Worker's Compensation

Commonly Asked Questions
(The following is a transcript of the video presentation available HERE)

Texas has a very complex Workers’ Compensation system. It gives Insurance Companies many ways to deny your weekly compensation checks and medical treatment. 

I'm Richard Pena, owner of this law firm.  When this Workers’ Compensation Law went into effect in 1991, our Law Office was one of the first in the State to represent injured workers under the new law.  Since then, we have represented thousands of injured workers throughout the state.

Our goal is to protect your rights and to insure that you receive the compensation checks and medical treatment to which you are entitled.

Once we accept your case, you and our office form a team.  If we win, you win.

Watch Video with Information from Richard Pena, P.C.

Las Preguntas Comunes (Espanol)

We understand that this is a difficult and stressful time for you and your family.  Not only are you worried about getting proper medical treatment but also about paying your bills.  And then there’s the issue about your employer taking you back to work once you are released by your doctor. 

I wish I could tell you that this Workers’ Compensation Law was fair and could fix all your problems.  But I cannot.  But we can try to help you survive during this difficult time and get you back on the road to recovery. 

Now, let me take a little time to answer some commonly-asked questions.          

The first question usually asked is whether you have a right to receive benefits.

Basically, you want to know if you will receive weekly checks during the period you cannot work, and whether your medical bills will be paid by the insurance company.

Every case is different and depends on the facts and the medical reports.  However, you should know that it is not unusual for insurance companies to deny medical treatments or even to dispute an entire case.  For example, insurance companies often say that the worker is not insured or that if the worker is injured, the injury did not happen at work.

Many people ask if they have a right to receive medical care.

The law says that you have the right to receive medical treatment that is reasonable and necessary and caused by your work injury.  But, don’t be fooled into thinking that the Insurance Company will approve or pay for all of the treatment your doctor recommends.  Doctors are continually frustrated by Insurance Company denials of medical treatment they prescribe for their patients. 

Often, Employers or the Insurance Company will send the injured worker to “their” doctor.  And you may be wondering if you are entitled to see a doctor of your choice. 

The answer is yes.  If that’s what you want to do, ask us about it.

Do you have a right to hire an attorney?

Absolutely!  In fact, it is often difficult to navigate this Workers’ Compensation System without one.

 Here are some examples of areas that are potentially confusing without an attorney to help.

• Do you know what your average weekly wage is? Do you know whether your weekly checks are the right amount?

• What will you do if the Insurance Company reduces or stops your checks?

  • Insurance Companies can and do dispute your:

    • Wage Rate

    • Ability to Return to Work

    • Maximum Medical Improvement

    • Impairment Rating

    • Right to Change Doctors, and

    • Even "that you did not get hurt at work"

  • There is also an issue of your checks being sent to you in a timely manner.

An injured worker often asks:

• Can I sue my Employer?

  Generally, no, not  if you are covered by Workers’ Compensation.

  But, if someone other than your employer caused your injury, you may have a cause of action against that company.  If that is your situation and someone other than your employer caused your injury, let us know immediately.

Finally, some clients ask if they are entitled to a lump sum settlement.

• The answer is “no”.  There are no “settlements” under this law.

There are some things that are very important that you do.  Not doing any of these could ruin your case. 

• Number One:  When you are hurt at work, immediately tell your supervisor or employer.  The law says that you must tell your employer within 30 days of the date you were injured.

• Number Two:  Fill out a Notice of Injury Claim Form and send it to the Workers’ Compensation Commission within one (1) year of the injury.  When you hire us, we can help you with this.

• Number Three:  Keep all of your doctor appointments.  Tell your doctor how you were injured.  And  tell your doctor if you believe it is work related.  Tell your doctor about all of your physical complaints.  For example, if your neck, back, and leg hurt, don’t just mention your neck and back and leave out the problem with your leg.  Include everything.

Now lets talk about the money benefits provided for under the Law. 

Workers hurt on the job first receive weekly checks when they cannot work.  These are referred to as TIB’s (Temporary Income Benefits).  The benefits will be paid until the disabled worker is certified to have reached MMI (Maximum Medical Improvement).

After the worker reaches MMI, he/she may be entitled to Impairment Income Benefits (IIB’s).  If the doctor determines that the worker has a permanent impairment rating using the AMA guidelines, the worker is entitled to three weeks of benefits for every percent point of impairment given.  So, for example, if the worker is assessed 3% Impairment, he/she would receive nine weeks of IIB’s.

It is not unusual for the workers’ doctor to give a higher percentage, and the insurance doctor a lower percentage.  In this case the Texas Workers’ Compensation Commission will approve a Designated Doctor to determine the proper percentage.

After IIB’s runs out, the worker may be entitled to additional checks if the worker has received fifteen percent or greater impairment.  These checks are referred to as SIB’s (Supplemental Income Benefits).  Remember, the key to receiving these benefits is an Impairment Rating of 15% or greater.

Two benefits which seldom come into play are Lifetime Benefits and Death Benefits.

A worker who suffers a catastrophic injury while on the job may be eligible for Lifetime Benefits, while the legal beneficiaries of someone killed on the job may be eligible for death Benefits.  If you wish, our office can provide you with more information on these benefits.

Ok, so lets say there is a dispute between you and the Insurance Company on your case.  If the Insurance Adjuster does not budge, you must enter the Hearing Process.  So long as we are your attorneys, we will represent you at those Hearings.

The first hearing is called a Benefit Review Conference.  We refer to it as a BRC.  This is an informed proceeding conducted by Benefit Review Officer.  Present is the Insurance Company Representative, either an attorney or adjuster, you and your attorney.

The goal is to resolve the dispute.  If this cannot be done, the Benefit Review Officer makes a recommendation and the case proceeds further to a Contested Case Hearing which we call a CCH.

A CCH is an Administrative Trial, complete with a Hearing Officer, evidence, witnesses and lawyers.  The Hearing Officers receive direct and cross-examination testimony as well as other evidence from witnesses.  After the record closes, the hearing officer renders a written decision.  This officer’s award is final unless the decision is appealed.

The Decision of the Hearing Officer at the CCH can be appealed to the Appeals Panel and that decision can ultimately be appealed to District Court.  As this is a Trial de Novo, the proceedings start anew.

The goal of this presentation is not to summarize the nearly to 600 pages of the Workers’ Compensation Act and Rules of the Texas Workers’ Compensation Commission. 

Rather our goal is to just touch on some of the provisions which are important to injured workers and to the attorneys representing them.

Do you find all of this somewhat confusing?  Well, you’re not alone.  You have now entered the land called Texas Workers’ Compensation Law.  Note that it is not called the Texas “Fair” Compensation Law.  The word “fair” appears nowhere in this law. 

We understand that this law is very confusing.  You may think you can’t get anywhere with it, but that is why you are here.  Our office has handled thousands of these cases.  We do understand them and we can help you, step by step, get the most you can possibly get for yourself and your family without you having to understand all the legalities and without you having to deal with the insurance company.

So let’s work together as a team and move forward. 

Thank you for taking time to view this video. We hope that you have learned some basics about the Workers’ Compensation Law in the State Texas and we look forward to working with you in the future.