Amarillo Workers Compensation Attorney
DO I NEED AN ATTORNEY AS AN INJURED WORKER?
That is the question an injured worker must ask after getting hurt on the job. There is no requirement that an injured worker must get worker compensation attorney. It is not against the law to operate on behalf of yourself in Texas either, but it is not recommended.
One of the most tragic events in a working person’s life is to be injured in Texas. Texas Mutual is a bureaucratic giant that writes approximately 80% of the workers compensation insurance policies in this state alone. Texas Mutual came about in the early 90’s to “break even” and to offer a more affordable option for business owners who simply could not afford your standard workers compensation insurance. However there are numerous traps and pitfalls that an injured worker must look out for when winding through this complicated and complex system. Here at the Warner Law Firm we will be more than happy to take you through a $.25 cent tour of this unique system.
Two Ways to File a Worker Comp Claim
After an injured worker gets hurt on the job, an Employer files the DWC-1 which is the Employers Notice of Injury. If the Employee initiates the Claim, a DWC-41 is filed. The DWC-41 must be filed within 30 days from the date of injury or the injured worker must show “good cause” on why the DWC-41 has not been filed. This is the first trap to be wary of when injured in Texas.
Tip: If the DWC-41 is not filed within the 30 day period, but the DWC-1 is filed, then the Employer and the Carrier are presumed to have notice of the Claim.
Rights of the Injured Employee
One right that an injured worker has is the absolute right to select your Treating Doctor. An injured worker’s right to select your own Treating Doctor cannot be over emphasized. Often times, especially when Texas Mutual is involved, the Employer will take the injured worker to the Employer’s doctor and an injured worker gets a UA before they get any treatment. The sole purpose of the UA is to attempt to invoke the intoxication defense. For Instance here in Amarillo Texas if you have a broken arm you might end up at Concentra clinic and will be required to take a UA prior to receiving any possible treatment.
Tip: If Texas Mutual is the Carrier, you must choose your initial treating doctor from the list of providers from the Texas Star Network.
Mike Warner suggestion’s is to use the BSA Urgent Care facility. However if you have to choose from the list provided by the Carrier if they have a health care network. Typically the Employer has already selected a physician, and we will use that term loosely. The providers will typically not take you off of work, but issue a “light duty” release and provide restrictions so that the Employer does not have to report a “lost time” injury.
Tip: Lost time injury affects bonuses to Safety Coordinators and “lost time” injuries are a big no-no.
Benefits For Injured Workers
There are two types of benefits that an injured worker is generally entitled to.
The first benefit is called Temporary Income Benefits (TIBs) which are the weekly income benefits for the injured worker. Typically TIBs are based on the prior 13 weeks of wages and benefits immediately preceding the injury. If you have not worked for the Employer for the 13 weeks immediately preceding the date of injury there are a couple of other ways to determine your AWW. You can take the “fair and just method” or the “same or similarly situated employee” method. If you make less than $8.50 per hour you are entitled to 75% of your Average Weekly Wage (AWW) for the first 26 weeks after your injury and then that amount is reduced to 70% of your AWW the following week. If you make $8.50 per hour or more at the time of your injury, then your AWW is based on 70% of your AWW.
An injured worker is entitled to TIBS until Maximum Medical Improvement (MMI) is reached. TIBS begin to accrue on the 8th day of lost time and continue until MMI is reached. This date can be up to 2 years from the date of injury or the date that lost time began. The Employer has 30 days to file the Wage Statement (DWC-3) from the date of injury. A failure to do so may result in an administrative violation. There are some other specific situations that might arise arising in the calculation of TIBs which are out of the ordinary and not addressed in this brief overview.
No Lump Sum Workers Comp Payments in Texas
An injured worker received better benefits 30 years ago than today. It is sad that the Texas Legislature and the Supreme Court have protected insurance companies and big businesses in Texas at the expense of the injured worker. If you can file your case in another state you need to seriously consider doing so. Our firm is able to assist in this process and have contacts in other states to assist you in obtaining your maximum recovery should you be unfortunate enough to get hurt in Texas.
What Happens After Obtaining MMI (Maximum Medical Improvement)?
Once you have obtained MMI you are entitled to Impairment Income Benefits (IIBS). IIBs are in lieu of a lump sum payment. An injured worker is entitled to 3 weeks of benefits for every1% of whole body impairment assigned by your treating physician or a Designated Doctor (DD). If a dispute arises, and it usually does, the injured worker or the Carrier has the right to request a DD to determine several different issues. Typically the DD will address the ability to return to work, whether or not MMI has been reached and the Impairment Rating (IR) that should be assigned to the injury, if any. There are several doctors that are in the insurance company “back pocket” and will lay the wood to the injured worker when assessing MMI and the IR. This is the main trap that you must watch out for. There are time limits and a technical minefield that await the injured worker in this state of the Claim.
Tip: The most important thing to remember is that the DD’s report carriers “presumptive weight” which means regardless of the opinion given whether it is favorable to you or the Carrier, the party that may not agree with the DD report has 90 days to appeal that ruling or it becomes final. I cannot stress that rule enough.
What Happens if You Receive 15% of More on the IR (Impairment Rating)?
If you receive an IR of 15% or more you may then be entitled to Supplemental Income Benefits (SIBs). I rarely see this high of an IR anymore. The maximum number of weeks that an injured worker may receive is 401 weeks unless, under circumstances, unless you are entitled to lifetime benefits. Death benefits must be addressed separately. Mental health injuries are another type of injury that are very difficult to address and even win. There is no mental injury claim which results from termination or any other “legitimate personnel action.” Heart attach cases are also very difficult cases to win. If you are not physically exerting yourself at the time of the heart attack, you have an uphill battle.
Insurance Companies Start by Denying Claims
An insurance companies will traditional begin a claim by denying medical treatment early on in the Claim. The system was set up to assist an injured worker with “lifetime medical.” What a joke. I can recall one on one hand the number of cases in the last 24 years where the Carrier has continued to pay the benefits under the policy. Typically, after about 5 years you will have to fight tooth and nail for every dime you are entitled to. Because the insurance company knows that an attorney can’t get paid for helping you get your reasonable and necessary medical treatment you become a target for the Carrier to start denying and/or delaying you medical benefits. The denial of medical benefits is merely a pretext for insurance companies to deny and/or delay claims for a litany of bogus reasons. First, insurance companies make money by denying or delaying your medical benefits. Even if they ultimately pay the Claim, if you deny or delay thousands of claims each day, the interest on that money is enormous. Insurance companies factor in a few administrative violations as a cost of doing business. They could care less whether or not it is your medicine or medical procedure that is being delayed or denied. Must appeal your denial of a medical procedure or even your medicine within 15 days. Once it is denied a second time, you must file a Request for an Independent Review Organization (IRO) within 45 days. The form is the LHL-009 and it is available on the Texas Department of Insurance-Division of Workers’ Compensation website.
Brief Texas Workers Compensation Overview
This if an extremely brief overview of the comp system here in Amarillo Texas. Our firm takes wrongful termination cases and insurance bad faith cases when Employers and Carriers do not treat you fairly and in accordance with the rules. An example of the treatment you can expect if you are injured relates to an Employer who terminates you in violation of Texas Labor Code §451.001 et seq. which provides in pertinent part:
Section 451.001 prohibits an Employer for discharging or in any other manner discriminating against an employee, not just the injured worker, because the employee has filed a workers’ compensation claim in good faith, hired an attorney to represent the employee in a claim, instituted or caused to be instituted a claim pursuant to the Texas Labor Code or testified or is about to testify in a proceeding brought pursuant to the Texas Labor Code for benefits.
If your Employer does not carry workers compensation insurance, then the Texas Supreme Court has ruled that you cannot file suit for being terminated because you get hurt on the job. Chalk one up for insurance companies and big business. Thus, your Employer is “reward” for failing to carry workers compensation insurance. The downside for Employers who fail to carry workers compensation insurance is that the Employer waives its common law defenses and may be sued for damages just like in a car wreck.
Why Mike Warner for Workers Comp?
Mike Warner experience has been if your Employer does not carry comp they are usually a large company that determines it is cheaper to pay the claim outright than pay the insurance premiums. If an Employer does carry workers compensation insurance then unless you die, THIS IS THE EXCLUSIVE REMEDY for the injured worker. It does not matter if your employer is negligent or creates the dangerous condition that allows you to get hurt.
Our firm will be glad to assist you in your workers compensation case. We have been helping injured workers in the Top of Texas area for more than 23 years. We have tried cases to juries and/or obtained settlements for wrongful termination against just about every entity you can image. You will find out very quickly that you are outgunned when you have to fight an insurance company. They have all of the money and power and the penalties for violating the rules are rarely, if ever, enforced. I will fight for your rights. My motto is “if they are not paying you, they need to be paying someone. Insurance companies don’t bleed red, they bleed green.” Fight fair, fight hard and most importantly…WIN.
“A HALF A CUP OF JUSTICE IS A HALF A CUP OF INJUSTICE “