Injured Workers' Benefits

Beneficios

The information on this page is presented on Benefits Fact Sheets available for downloading and printing by clicking on the links at the bottom of the page.

See also Maximum and Minimum Weekly Benefits

What are workers' compensation benefits?
[Sections 408.081-408.187]

There are four types of workers' compensation benefits:

• Income benefits replace a portion of any wages you lose because of a work-related injury or illness.
• Medical benefits pay for necessary medical care to treat your work-related injury or illness.
• Burial benefits pay for some of the deceased worker's funeral expenses to the person who paid the funeral expenses.
• Death benefits replace a portion of lost family income for eligible family members of workers killed on the job.

Payment of income or death benefits can be made to you or your beneficiary by:

(1) check, or
(2) electronic fund transfer (EFT)

To be eligible for electronic funds transfer, you must be expected to receive benefits for at least eight (8) weeks. To receive payment by electronic funds transfer you or your beneficiary must make the request in writing to the insurance carrier and provide:

• the name of the financial institution;
  
• the type of account (checking or savings);
  
• the routing/transit number; and
  
• the account number you want benefits electronically transferred to.

Definitions

The following terms are defined:

Average Weekly Wage (AWW) is the average amount of weekly wages you earned during the 13 weeks immediately before your work-related injury or illness occurred. Income and death benefit payments are based on your average weekly wage.

Claim Employer is an employer with whom the injured worker filed a claim for workers' compensation benefits and for whom the injured worker was working at the time of the on-the-job injury.

Disability occurs when a work-related injury or illness causes you to lose the ability to earn your weekly wages. Disability refers to your ability to earn an income, not to a physical handicap.

Impairment Rating is the percentage of permanent physical damage to your body that resulted from a work-related injury or illness.

Maximum Benefit Amount may not exceed 100 percent of the state average weekly wage, rounded to the nearest whole dollar. The Division will compute the maximum weekly income benefit for each state fiscal year no later than September 1st of each year.

Maximum Medical Improvement (MMI) is the earlier of:

• the point in time when your work-related injury or illness has improved as much as it is going to improve or
  
• 104 weeks from the date you became eligible to receive temporary income benefits.

Minimum Benefit Amount is 15 percent of the state average weekly wages, rounded to the nearest whole dollar. The Division will compute the minimum weekly income benefit for each state fiscal year no later than September 1st of each year.

Multiple Employment means a worker who has more than one employer.

Non-Claim Employer is an employer, other than the claim employer, by whom the worker was employed at the time of the on-the-job injury.

Non-pecuniary Wages are wages in a form other than money (i.e., health insurance premiums, vehicle, clothing, or rent/housing).

Pecuniary Wages are wages in the form of money (i.e., salary; commissions; and bonuses). 

Income Benefits [Sections 413.041-408.047, Rules 128.1-128.7]

Income benefits replace a portion of wages you lose because of a work-related injury or illness. There are four types of income benefits:

• temporary income benefits (TIBs);
  
• impairment income benefits (IIBs);
  
• supplemental income benefits (SIBs); and
  
• lifetime income benefits (LIBs).

Income benefits may not exceed the maximum weekly amount set by state law. Temporary income benefits, impairment income benefits, and lifetime income benefits are also subject to a minimum amount set by state law. Maximum and minimum benefit amounts are based on the state average weekly.

You must report any income (other than income benefits you may be receiving) to the Division and the Insurance Carrier so an adjustment can be made to your income benefit payments. You may be fined and/or charged with fraud if you receive temporary income benefits while also receiving wages from an employer without informing the Division and the insurance carrier.

Income benefits are no longer payable following the death of an injured worker receiving income benefits. The injured worker's beneficiaries may be eligible to apply and receive death benefits if the injured worker's death was due to the work-related injury or illness.

Average Weekly Wage Calculations [Sections 408.041 - 408.047]

Calculation of Average Weekly Wage (AWW) [Section 408.041, Rules 128.1 - 128.7]

Your income benefits are determined from the calculation of your average weekly wage (AWW). A full-time employee is one who regularly works at least 30 hours per week. To calculate your average weekly wage, (Note: Calculation is different for school district employees - see below), add your earnings for the 13 weeks prior to the injury including any overtime or other special pay and any non-pecuniary wages the employer does not continue after your injury and divide by 13. If you did not work for your employer for 13 weeks before the work-related injury or illness occurred, your average weekly wage may be calculated using the earnings of an employee with the same or a similar job.

AWW Calculation - Full-time employee:

13 weeks wage at $824.23 = $10,714.99

Health Insurance Premium
(discontinued $82.00 per week x 13) = $ 1,066.00

Average weekly wage = $11,780.99 / 13 = $906.23

Multiple Employment [Section 408.042]

If you have more than one job and your work-related injury occurred with an employer carrying workers' compensation insurance and the injury keeps you from working at your other job(s), you may report any wages that are reportable for federal income tax purposes for consideration of lost wages. The following are examples of how your AWW would be calculated for multiple employment:

AWW Calculation - Multiple Employment:

Figure Claim Employer AWW: $700
 As in the previous example

Figure Non-Claim Employer AWW: $300
 Regardless of the type of employment
 NEVER includes non-pecuniary wages

Add all the AWWs together to compute multiple employment AWW:

$700 (+) $300 (=) $1,000 Multiple Employment AWW

School District Employees [Section 408.0446, Rule 128.7]

If you work for a school district, the average weekly wage is calculated based on the wages earned, not on the basis of wages paid during that period. A school district employee can choose to be paid their wages either during the nine (9) months of the school year or receive equal payments over a twelve (12) month period. Therefore, the wages are only earned during the nine (9) months of school even though the wages continue to be paid over a twelve (12) month time frame. For example, if there are no actual wages earned for the three (3) months during the summer break and you do not work for another employer during that time, the AWW will be zero and no TIBs will be due. The carrier may adjust the AWW as necessary to reflect the actual wages the school district employee earned. If you have earnings from a second job including any employment during the summer break, these earnings will be used to calculate an AWW for TIBs.

The AWW for the calculation of impairment income, supplemental income, lifetime income, and death benefits is also different. Only pecuniary wages are used in this calculation. Non-pecuniary wages are never included. The total wages earned during the past twelve (12) months are divided by fifty (50) to establish the average weekly wage for these benefits. Evidence of earnings from employers other than the school district during the last 12 months may be included. The following are examples of how a school district employee's AWW is calculated:

# 1 - Sample School District - Written Contract Based on Months Worked

Amount of Contract: $45,000
Contract Based on: 9 months of work

Calculation of AWW for TIBs Based on this Contract
$45,000 / 9 = $5,000 monthly amount
$5,000 / 4.34821 = $1,149.90 AWW for TIBs
Apply the maximum compensation rate of $539
Note: 4.34821 is the average number of weeks per month

Calculation of AWW for Benefits other than TIBs Based on this Contract
$45,000 / 50 = $900
Apply the maximum compensation rate of $377

# 2 - Sample School District - Written Contract Paid Based on Number of Days Worked

Amount of Contract: $45,000
Contract Based on: 189 days

Calculation of AWW for TIBs Based on this Contract
$45,000 / 189 = $238.09 (daily amount)
$238.09 x 5 = $1,190.45 ( AWW for TIBs)
Apply the maximum compensation rate of $539

Calculation of AWW for Benefits other than TIBs Based on this Contract
$45,000 / 50 = $900
Apply the maximum compensation rate of $377 

Temporary Income Benefits (TIBs) [Sections 408.101 - 408.105, Rules 129.1 - 129.11]

You may be paid temporary income benefits (TIBs) if your work-related injury or illness causes you to lose all or some of your wages for more than seven (7) days. If you work more than one job, you may be paid TIBs if you lose all or some of your wages from other employers. (See multiple employment).

Amount of Temporary Income Benefits

Temporary income benefits equal 70 percent of the difference between your average weekly wage and the wages you are able to earn after your work-related injury. If you earned less than $8.50 per hour before you were injured, your temporary income benefits for the first 26 weeks of payments will equal 75 percent of the difference between your average weekly wage and the wages you are able to earn after your work-related injury.

The amount of temporary income benefits is subject to maximum and minimum benefit amounts. For example, if your average weekly wage was $500, and your injury or illness caused you to lose all of your income, your TIBs would be $350 a week:

Your average weekly wage $500
Minus your wages after the injury - 0
Lost wages $500

70 percent of $500 (.70 x 500) equals $350

After an injury, your doctor may release you to return to work at modified duty; i.e., changes made to your regular job, or a temporary or alternate work assignment. You may still be entitled to TIBs if your employer provides the modified duty at reduced wages.

For example, if your average weekly wage prior to the work-related injury was $500, and you returned to work doing a modified job after the work-related injury and you are now earning $200 per week to work only 4 hours a day, your temporary income benefits would still be $210 a week.

Your average weekly wage $500
Minus your wages after the injury - 200
Lost wages $300

70 percent of $300 (.70 x 300) equals $210

By returning to work, you are able to receive a total of $410 per week. This includes the wages you are able to earn ($200) plus the TIBs ($210) paid to you by the insurance company for lost wages.

When TIBs begin and end

You become eligible for TIBs after you miss eight (8) days from work. Remember, disability refers to your inability to earn an income, not to a physical handicap. You have disability if your work-related injury or illness causes you to lose all or some of your usual pay. Benefits are not paid for the first week of lost wages unless disability lasts for two (2) weeks (14 days) or more.

TIBs end at the earlier of:

• the date you reach maximum medical improvement (the point that your work-related injury or illness has improved as much as it is going to improve),
• the date you are again physically able to earn your average weekly wage which would be the same wages you were earning prior to being injured on-the-job, or
• at the end of 104 weeks. 

Impairment Income Benefits (IIBs) [Sections 408.121 - 408.129, Rules 130.1 - 130.11]

You may be entitled to Impairment Income Benefits (IIBs) if you have a permanent impairment from a work-related injury or illness. Generally, Maximum Medical Improvement (MMI) is reached when you are as well as you are going to be from the work-related injury or illness. This does not mean that you will not need to follow up care with your health care provider, be completely pain free, or that you are released to return to work. When the health care provider determines you have reached MMI, the health care provider will determine if there is any permanent physical damage. The health care provider will assign an impairment rating (IR) using the 4th Edition of the American Medical Associations (AMA) Guides to the Evaluation of Permanent Impairment. The impairment rating describes the degree of permanent damage to your body as a whole.

If the injured worker has not previously reached maximum medical improvement, the workers' compensation law establishes MMI at 104 weeks. A doctor that is certified by the Division to do IR examinations must make an assessment of permanent impairment on whether the work-related injury or illness has been resolved or not. If an IR has not been assigned before the 104-week date when your temporary income benefits (TIBs) end, you may not receive IIBs until a doctor assigns an IR. TIBs can no longer be paid after 104 weeks (or maximum medical improvement). Your impairment rating determines whether you are eligible for IIBs. Three (3) weeks of IIBs are paid for each percentage of impairment.

For example, if you receive a 10 percent IR, you will receive 30 weeks of IIBs because 3 weeks of IIBs are paid for each percentage of impairment (10 x 3 = 30 weeks of IIBs).

Amount of Impairment Income Benefits

Impairment Income Benefits equal 70 percent of your average weekly wage (AWW). There is a state maximum for impairment income benefits just as there is for TIBs. The maximum for IIBs is 70 percent of the state AWW.

For example, if the state average weekly wage were $539, the maximum IIB rate would be $377.

Average weekly wage $539
70 percent of $539 = $377

If your average weekly wage were $500, your IIB rate would be $350.

Average weekly wage $500
70 percent of $500 = $350

If your average weekly wage is higher than the state average weekly wage ($539), such as $634.36, you will not receive 70 percent of $634.36, you will receive $377 per week, the maximum IIB rate allowed by law.

Average weekly wage $634.36
70 percent of $634.36 = $444.05 ($377 maximum limit for IIBs)

When Impairment Benefits Begin and End

You become eligible for Impairment Income Benefits (IIBs) the day after you reach maximum medical improvement (MMI). IIBs end after you have received a total of three (3) weeks of payments for each percentage of your impairment rating.

For example, if you have an impairment rating of 6 percent, you would receive a total of 18 weeks of IIBs. 

Supplemental Income Benefits (SIBs) [Sections 408.141 - 408.151, Rules 130.100 - 130.108]

Supplement Income Benefits (SIBs) are income benefits that you apply for quarterly (4 times per year, or every 3 months) and are paid monthly to injured workers that meet specific eligibility requirements.

You may be entitled to SIBs if you meet the following entitlement requirements:

• you have an impairment rating of 15 percent or more;
• you have not returned to work because of your impairment, or you have returned to work but are earning less than 80 percent of the average weekly wage because of the impairment;
• you have made a good faith effort to find a job that matches your abilities to work; and
• you did not take your impairment income benefits in a lump sum payment.

Amount of Supplemental Income Benefits

Supplemental Income Benefits equal 80 percent of the difference between 80 percent of your average weekly wage (earned prior to your work-related injury) and your weekly wages (if you have any earnings or offered wages during this 13 week period) after the work-related injury.

For example, if your average weekly wage was $500 before you were injured, and your injury caused you to lose all of your income, your SIB rate would be $320 a week:

Your average weekly wage $500
80 percent of $500 (.80 x500) equals 400
Minus your wage now - 0
Equals $400

80 percent of $400 (.80 x 400) equals $320

Supplemental income benefits are paid monthly. To determine the amount of your monthly SIBs, multiply the weekly benefit amount by the average number of weeks in a month (4.34821). In this example, your monthly supplemental income benefit would be $1,391.43:

$320 x 4.34821 equals $1,391.43

If you earn any wages during the qualifying period, the wages are deducted when calculating your SIB rate.

Example:

Your average weekly wage $500
80 percent of $500 (.80 x 500) equals 400
Minus your wages earned 200
Equals 200

80 percent of $200 (.80 x 200) equals $160
$160.00 x 4.34821 equals $695.71 (monthly SIB rate)

When Supplemental Benefits Begin and End

If you are eligible, Supplemental Income Benefits will begin the day after your Impairment Income Benefits end. The Division will automatically notify you if your impairment rating is 15 percent or greater and inform you of what information is necessary to support your application for the 1st quarter of SIBs. The application for the 1st quarter of SIBs is sent to the Division. The information to support your entitlement to the first quarter of SIBs is based on your job search efforts (if able) and wages earned during the 13 weeks before the end of your IIBs period. This 13-week period is called the qualifying period.

The Division will make a determination of entitlement based on the information on your application. The Division will review your job search efforts during the qualifying period, any possible job offers, current medical documentation provided by your doctor supporting why you are unable to work (if applicable), and will look at whether your inability to earn your pre-injury wage is a direct result of your impairment.

The carrier will provide you with an application for future quarters of SIBs with the first payment of any quarter or with any notice of non-entitlement. You must send all other SIBs applications to the insurance carrier showing that you are eligible to receive SIBS. If the insurance carrier agrees you are eligible, you will receive benefits for the quarter. Each time you file an application with the carrier, you must show that:

• you looked for work each week of the qualifying period; or
  
• you have current medical documentation from your doctor that explains clearly why your work-related injury or illness prevented you from working or looking for work during that 13 week timeframe; and
  
• your cooperation with the Texas Department of Assistive & Rehabilitative Services, or a private provider of vocational rehabilitation.

Your entitlement to receive supplemental income benefits ends at 401 weeks (approximately 7 1/2 years) from the date of your injury. If you have an occupational illness, entitlement for supplement income benefits ends at 401 weeks from the date you first became eligible to receive income benefits. 

Lifetime Income Benefits (LIBs) [Sections 408.161 - 408.162, Rules 131.1 - 131.4]

Certain work-related injuries may result in a condition for which you are entitled to income benefits for your lifetime.

Lifetime Income Benefits are paid if you incur:

• total and permanent loss of sight in both eyes;
  
• loss of both feet at or above the ankle;
  
• loss of both hands at or above the wrist;
  
• loss of one foot at or above the ankle and the loss of one hand, at or above the wrist;
  
• an injury to the spine that results in permanent and complete paralysis of both arms,
  both legs, or one arm and one leg;
  
• a physically traumatic injury to the brain resulting in incurable insanity or imbecility; or
  
• third degree burns that cover at least 40 percent of the body and require grafting, or
  
• third degree burns covering the majority of either both hands or one hand and the face.

Amount of Lifetime Income Benefits

Lifetime income benefits equal 75 percent of your average weekly wage, with a 3 percent increase each year.

For example, if your average weekly wage is $500, your lifetime income benefits would be $375 a week:

75 percent of $500 (.75 x 500) equals $375

There is a maximum and minimum rate for LIBs. For example, if your average weekly wage is $1000.00, your lifetime income benefits would not be $750.00 a week because the maximum rate is $539.00. The maximum and minimum rate changes each year based on the state average weekly wage.

When Lifetime Income Benefits Begin

Lifetime income benefits are paid from the time it is determined that your injury has resulted in a condition that meets one of the qualifying conditions for lifetime income benefits.  If there is a dispute over eligibility for lifetime income benefits, the issue is addressed through the dispute resolution process.

When Lifetime Income Benefits End

You will receive Lifetime Income Benefits for the rest of your life. 

Medical Benefits [Section 409.005(j-k), 413.021, Rule 129.5, 129.6]

Medical benefits pay for necessary medical care to treat your work-related injury or illness. Your employer's workers' compensation insurance company pays medical benefits directly to the health care provider who provides your medical treatment.

Medical benefits are paid only for the treatment of your work-related injury or illness. The insurance carrier does not pay for the treatment of other injuries or illnesses, even if the treatment was provided at the same time you received treatment for your work-related injury. Your health care provider may not bill you for treatment related to a work-related injury or illness, but may bill you for treatment of other injuries or illnesses.

When medical benefits begin and end

You may receive necessary medical treatment immediately after the work-related injury or illness. You have the right to an initial choice of doctor. The doctor you choose must be on the Division's Approved Doctor List (ADL). You may access the ADL online: www.tdi.state.tx.us. Under the "Worker" portion of the homepage click on "Find a Doctor". Then click on "TXCOMP". Place the cursor on main menu, and then click on "Locate Doctor". You can then search for a doctor by name, city, county, or specialty. If you do not have access to the Internet, you may contact Customer Assistance at 1-800-252-7031 and request a list of Division approved doctors in your area, which can be mailed or faxed to you.

After you have chosen a doctor, any request to change doctors must be approved by the local Division office handling your claim. If you or your doctor move or the doctor becomes unavailable to provide medical treatment, you will be allowed to choose another doctor from the ADL. This will be considered an exception to the law and will not be viewed as a request to change doctors. You will need to complete the Employee's Request to Change Treating Doctors (F-53) and file it with the local Division office. We will notify all parties that your treatment is going to be managed by a different doctor. All medical treatment for a work-related injury or illness must be approved by your treating doctor except in an emergency. If your work-related injury or illness poses a risk to your life and your doctor is unavailable to treat you, you may seek the help of another doctor. Your treating doctor may refer you for medical treatment to another doctor, without permission or approval from the Division or the insurance carrier.

A doctor may not bill you for treatment of a work-related injury or illness. The doctor may send you a copy of the bill marked as "information only" upon your request.

Death and Burial Benefits [Sections 408.181 - 408.187, Rules 132.1 - 132.17]

Death benefits can replace a portion of lost family income for the eligible family members of workers killed on the job. Burial benefits pay for some of the deceased worker's funeral expenses.

When Death Benefits Begin and End

A beneficiary becomes eligible for death benefits the day after the worker's death. Death benefit end at different times depending on the beneficiary's qualifications to be entitled.

Death benefits are paid if there is a:

• surviving spouse;
  
• dependent child;
  
• dependent grandchild; or
  
• other eligible dependent family member

of an employee killed on the job. Except for the spouse and minor children, other family members must have been at least 20 percent dependent on the deceased worker's income to receive death benefits.

Eligible Beneficiaries:

A spouse is eligible to receive death benefits for life unless he/she remarries. Upon remarriage, the insurance carrier will pay a two (2) year (104 weeks) lump sum payment. If there are minor children, the benefit is divided between the spouse and the minor children. One half is paid to the spouse and the other half is divided equally among the children. If the spouse remarries and the insurance carrier pays the lump sum, at the end of the 104 weeks, if there are still minor children that are eligible for benefits, the entire benefit will be divided equally between the minor children.

Eligible children can receive death benefits until age eighteen (18) or twenty-five (25) if enrolled as a full time student in an accredited college. If there is more than one minor child, as a child loses eligibility the benefits are re-distributed among the other eligible children.

A dependent child, such as a stepchild or dependent child, over the age of 18, is only entitled to benefits for 364 weeks unless the child has a physical or mental disability. In this instance, benefits are paid until the child no longer has a disability.

If the grandchild is a minor at the time of death, benefits are paid until the child is no longer a minor. If the grandchild is not a minor but a dependent of the deceased at the time of death, the benefits are limited to 364 weeks.

Dependent Child, Grandchild, and Other Eligible Parties:

These benefits are limited to 364 weeks and the beneficiaries must show at least 20 percent dependency on the deceased worker. This includes the parents or stepparents of the deceased, a brother, sister, or grandparent. If at any time there are no eligible beneficiaries, or the eligible beneficiaries are no longer eligible and at least 364 weeks have not been paid by the insurance carrier, the remaining benefits are paid to the Subsequent Injury Fund administered by the Division.

Amount of Death and Burial Benefits

Death benefits equal 75 percent of the deceased worker's average weekly wage.

For example, if the deceased worker's average weekly wage were $500, death benefits would equal $375 per week:

75 percent of $500 (.75 x 500) equals $375

Burial Benefits:

Burial benefits are paid to the person who paid the deceased worker's burial expenses. The maximum burial benefit allowed is $6,000.

When Death Benefits Begin and End

A beneficiary becomes eligible for death benefits the day after the worker's death.

For more information, view the Workers' Compensation Benefits Fact Sheets (PDF):

• Workers' Compensation Benefits
  
• Temporary Income Benefits (TIBs)
  
• Impairment Income Benefits (IIBs)
  
• Supplemental Income Benefits (SIBs)
  
• Lifetime Income Benefits (LIBs)
  
• Death and Burial Benefits
  
• Average Weekly Wage Calculations
  

For more information contact: Webstaff@tdi.state.tx.us