duty capacity, then your disability income benefits may be reduced.

My workers’ comp benefits were cut off too soon, why?

If during your last doctor visit, the doctor cleared you to go back to work on full working capacity, the workers’ comp insurer may stop paying your benefits all at once. At this point, the workers’ comp insurer may feel that you no longer need income benefits because now you’re able to work, just as you were doing before the incident.

Your income benefit payments may have also come to an end because 104 weeks may have passed from the eight days after you became disabled. The maximum amount of time that you can receive temporary income benefits is 105 weeks after your disability date. If you find that you’re still injured after 105 weeks, but are not eligible to receive impairment income benefits, supplemental income benefits, or lifetime income benefits, that will be the end of your disability income.

My employer fired me after filing my workers’ comp claim, can I dispute this?

If your employer fires you to avoid workers’ comp payments, that is a red flag. Your employer is not permitted to do this. If you think that this is what happened to you, contact us immediately at 713-688-4878. Don’t delay!

If your workers’ comp benefits were cut too soon, you don’t have to go through it alone. Contact the Waldman Legal Group!

If you’re in a situation where the workers’ comp insurer has stopped paying you benefits, immediately contact the attorneys at the Waldman Legal Group at 713-688-4878. You have nothing to lose by giving us a call! We look forward to helping you.