Workers' Compensation Income and Medical Benefits
Definitions | Average Weekly Wage | Maximum and Minimum Weekly Benefits | Temporary Income Benefits | Impairment Income Benefits | Supplemental Income Benefits | Lifetime Income Benefits | Medical Benefits | Death and Burial Benefits
What are workers' compensation benefits?
Texas Labor Code (TLC) Sections 408.081-408.187
There are four types of workers' compensation benefits:
- Income benefits (other than impairment income benefits) replace a portion of any wages you lose because of a work-related injury or illness. Income benefits include temporary income benefits (TIBs); impairment income benefits (IIBs); supplemental income benefits (SIBs); and lifetime income benefits (LIBs).
- Medical benefits benefits pay necessary medical care to treat your work-related injury or illness.
- Burial benefits pay for some of the deceased employee'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 employees killed on the job.
Payment of income or death benefits can be made to you or your beneficiary by one of these three methods:
(2) Electronic funds 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.
(3) Access card program - Both you and the insurance carrier have to agree to use an access card program in writing before you can receive your income or death benefit payments through an access card.
- 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 employee filed a claim for workers' compensation benefits and for whom the injured employee was working at the time of the on-the-job injury.
- is 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
- is the percentage of permanent physical damage to your body that resulted from a work-related injury or illness.
- Maximum Benefit Amount
- is the maximum amount of weekly benefits an employee may receive. This maximum benefit amount may not exceed the state average weekly wage (SAWW), rounded to the nearest whole dollar, as follows:
- 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 an injured employee receives LIBs
- Death Benefits (DBS) = 100% of SAWW
TDI-DWC computes the maximum weekly income benefit for each year (October 1st through September 30th) no later than October 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 the minimum amount of weekly benefits an employee may receive. The minimum benefit amount is 15 percent of the state average weekly wage, rounded to the nearest whole dollar. TDI-DWC computes the minimum weekly income benefit for each year (October 1st through September 30th) no later than October 1st of each year.
- Multiple Employment
- means an employee has more than one employer.
- Non-Claim Employer
- is an employer, other than the claim employer, by whom the employee 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). Wages include all forms of payment for a given period to an employee for personal services. The term includes the market value of room and board, laundry, fuel, and any other benefit that can be estimated in money that the employee receives from the employer as part of the employee's pay.
- State Average Weekly Wage
- is equal to 88% of the average weekly wage in covered employment computed by the Texas Workforce Commission under §207.002(c).
Last updated: 03/28/2016