Workers’ Compensation Overview San Antonio

A personal injury lawyer, in this case, a workers comp lawyer, specializes in assisting workers who need help receiving workers compensation insurance from work related incidents occurred while working 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. The biggest and the best law firms in Houston can have one or two personal injury attorneys, that concentrate not only on workers compensation insurance claims, but also personal injuries. A workers comp lawyer can also be a car accident lawyer and represent victims of sustained injuries in automobile accidents.

Going back to work related 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 the most difficult claims, a workers compensation board may be called in to help settle the claim. Workers’ comp is a typical form of insurance that almost all employers in Texas are required to provide. Employment lawyers are well educated in workers comp insurance and the “ins and outs” that can help employees get fair workers compensation settlements.

The Rights of Injured Workers To Have Workmans Comp Insurance

In Texas, someone who has been in a work related accident and has sustained an injury, has certain rights according to the Texas workers’ compensation system.

These rights are listed as:
1. The right to have a workers compensation attorney assist the injured employee at any point during the workers’ comp claims process;
2. The right to get aid from the Office of Injured Employee Counsel if the injured worker has not already had a workers comp lawyer;
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 resolution regard claim in concern to death or income benefits.
7. The ability to decide on what doctor you want 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

Under laws in regard to workers compensation in Texas, workers that have been injured have certain responsibilities. Texas state laws say that an employee must fulfill the following responsibilities before they are eligible for workers’ compensation benefits:

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 discovering if the worker 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 talking to the medical physician about the injury or sickness and whether it is related to work;
5. The responsibility of carrying out 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 recent contact information to the Texas Division of Workers’ Compensation;
7. The responsibility of notifying the workers’ comp insurance provider and the Texas Division of Workers’ Compensation, in the case that the workers’ employment status changes;
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 not creating 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. Restrictions are in place while obtaining medical assistance, such as having to acquire medical care within a workers’ comp insurance provider’s service framework, as well as, choosing a medical physician from a list of network care providers that are prescribed (in the situation where you do need emergency treatment due to a life threatening work-related injury or ailment, you may find care in an emergency care facility).
  • Income Benefits – In Texas, workers with a work-related injury are eligible for four different kinds of “income” benefits.
    • Temporary Income Benefits (TIBs) – Temporary income benefits are compensated in the case that a worker has missed seven days or more of work due to a work related injury or ailment. An injured worker can be eligible for temporary income benefits as soon as they have missed eight days of work. The TIBs amount paid is equal to 70 percent of the difference between the average worker’s weekly wage and any wages the injured employee is still able to earn after their work related injury. 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. In the case that the employee has received a reduced pay while in a modified position, 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 known as 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. After an injured employee has hit their maximum medical improvement, or the greatest level of recovery that is able to be made, then a health care provider will check the injured employee to see what the impairment rating may be. The employee’s impairment rating is used to determine their eligibility for IIBs. Three weeks of IIB compensations are paid dependent of the percentage of the impairment rating. IIBs are paid under the following two options: Having 70 percentage of the worker’s weekly wage or the state average weekly wage (while the state wage acts at 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.
      SIBs will pay out benefits up to 80 percent of the difference between the worker’s pre-injury average weekly pay and the worker’s post-injury weekly pay. 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 then end after 401 weeks (about 7 and a half years) after the worker sustained the injury.
    • Lifetime Income Benefits (LIBs) – Sometimes injuries could enable to injured worker to gain lifetime income benefits. For example:
      • If you lose both of your feet, or lose both hands, with any combination of the two;
      • Paralysis of both legs, or both arms, or one of each;
      • If there is a traumatic brain injury producing insanity or making the worker mentally disabled; or
      • In the case of third degree burns that either cover 40 percent of the body and require grafting, or covering both hands and the face.

      Each of these injuries could enable a worker to be eligible for LIBs. Paid at 75% of an injured worker’s weekly salary, LIBs are subject to a 3% raise, or increase, after each year. LIBs must be applied by a written request with the workers’ compensation insurance carrier.

  • Death Benefits – In the event that an employee has died as a result of a work-related injury or sickness, the worker’s family (for example, a spouse, minor children, dependent, grandchildren, and other dependents) could be qualified for death benefits through workers’ comp.
    Paid at 75% of the departed employee’s average weekly wage, death benefits are subject to a maximum and minimum death benefit. The surviving spouse of the deceased is eligible to receive death benefit payments for the remaining span of their lifetime, under the assumption that they are not remarried in the future. Any children of the deceased may be eligible to receive death benefits until they reach age 18, or if they are enrolled in an accredited educational college full time, until they are 25. Once the older child is ineligible to receive benefits due to their age, the death benefits are redistributed to the younger children. Any grandchild that is dependent upon the deceased, at least 20%, may receive benefits until they are 18, unless the grandchild’s own parents are also eligible for such benefits. Grandchildren who have exceeded the 18 year old age limit may still gain benefits, but only 364 weeks’ worth of such benefits. Parents that are non-dependent may collect death benefits in the case that are no surviving spouse, children or grandchildren; however, these benefits are limited to only 104 weeks.
  • 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?

Throughout Texas, for the worker to get workmans compensation benefits, the wounded employee must choose a designated doctor so that the injured employee can receive a medical examination to determine the eligibility of the worker in regards to workers’ compensation. The medical specialist must 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 employees can ask for this info from their employers.

Once the harmed laborer is in contact with a treating specialist, they will have the capacity to guide the harmed laborer to other in-network doctors or specialists as required. In certain cases an employer may not have a care provider obligation, so the injured worker has to find 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 not, the employee can discuss with their regular health care provider for a recommendation.

When all else tends to fail, a workers’ compensation chosen doctor can be found on the internet or the telephone directory. In emergency case situations, an injured laborer may look for emergency care from any doctor or hospital. Once there are is an alleviation of any initial trauma or life-threatening risks, the injured worker must discover and go to a designated workers’ compensation treating medical doctor for all further treatment of the work-related injury or illness.

An injury attorney shouldn’t be sought after until you have had your emergency medical and urgent follow up. Here are the two reasons why you should wait to seek advice from a San Antonio personal injury attorney or workers compensation attorney. The first is simply because you don’t want to lose precious time in regards to getting medical treatment. The second reason isn’t 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. You will be able to use this info to make a better and stronger case for yourself.

Regarding a Work Compensation Case What Is The Responsibility Of A Designated Doctor?

In addition to a workers’ compensation lawyer defending your case, a designated doctor will ensure that you have been properly examined and provide a recommendation about the work-related accident. In some cases, a designated doctor may have to help with the resolution of a dispute in regards to a work-related injury. Also, the doctor could be called on 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 Ideal situation for an injured laborer is to receive workers’ compensation benefits for the work-related injury or sickness until the laborer is fully ready and well-enough to return back to their job. This ensures that that worker is productive and engaged in their work, and also reduces any costs associated with the worker’s injury and time out of the workplace. 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 San Antonio often have to impede on the argument between the two parties to get the employer off the employee’s back. After the worker has finished recovering from a work-related accident, the employee is then able to go back to work.

The employee that is injured does not have to necessarily be recovered to return back to the workplace. Injured employees who are almost recovered, but are eager to go back to work, should consult this possibility of going back to work early with both their employer and designated doctor. 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. This means that the worker should make sure to read the “fine print.”

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. With a program such as this, the thought process is that having some work is better than no work at all, while allowing the laborer to be productive, stable, and reach normalcy once again. 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.

Can I Be Fired for Filing Workers’ Compensation in San Antonio

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