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Texas Department of Insurance
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Workers' compensation income and medical benefits

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Payment methods | Average weekly wage | Definitions

Workers' compensation benefits

There are four types of workers' compensation benefits:

  • Income benefits replace some of the money you lost because of your work-related injury or illness. (except for impairment income benefits). Types of income benefits include:
  • Medical benefits pay for reasonable and necessary medical care to treat your work-related injury or illness.
  • Burial benefits pay for some of an employee's funeral expenses to the person who paid those expenses.
  • Death benefits help families replace some of the money lost when an employee dies because of a work-related injury or illness. Spouses of first responders can get death benefits for life even if they remarry (for marriages on or after September 1, 2017).

If you have questions about benefits, call 800-252-7031, option 1.

Benefits are authorized by Texas Labor Code (TLC) Sections 408.081-408.187


Payment of income or death benefits

Payment of income or death benefits can be made to you or your beneficiary by one of these three ways:

(1) Check

(2) Electronic funds transfer (EFT) - To be able to get electronic funds transfer, you must be expected to receive benefits for at least eight (8) weeks. To get payment by electronic funds transfer you or your beneficiary must ask the insurance carrier to do so, 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 get your income or death benefit payments through an access card.


Average weekly wage calculations

Calculating average weekly wage (AWW)

Your Average Weekly Wage (AWW) is the average amount of money your employer paid you each week in the 13 weeks before your injury or illness. That AWW includes any other things (non-pecuniary benefits) your employer pays like:

  • Health insurance
  • Car allowance
  • Dry cleaning

Your AWW determines how much your income benefit will be. To calculate your AWW, add up all your earnings for the 13 weeks before you were hurt (including overtime or other special pay) and divide that by 13. If you did not work for your employer in the 13 weeks before the work-related injury or illness happened, your AWW may be calculated using earnings of an employee who has the same or similar job that you do.

AWW calculation for a full-time employee (works at least 30 hours per week):

13 weeks wage at $824.23/wk. = $10,714.99

Plus:

Health Insurance Premium:
($82 /wk. x 13) = $1,066

$10,714.99 + $1,066 = $11,780.99

Average weekly wage = $11,780.99 / 13 weeks = $906.23/wk.

Multiple employment

If you had more than one job when you were hurt, you can report those wages as well. Your insurance carrier can include these wages from another employer if your injury keeps you from working.

Here are examples of how your AWW would be calculated for multiple employment:

AWW calculation - multiple employment:

Claim employer AWW: $700, non-claim employer AWW (can be part-time): $300 (you cannot include other pay for this employer such as health insurance, car allowance, or dry cleaning)

Add all the AWWs together:

$700 + $300 = $1,000 = multiple employment AWW

School district employees

Unlike other employees, if you work for a school district, your AWW is based on wages earned, not wages paid. That’s because some employees choose to be paid only during the nine-month school year while others choose to be paid equal payments over 12 months.

Also, for district employees, benefits like health insurance, car allowance, or dry cleaning are not included in calculating AWW.

The AWW used to calculate income benefits is also different. The total wages earned during the past 12 months are divided by 50 to establish the AWW for these benefits. Wages from employers other than the school district earned during the last 12 months may also be included. Here are examples of how a school district employee's AWW is calculated:

# 1 - 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 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)

# 2 - 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 an employee was working for at the time of the illness or injury. It is also the employer that the employee filed the workers' compensation claim through.

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
A rating that shows what percent of the work-related injury or illness affect your body as a whole.

Maximum benefit amount
The maximum amount of weekly benefits an employee can get. The amount may not be more than the state average weekly wage (SAWW), rounded to the nearest dollar, as follows:

  • TIBs = 100% of SAWW
  • IIBs = 70% of SAWW
  • SIBs = 70% of SAWW
  • LIBS = 100% of SAWW for the first year an injured employee gets LIBs
  • DBS = 100% of SAWW

DWC 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 one of the following occurs:

  • A work-related injury or illness has improved as much as it is expected to improve, or
  • 104 weeks after an employee becomes eligible for TIBs.

Minimum benefit amount
The lowest amount of weekly benefits an employee can get. The minimum benefit amount is 15% of the SAWW, rounded to the nearest dollar. 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.

Non-claim employer
An employer that the employee worked for at the time of the injury or illness that is NOT the claim employer.

Non-pecuniary wages
Wages that are not paid in money, such as health insurance premiums, a vehicle or housing allowance, or clothing.

Pecuniary wages
Wages paid in money, such as salary, commissions, and bonuses. Wages include all forms of payment for a given period. Pecuniary wages include the market value of room and board, laundry, fuel, and any other benefit that can be estimated in money.

State average weekly wage
Equal to 88% of the average weekly wage, as determined by the Texas Workforce Commission under §207.002(c).

Last updated: 8/14/2023