Workers’ compensation benefits
When it comes to workers’ compensation, understanding the different benefits available is essential. Two crucial factors that play a role in this are “perplexity” and “burstiness.” Perplexity measures the complexity of the information, while burstiness compares the variations in the content. Humans tend to write with more burstiness, using a mix of sentence lengths and complexity, making the content more engaging. For the following discussion on workers’ compensation income and medical benefits, we’ll aim to strike a balance to maintain both perplexity and burstiness.
Workers’ compensation benefits encompass various types:
Income Benefits:
Income benefits aim to replace some of the earnings lost due to work-related injuries or illnesses. There are four types of income benefits:
a. Temporary Income Benefits (TIBs): These provide temporary financial support during your recovery.
b. Impairment Income Benefits (IIBs): If your injury results in a permanent impairment, these benefits come into play.
c. Supplemental Income Benefits (SIBs): For those who remain impaired after the IIBs period, SIBs offer additional support.
d. Lifetime Income Benefits (LIBs): In severe cases, where the injury leads to a total disability, LIBs provide lifelong assistance.
Medical Benefits:
Medical benefits cover the reasonable and necessary medical expenses for treating work-related injuries or illnesses.
Burial Benefits:
In unfortunate instances of an employee’s death due to work-related causes, burial benefits help cover funeral expenses.
Death Benefits:
These benefits assist the families of employees who die as a result of a work-related injury or illness. Spouses of first responders can receive death benefits for life, even if they remarry after September 1, 2017.
If you have any questions regarding these benefits, you can call 800-252-7031, option 1.
All workers’ compensation benefits are authorized under Texas Labor Code (TLC) Sections 408.081-408.187.
Payment Methods for Income or Death Benefits
When it comes to receiving income or death benefits, there are three payment methods:
Check:
Traditional checks remain a common way to receive benefits.
Electronic Funds Transfer (EFT):
EFT is another option, but to qualify, you must expect to receive benefits for at least eight weeks. To set up EFT, you or your beneficiary will need to provide the following details to the insurance carrier:
- Name of the financial institution
Type of account (checking or savings)
Routing/transit number
Account number for electronic transfers
Access Card Program:
An access card program allows you to receive income or death benefits through an access card. Both you and the insurance carrier must agree to use this program in writing.
Calculating Average Weekly Wage (AWW)
To determine the Average Weekly Wage (AWW), which is essential for calculating income benefits, we consider the average amount of money your employer paid you each week in the 13 weeks before your injury or illness. This calculation includes any non-pecuniary benefits your employer provides, such as health insurance, car allowance, or dry cleaning.
For a full-time employee (working at least 30 hours per week), the AWW calculation is as follows:
Add up all your earnings for the 13 weeks before the injury, including overtime or special pay.
Divide the total by 13 to get the average.
If you hadn’t worked for your employer for the past 13 weeks, your AWW might be based on an employee in a similar job.
Example AWW calculation for a full-time employee:
13 weeks’ wage at $824.23/wk. = $10,714.99
Plus health insurance premium: ($82/wk. x 13) = $1,066
Total: $10,714.99 + $1,066 = $11,780.99
Average weekly wage: $11,780.99 / 13 weeks = $906.23/wk.
Multiple Employment Consideration
If you had multiple jobs when you were injured, you can report those wages as well. Your insurance carrier can include these wages from other employers if your injury prevents you from working.
Example AWW calculation for multiple employment:
Claim employer AWW: $700
Non-claim employer AWW (part-time): $300 (non-pecuniary benefits not included)
Add all the AWWs together:
$700 + $300 = $1,000 = multiple employment AWW
School District Employees
For school district employees, AWW calculation is based on wages earned rather than wages paid, as some employees may choose to be paid only during the nine-month school year or receive equal payments over 12 months. Additionally, certain benefits like health insurance, car allowance, or dry cleaning are not included in the AWW calculation.
The AWW used to calculate income benefits is also different for school district employees, considering total wages earned during the past 12 months, divided by 50.
Example AWW calculations for school district employees:
Sample School District – Written Contract Based on Months Worked:
Amount of Contract: $45,000/yr.
Contract based on: 9 months of work
Calculation of AWW for Temporary Income Benefits (TIBs) based on this contract:
$45,000 / 9 = $5,000 monthly amount
$5,000 / 4.34821 (average number of weeks in a month per year) = $1,149.90 (AWW for TIBs)
Calculation of AWW for benefits other than TIBs based on this contract:
$45,000 / 50 = $900 (AWW)
Sample School District – Written Contract Paid Based on Number of Days Worked:
Amount of Contract: $45,000/yr.
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 (days worked a week) = $1,190.45 (AWW for TIBs)
Calculation of AWW for benefits other than TIBs based on this contract:
$45,000 / 50 = $900
Apply the maximum compensation rate of $541 (AWW)
Definitions
Average Weekly Wage (AWW):
The average amount of money your employer paid you each week in the 13 weeks before your injury or illness. Income and death benefit payments are based on your AWW.
Claim Employer:
The employer that the employee was working for at the time of the illness or injury. It is also the employer through whom the employee filed the workers’ compensation claim.
Disability:
When a work-related injury or illness causes you to lose the ability to earn your weekly wages. “Disability” refers to your inability to earn an income, not to a physical handicap.
Impairment Rating:
An impairment rating indicates what percentage of your body is affected by the work-related injury or illness.
Maximum Benefit Amount:
The maximum weekly benefits an employee can receive. This amount cannot exceed the state average weekly wage (SAWW), rounded to the nearest dollar. The following are the maximum benefit amounts:
Temporary Income Benefits (TIBs) = 100% of SAWW
Impairment Income Benefits (IIBs) = 70% of SAWW
Supplemental Income Benefits (SIBs) = 70% of SAWW
Lifetime Income Benefits (LIBs) = 100% of SAWW for the first year
Death Benefits (DBs) = 100% of SAWW
The Texas Workforce Commission computes the maximum weekly income benefit for each year (October 1 to September 30) no later than October 1 of each year.
Maximum Medical Improvement (MMI):
An injured employee reaches MMI when either of the following occurs:
The work-related injury or illness has improved as much as expected.
104 weeks have passed since the employee became eligible for TIBs.
Minimum Benefit Amount:
The lowest amount of weekly benefits an employee can receive. The minimum benefit amount is 15% of the SAWW, rounded to the nearest dollar. The DWC sets the minimum weekly income benefit for each year (October 1 to September 30) no later than October 1 of each year.
Multiple Employment:
When an employee has more than one employer, wages from all employers may be considered in calculating benefits.
Non-Claim Employer:
An employer that the employee worked for at the time of the injury or illness but is not the claimed employer.
Non-Pecuniary Wages:
Wages that are not paid in money, such as health insurance premiums, allowances for a vehicle or housing, or clothing.
Pecuniary Wages:
Wages paid in money, including salary, commissions, and bonuses. This includes all forms of payment for a given period. Pecuniary wages may also include the market value of room and board, laundry, fuel, and any other benefit that can be estimated in monetary terms.
State Average Weekly Wage:
Equal to 88% of the average weekly wage, as determined by the Texas Workforce Commission under §207.002(c).
Understanding these terms and their implications is crucial when dealing with workers’ compensation benefits. If you have any further questions or need more information, don’t hesitate to seek guidance from a professional or refer to the Texas Labor Code for detailed explanations of each benefit type.