If your Texas employer has workers’ compensation insurance, you should be eligible to receive benefits for an on-the-job injury or illness through the state’s workers’ comp program. These benefits are intended to help you get proper medical care, compensate you for some of your financial losses, and help you get back to work. Below is a summary of the benefits provided under Texas law. (To get these benefits, you’ll first need to file a Texas workers’ compensation claim.)
Workers’ comp pays for all necessary medical treatment for a work injury, as long as it’s been recommended or approved by your treating doctor. (For more information, see our article on how to get medical treatment through workers’ comp.)
If you have to miss work while recovering from your injury, or your injury keeps you from earning your usual wages, you may be able to collect temporary income benefits. Florida calculates these benefits under a formula: 70% of the difference between your average weekly wages and the wages you are able to earn after your injury, or 75% of the difference if you earned less than $10 an hour.
Example: If you earned $15 an hour before your injury ($600 per week) and you aren’t able to work at all, the difference between your pre- and post-injury wages is $600; you would receive $420 per week (70% of $600) in temporary income benefits.
State law sets upper and lower limits on these benefits. The maximum and minimum amounts depend on when you were injured (or, for occupational illnesses, when you started receiving benefits). For injuries that happened in the 2018 fiscal year, the maximum is $913 per week, and the minimum is $137.
Temporary income benefits won’t kick in until after the first week of missed work, unless you ultimately have to miss two weeks or more. These benefits last until the earliest of the following events:
Texas allows an extension of the 104-week limit if you have (or will have) spinal surgery within 12 weeks before the deadline.
Once you have reached maximum medical improvement, your doctor will evaluate you to determine whether your work injury has left you with a permanent loss of function or limitation (called an “impairment”). If so, the doctor will rate the severity your impairment from 1% to 99%. You’ll be eligible to receive benefits for a period of time determined by your impairment rating: three weeks for each percentage point. In Texas, these payments are called impairment income benefits (commonly known as partial permanent disability benefits in many other states).
The weekly benefit amount will be 70% of your average weekly wage before the injury. Here again, there are limits. For injuries that happened in fiscal year 2018, the upper limit for impairment income benefits is $639.
Example: You earned $600 per week before your injury and receive a 20% impairment rating. You will receive $420 per week (70% of $600) for 60 weeks (3 weeks x 20).
After your impairment income benefits have run out, you may be able to receive supplemental income benefits if you meet all of the qualifications:
As long as you qualify, you can receive supplemental income benefits for up to 401 weeks. To calculate the weekly benefit amount, take the difference between 80% of your pre-injury wage before your injury and your post-injury wages. You will receive 80% of that amount, subject to the same maximum and minimum as impairment income benefits.
Example: Suppose you have a permanent impairment rating of 30%. You used to earn $600 per week before your injury, but now you earn $200 per week. Subtract $200 from $480 (80% of your pre-injury wage) to get $280; you will receive 80% of $280, or $244 per week.
Texas also allows lifetime income benefits, but only for a few very severe types of impairments:
Lifetime income benefits are 75% of your pre-injury average weekly wage, with the same maximum and minimum as temporary income benefits. Unlike other types of benefits, however, lifetime income benefits are increased 3% every year, regardless of the maximum.
In addition to compensation for medical treatment and part of your wage loss, Texas also provides other types of workers’ comp benefits, including:
As you can see, there are limits to workers’ comp benefits: you’ll receive only a portion of your lost wages (although it may help to learn that workers’ comp benefits are generally tax-free). In addition, you can’t receive any payment for the pain and suffering related to your injury. This is part of the trade-off of the workers’ comp system: You can receive benefits relatively quickly without having to prove that your employer was at fault for your injury, but you won’t be fully compensated for all of your losses.
Texas is one of the only states that don’t require private employers to participate in the workers’ compensation system. If your employer opted out by not carrying workers’ comp insurance, you can sue for your injury in court. While this is usually a longer and more involved process, you can receive the full value of your wage loss and pain and suffering. To learn more, see our personal injury page. And if your employer has chosen to participate in the Texas workers’ comp system, an experienced workers’ comp lawyer can help make sure that you get all of the benefits you deserve. To learn more, see our article on when you may need to hire a workers’ comp attorney.