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How Do Workers’ Comp Benefits Work in Texas?

An Overview of Texas Workers' Compensation Benefits

When clients ask us about Texas workers' compensation, they're usually not looking for a full rundown on the ins and outs and subtle nuances, they just want answers to a few standard questions about the benefits available to them through this system.

Questions Answered on This Page:

  • How much is my workers' comp case worth?
  • How much does my employer have to pay me for my work injury?
  • Do I have to file suit to receive my workers' comp benefits?

In this article, we'll answer these questions, and we're certain you'll walk away with a thorough understanding of your rights as an injured worker, as well as how much you can expect.

Benefits: The Real Meaning of "Compensation" in Workers' Compensation

When most people think about compensation for an injury, what comes to mind are settlements and jury verdicts (i.e. a lump sum cash payment). But in a workers' comp case, that's actually not how workers are compensated. You see, Texas lawmakers did away with lawsuits and court room when they made the Workers' Comp system, and they replaced it with a type of disability program.

So, when a worker is injured, and their employer participates in a workers' compensation plan, the injured worker cannot sue for cash. Instead, they file an administrative claim for benefits much the same way that people who are laid off file for unemployment benefits or also like the way that retirees file for social security benefits.

You're entitled to four different kinds of benefits.

So you may be thinking, "If workers' compensation doesn't involve lawsuits and cash payments, then what exactly are these benefits you keep talking about?" Well, there are four types, and you can click on the links below for further information on each:

  1. Medical Benefits are exactly what you'd guess. If you're injured on the job, you can bet you'll have to obtain some medical care. It may even be ongoing, perhaps for the rest of your life. Under the TX workers' comp system, your employer has to pay for these medical bills, at least in theory. The reality is that they also get to choose your doctor and the "in-network" WC doctors are often very favorable to the employer. They get all of their pay from the workers' comp carriers, so they are reluctant to bite the hand that feeds. This often results in doctors saying you don't need treatments that you actually do need. Click here to read more about Medical Benefits.
  2. Income Benefits are monies intended to cover your lost wages. If you're injured on the job, and cannot return back within seven days, you are eligible for this class of benefits. However, it's not that simple. Income benefits are not just a dollar-for-dollar match for your lost wages. In fact, there are four kinds of income benefits, all of which are based on their own formula, all of which are paid under different circumstances, and all of which are subject to a cap or maximum payout. Suffice it to say, we have a separate article to explain these benefits. Read about Income benefits here.
  3. Death Benefits are like Income Benefits (they cover lost wages), only they're paid to a deceased workers' family (spouse, and children) following a fatal accident. Read up on Death Benefits here.
  4. Burial Benefits are provided to cover minimal burial expenses. The details of this can be found here: Burial Benefits.

Are There Workers' Compensation Settlements Under Texas Law?

The short answer is no. As we explained above, WC claims are not normal person injury claims, and they're not claims where the defendant (your employer) can get taken to task by a jury. Since there is no threat of a jury making them pay you a significant amount of compensation, there is no reason for the employer to want to settle with you. Further, the law doesn't require them to. In other words, there is no legal reason why an employer would want to settle with an injured worker in a WC claim.

However, there is something kind of like a settlement in a WC claim. If your injury results in long-term impairment, you can be paid a specific type of Income Benefit for that impairment (aptly named Impairment Income Benefits), and it can be paid in a lump sum, much like a settlement. But that's really the only similarity between such benefit pay and a settlement. The motivation, law, and concept underpinning a settlement is totally different than Impairment Income Benefit pay. They're only coincidentally similar.

Even though workers' compensation is supposed to provide benefits without any dispute, that doesn't mean it is always works out that way.

Sure, this benefits system seems pretty streamlined. However, you may find that your employer is all too happy to avoid paying you something that you are owed by law. Many of our clients had to fight tooth and nail with their employers to get the benefits they deserve. When they exhausted themselves with trying, they turned to us to go to bat for them. This just goes to show you that even with laws that specifically require an employer or workers' comp carrier to pay benefits, there is always a way that these benefits can be denied.

Naturally, your best bet is to speak an attorney immediately after your accident. When you call our office, you'll probably surprised at how frank we are about hiring us. Our philosophy is simple: If the employer is paying you what the law requires them to pay, then save your money and don't hire an attorney. You only need our help if you're not being paid what the law says you're entitled to.

Our Texas workers' compensation attorneys are here to help if you have more questions about compensation, benefits, or anything else.

Above, we explained that being injured on the job while working for an employer who opts in to a Texas workers' compensation policy entitles you to benefits (different from traditional compensation), what benefits you are owed by your employer after a work injury, and even why you might need a lawyer to assist with your workers' compensation case. Not sure if we answered your question?

Call us anytime at (855) 326-0000.

Other articles about worker's compensation that may be helpful to you:

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