A workers comp attorney, also known as, a personal injury lawyer, concentrates on helping workers collect workers comp insurance from a work related accident that sustained injuries on the job.
To start the process, the workers comp attorney will look at the workers comp policy and then if there is a conflict between employees and employers, the attorney will discuss with the workers compensation insurance companies in order to agree on a fair and reasonable workers comp settlements.
A workers comp attorney can also be called an employment lawyer, injury attorney, or accident lawyer.
In Houston, some of the best and biggest law firms can only have a one or two personal injury lawyers that specialize in workers compensation insurance claims and personal injuries.
Not to overstate the point, but a workers compensation lawyer can sometimes act as a car accident lawyer, who can represent victims of injuries sustained in car accidents.
Back to workers’ injuries.
A workers compensation lawyer can determine if an injured worker has a chance to benefit from a workers’ compensation insurance in the event that they have to look for medical treatment for their sustained injures and recovery period. In very complicated cases a workers’ compensation board may be called to help settle a claim.
Workers’ comp is a typical form of insurance that almost all employers in Texas are required to provide. Workers’ employment lawyers are well trained in workers comp insurance and can help employees get reasonable and fair workers comp settlements.
The Rights of Injured Workers To Have Workmans Comp Insurance
When it comes to the Texas workers’ compensation system, a worker that has sustained an injury at work has certain rights.
These rights are:
1. The right that at any time during the workers’ comp claims process, the injured worker can be assisted by a workers’ comp attorney;
2. The right to acquire assistance from the Office of Injured Employee Counsel if the injured employee doesn’t have a workers compensation attorney;
3. If one is eligible and notwithstanding of fault, the injured worker may have the ability to gain financial and medical benefits through workers’ compensation (limited exceptions), and any surviving family members, have to option and right to burial benefits if the eligible injured employee were to pass way due to the work related injury.
4. The right to medical care to help treat the workplace injury or illness while the treatment is required;
5. The right to gain benefits for any work-related injuries of illnesses;
6. The right to disagree with a resolution regard claim concerning income benefits or death benefits;
7. The right to choose a treating medical physician within the Workers’ Compensation Health Care Network; and
8. The right to have all workers’ comp claim info kept confidential.
The Responsibilities of Injured Workers
In Texas, due to workers comp laws, injured workers have certain responsibilities.
The workers compensation law in Texas says that a worker who wanted to be eligible for workers’ comp benefits, they must fulfill the following responsibilities:
1. The responsibility of reporting your work-related sickness or accident injury to your boss within 30 days of the sickness or injury;
2. The responsibility of determining whether or not the employee is a part of the Workers’ Compensation Health Care Network;
3. The responsibility of determining how to get medical care if the employee belongs to a political subdivision, which can be work for a school district, a city, or a county;
4. The responsibility of discussing with a trained physician about the injury or illness and it’s relatedness to work;
5. The responsibility of completing and presenting an Employee’s Claim for Compensation for a Work-Related Injury or Occupational Claim Form to the Texas Division of Workers’ Compensation;
6. The responsibility of providing up-to-date contact information to the Texas Division of Workers’ Compensation;
7. The responsibility of informing the workers’ compensation insurance provider and the Texas Division of Workers’ Comp if the Injured employee’s status has changed;
8. If the injured worker dies due to the work-related accident or illness, the surviving members of their family now have the responsibility to complete and submit a Beneficiary Claim for Death Benefits to the Texas Division of Workers’ Compensation within the one year from the death of the worker; and
9.The responsibility of being honest and not sending in a fraudulent or frivolous claim.
Types of Workmans Comp Insurance Benefits
In Texas, workers’ compensation is available in four different kinds of benefits:
- Medical Benefits. Medical benefits allow injured workers to be able to pay for their medical care needed to treat the work-related injury or sickness. Some restrictions are designed when obtaining medical benefits, which include gaining medical treatment under the workers’ compensation insurance provider’s service facility or you may have to choose a doctor from a list of prescribed network care providers (if however, the worker needs immediate treatment with a life threatening injury or illness, the worker can go to an emergency care hospital.)
- Income Benefits. In Texas, workers with a work-related injury are eligible for four different kinds of “income” benefits.
- Temporary Income Benefits (TIBs). In the case that a worker has missed seven or more days of work, Temporary income benefits will be compensated because of the work related injury or sickness. After eight days of missing work, temporary income benefits will be a possibility for the injured employee. The total amount paid for TIBs is 70 percent of the entire difference between the worker’s typical weekly wage, as well as, any wages that the injured worker could be able to earn after their work related accident. There is still a possibility for the injured worker to be compensated if the employee returns to work, but this is in a modified position that would accommodate their injury. If the worker is in a modified position and receives a reduced wage, TIBs can continue. As a general rule, TIBs will conclude after 104 weeks of payment, or as soon as the employee has reached their maximum medical improvement, which is determined by the worker’s health care provider. TIBs are also considered wage replacement benefits.
- Impairment Income Benefits (IIBs). When an injured worker has concurred a permanent impairment due to their work-related injury in Texas, the injured worker may receive impairment income benefits. Once the injured employee has reached their maximum amount of medical improvement, or that the best level of recovery that is possible, a health care provider can ascribe the injured employee an impairment rating. IIBs are eligible on the basis of the worker’s impairment rating. Three weeks of IIB reimbursements are paid per percentage of the worker’s impairment rating. IIBs are compensating at 70 percent of the worker’s average weekly wage, or 70 percent of the state average weekly wage (the last being the cap on IIBs)
- Supplemental Income Benefits (SIBs). In any case where a worker has an impairment with a rating of 15 percent or more, did not return to work because of their impairment, returned but can only make less than 80 percent of their pre-work injury average pay, is looking for a new job, and didn’t receive the IIBs in a lump sum benefit, the injured employee may be eligible for supplemental income benefits. An SIB will compensate 80% of the total difference between the employee’s pre-injury average weekly wage and the employee’s post-injury average weekly wage. Once the IIBs have been closed, it the worker’s responsibility to apply for the SIBs each quarter, at which they will be paid monthly. SIBs will be closed 401 weeks (estimated 7.5 years) after the employee suffered the injury.
- Lifetime Income Benefits (LIBs). Certain injuries could allow an injured worker to lifetime income benefits. For instance:
- If you lose both of your feet, or lose both hands, with any combination of the two;
- A combination of paralysis between two limbs;
- If there is a traumatic brain injury producing insanity or making the worker mentally disabled; or
- There is a third degree burn that covers 40% of the body, requiring grafting, or covering both hands or a hand and the face
For LIBs, one of the above injuries could make an injured worker eligible. LIBs are typically reimbursed at 75 percent of an injured employee’s weekly salary, where in time, the average weekly salary is subject to a 3 percent raise, or increase, each year. LIBs must be applied by a written request with the workers’ compensation insurance carrier.
- Death Benefits. If a worker has died due to a work-related injury, the employee’s family (any surviving spouse, minor children, dependent grandchildren, and/or other dependents) could be eligible for death benefits through the workers’ compensation framework. Death benefits will be paid at 75% of the deceased worker’s average weekly wage, subject to maximum and minimum death benefit limits. The spouse of the deceased is qualified to receive death benefit payments for the rest of their lifetime, unless they decide to remarry. They’re children can receive death payment benefits until they are 18 years old, though if they are enrolled full time in an accredited university, they may receive them until they are 25. These death benefits are then redistributed to any younger children once the oldest child has become ineligible because of their age. If grandchildren are at least 20% dependent of the person who passed away, they can receive benefits until they are 18, unless their parents are eligible for these benefits.
Grandchildren who have exceeded the 18 year old age limit may still gain benefits, but only 364 weeks’ worth of such benefits. In the event that there is no surviving spouse, grandchildren or children, a non-dependent parent may be eligible to get death benefits, though only 104 weeks of benefits.
- Burial Benefits. Whoever pays for the burial of the worker may also obtain burial expenses for the departed worker. Funeral benefits are recovered as reimbursements.
Can I Choose My Own Doctor?
In Texas, in order for the employee to obtain workers compensation benefits, a wounded worker must select a medical professional so that they may get a medical examination to decide on the eligibility of the worker and whether they can get workers’ compensation benefits.
The medical professional has to be designated by the Texas Department of Insurance Division of Workers’ Compensation.
In most cases, managers have data for harmed specialists on the most proficient method to discover an assigned specialist inside the employer’s workers’ compensation insurance provider’s health care network.
Injured workers can request this information from their bosses.
After the injured employee has talked to a treating medical professional, they will be able to assist the injured employee in the right direction towards other in-network specialists or medical centers, as needed.
In some cases a manager might not hold a care provider requirement; therefore the injured worker has to locate a designated doctor. In such situations, the best place to look is the employee’s regular care provider.
As long as the workers’ regular health care provider works with workers’ compensation patients then the regular health care provider should suffice.
If this is not the case, the worker can talk to their normal health care provider for a recommendation.
If everything else fails, an employee’s comp designated doctor can be located in a telephone directory or somewhere on the internet.
In emergency case situations, an injured laborer may look for emergency care from any doctor or hospital.
After any initial trauma or life-threatening risks are lessened, the injured employee must find and go to a designated workers’ comp treating medical physician for any other treatment of the work-related injury or illness.
Only after the emergency medical and urgent follow up, should you locate the services of a work related injury lawyer be looked for.
You should wait before you talk to a Houston personal injury attorney or workers comp lawyer, because of these two reasons.
Obviously, the first reason is that you do not want to waste any time in getting medical treatment. The second may not be as obvious.
Waiting to see what the doctors will say or waiting to see the amount of bills you start to rack up before you contact a workers comp attorney you will have more info in the end, to give to the workers’ comp attorneys that you will interview.
This info is useful in making a stronger case for your benefit.
Regarding a Work Compensation Case What Is The Responsibility Of A Designated Doctor?
Adding to a workers’ comp attorney defending your workers’ compensation claim, a designated doctor is brought in to perform a medical exam and provide you with a recommendation about the work-related condition.
In some cases, a designated doctor may have to help with the resolution of a dispute in regards to a work-related injury.
There is also the case that the designated doctor might have to
- Merge and look through any medical records and/or info that is related to the work-related injury or ailment
- Conduct scans, tests, exams, etc., as needed to full address the injury
- Determine whether or not the injured employee has reached maximum medical improvement, and when this maximum medical improvement has been reached
- Additionally, once the maximum medical improvement is reached, assigning an impairment rating; and
- To produce and submit a medical evaluation report for the injured employee to insurance provider and the Texas Division of Workers’ Compensation within the seven days after the medical examination has been concurred and should include both a narrative report and any other documentation that is related to the injured employee’s impairment rating.
Going Back to Work After An Injury Workers Compensation Forms
The best scenario for the injured employee is to acquire workers’ compensation benefits for a work-related accident until the worker is fully able to and ready to return back to the workplace.
This keeps the worker both productive and engaged with their job, and cuts the costs that could be associated with the worker’s injury and time off of their job.
At times, an employer will place stress on the worker, to try to get them to come back to work early, this is of course not allowed, but there are times where attorneys in Harris often have to impede on the argument between the two parties to get the employer off the employee’s back.
Once the worker has recovered from a work-related injury or ailment, the worker is allowed to go back to work. The worker does not have to fully recovered in able to return to work. Employees who are injured and want to return to work early, should talk to their boss and designated medical physician about the possibility of going back early. Before going back to the workplace, the employee should understand any kind of instructions related to returning back to work and the proper workers comp forms. ”Fine print” is a must for the employee to read.
It’s also imperative to check with the workers compensation lawyer that took on the case and to make sure that the employee is not in danger of losing his workers compensation insurance due to agreeing to accept a temporary position offered by the manager for the injured worker. There typically is at least some degree of workers’ compensation available until the laborer has made a full recovery.
Some managers have Return to Work Programs available which are created to get injured employees back off their feet by providing returning employees with temporary assignments or modifying their preceding job tasks to accommodate for the employee’s state of recovery. In order to help the employee get back into the workforce and provide a sense of being productive, stable, and promoting normalcy, these programs give the idea that some work, is better than no work.
Workers’ comp pay can then be reduced or suspended on the account of whether the employee is working in a limited capability when returning to work.
A worker’s benefits can be lost only dependent of the eligibility in the first place, as well as, the wage difference between their original wage and the post-injury wage.