In Texas, injury benefit programs include wage benefits (a percentage of your pre-accident average weekly wages) and medical benefits. You may also be eligible for a vocational rehabilitation program.
The State’s system greatly incentivizes safer workplace habits, improves injured worker return-to-work outcomes and delivers the lowest possible cost to businesses.
Temporary Income Benefits (TIBs)
The first benefit available is Temporary Income Benefits (TIBs). TIBs are paid weekly and are designed to replace 70 percent of an injured worker’s pre-injury average weekly wage. TIBs are subject to minimum and maximum rates set by state law.
A TDI/DWC representative will review your application for TIBs to determine if you are eligible for them. Your eligibility will be based on whether you have made reasonable job search efforts during your qualifying period, any possible jobs that have been offered to you, medical documentation from your doctor, and evidence that your inability to return to your pre-injury work is a direct result of your permanent impairment from your injury or illness.
You will continue to receive TIBs until you either return to your regular job at your pre-injury pay rate, reach the end of your Impairment Rating period or have reached 104 weeks from your initial benefit payment. Once your TIBs end, you may be eligible for Supplemental Income Benefits (SIBs) if you have a permanent loss of function resulting from your work injury or illness.
Occasionally, your doctor may allow you to return to work on modified duty, or a temporary or alternate job assignment, in which case your TIBs will stop. If you have a permanent loss of function — such as total blindness in both eyes, total paralysis in two limbs or a head injury causing incurable insanity or imbecility — you may be entitled to SIBs for life.
Impairment Income Benefits (IIBs)
If you have a permanent work injury, you may qualify for Impairment Income Benefits. IIBs are designed to replace around 70 percent of your average weekly wage, up to a state maximum. These benefits are based on your percentage of permanent impairment, and they last until you reach Maximum Medical Improvement or can return to work without restrictions.
Your doctor will assign you an Impairment Rating. The rating is a measure of the degree of permanent damage to your body from your work-related injury or illness. Once your IIBs are spent, you can apply for Supplemental Income Benefits (SIBs). SIBs offer a maximum of 401 weeks of benefits that replace 80 percent of your previous gross weekly wages.
If your employer is a non-subscriber to Texas workers’ compensation, the company will have its own system for providing medical and lost wage benefits to injured employees. These plans are subject to the Employee Retirement Income Security Act (ERISA), which ensures that these plans meet a minimum set of standards for worker protection.
Supplemental Income Benefits (SIBs)
Although the modern workplace is generally safer and more productive than ever before, a good portion of people still come home injured after work. As a result, Texas workers’ compensation benefits help ensure mortgages are paid and families can continue to be fed after a serious job-related injury or illness. The state workers’ compensation system also provides medical treatment and supplemental income replacement benefits to encourage employees to return to the workplace as soon as possible.
The first of these monetary benefits is temporary income benefits (TIBs), which are paid after the injured employee misses eight days of work. TIBs are equal to 80% of the average weekly wage earned before the injury and are subject to minimum and maximum limits.
Once a doctor determines that the worker has reached maximum medical improvement, they will evaluate their condition to assess whether the injury or illness has left them with a permanent loss of function or limitation (called an impairment rating). If so, the doctor will establish an amount for how long the injury will prevent them from returning to the workplace, called a disability percentage. This number is based on a formula that multiplies the severity of the impairment with a specific amount of time.
For those with severe and permanent injuries, such as amputations or paralysis, the system offers lifetime income benefits (LIBs). These are worth 75% of a worker’s pre-injury AWW and increase by 3% each year.
Lifetime Income Benefits (LIBs)
Lifetime income benefits (LIBs) apply to catastrophic injuries like blindness and loss of two or more limbs. They offer a lifetime benefit that is 75% of your pre-injury average weekly wage, subject to a maximum and minimum limit, and a 3% yearly increase in order to keep pace with inflation.
Once you have reached maximum medical improvement, a doctor will evaluate your injury to determine if it has left you with permanent damage. If this is the case, you will receive impairment income benefits for a period of time equal to three weeks for each percentage point of your rating. After these benefits run their course, supplemental income benefits (SIBs) kick in for those who have been rated at 15% or greater.
Medical travel expenses are also paid if you need to go out of town to receive treatment. Similarly, burial costs are covered when an employee dies from work-related causes.
In addition to these core benefits, many employers offer additional perks like pet insurance, discounted gym memberships and 401(k) matching. It is important for workers to understand their benefits and how they work so that they can make informed choices about their employment. It is also helpful to have a lawyer on your side to assist with navigating the process.
