Texas Department of Insurance

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The Texas Department of Insurance is the regulator of all Texas-based insurance companies and was founded as a result of the McCarran-Ferguson act.

[edit] References

Texas Department of Insurance website

Division of Workers' Compensation (“the Division”) is a part of the Texas Department of Insurance. Workers' compensation is a state-regulated insurance program that pays medical bills and replaces some lost wages for employees who are injured at work or who have work-related diseases or illnesses. The "Division", which became a part of the Texas Department of Insurance on September 1, 2005, is charged with ensuring that injured workers are compensated fairly and appropriately for workplace injuries.

                        TEXAS WORKERS’ COMPENSATION BENEFITS

                   Exclusive Remedy Rule

As a “claimant” before the Division of Workers’ Compensation (“the Division) your damages are limited. The recovery of workers' compensation benefits is the exclusive remedy of an employee covered by workers' compensation insurance coverage or a legal beneficiary against the employer or an agent or employee of the employer for the death of or a work-related injury sustained by the employee.

                   Exception to Exclusive Remedy Rule

The exception to the exclusive remedy rule is the recovery of exemplary damages by the surviving spouse or heirs of the body of a deceased employee whose death was caused by an intentional act or omission of the employer or by the employer's gross negligence.

                   Third Party Claim

You may have a “third party claim”. Here you would have to show that someone other than your employer was negligent. For example, if you fell from a ladder, you might be able to show that the maker of the ladder was negligent or that the ladder did not perform the job for which it was intended.

                   Income Benefits

The income benefits to which claimants are entitled are set out below:

Temporary Income Benefits (TIBS). In Texas, TIBS are paid for up to the first two years of your worker's compensation claim. The amount you are paid depends on how much you were earning before your injury. This two year period might be extended if you have a spinal injury. Your TIBS will stop when you return to work or receive an impairment rating.

Impairment Income Benefits (IIBS). Impairment income benefits start when you receive an impairment rating or when you reach statutory MMI (2 years after you income benefits began) or the insurance company assesses an impairment rating. For each percentage point of impairment you are entitled to 3 weeks of worker's compensation at the IIBS weekly rate. For example, if your impairment rating is 15%, multiply 15 x 3 = 45 weeks of IIBS times your IIBS weekly rate. You may dispute any impairment rating given by any doctor.

Supplemental Income Benefits (SIBS). Under Texas law, SIBS are available to those who: (1) receive a 15% impairment rating or higher, (2) do not commute IIBS to a lump sum, and (3) are not working, or (4) are working but earn less than 80% of their average weekly wage. Workers must apply within the final 2 weeks of the 3 months before a SIBS quarter (TWCC 52). If you have any ability to work you must make a good faith effort to find employment within your restrictions. You must provide proof that you have looked for employment with companies that have jobs available with these restrictions. To continue receiving worker's compensation SIBS you must continue to apply quarterly for SIBS as outlined above. If the carrier disputes your SIBS you can request a Benefit Review Conference (brC). If you win a disputed quarter the carrier pays for your attorney’s fees, not you.

                   Death Benefits

Death benefits may be available.

                   Lifetime Medical Benefits

You have medical benefits for life. But unless we can get the doctors to address the full extent of the injury and how all of it is work related, you will likely experience medical denials.