Workers' Comp FAQ

Texas is the ONLY state in the United States that does not require employers to have workers' compensation insurance. In order to receive workers' compensation benefits through the Division of Workers' Compensation your employer must have workers' compensation insurance through one of many companies who offer it. If you were injured while on the job or while performing any work for your employer, no matter the cause, you are entitled to workers compensation benefits.

How do I know if my employer has workers' compensation?

Although state law requires your company to inform you about coverage, many companies do not tell its workers. You can call our office and we can check for you, or you can go to the following link and type in your company's name to inquire.

Click here to find out if your employer has workers' compensation.

What do I do if the insurance company denies my claim?

There is a dispute resolution process established through the Division of Workers' Compensation which takes from 2-6 months to complete, depending on your location and the nature of the dispute. We HIGHLY recommend that you contact an attorney if your claim has been disputed as we often are able to resolve these disputes to the benefit of our clients at minimal cost. Miller & Bicklein attorneys are often able to resolve these disputes without going through an administrative hearing or appeal and can usually avoid district court.

What is a BRC, CCH, and Request for Review?

Benefit Review Conference (BRC)

A BRC is an informal mediation meant to try to resolve disputes between injured workers and insurance companies. It is an adversarial process where by the insurance company normally hires an attorney to represent them in an effort to win, and therefore all injured workers should consider hiring an attorney as well.

Contested Case Hearing (CCH)

A CCH is a more formal process and is considered an Administrative Trial. Any disputes between insurance companies and injured workers are sent to a CCH for adjudication. A judge, called a Hearing Officer hears evidence and testimony from the insurance company and the injured worker and issues a written decision, which is then binding on the parties. Insurance companies almost always have attorneys at this stage and it is highly recommended that you do as well.

Request for Review

A Request for Review is a written appeal of a decision from a CCH that is sent to the Appeals Panel. The Appeals Panel consists of three judges who review the CCH decision and can change the decision if they feel it is appropriate. This process takes approximately two months to complete and normally becomes the final decision from the Division of Workers' Compensation. Either the injured worker or the insurance company can file a Request For Review and once the Appeals Panel renders its decision either party can appeal the decision to district court. Miller & Bicklein frequently files for district court review when appropriate and also defend injured workers in district court against insurance companies.

What do I do if the insurance company sues me in district court?

Under current Texas Law you are entitled to an attorney to defend you if the insurance company files suit against you in an effort to appeal a decision from the Division of Workers' Compensation. Under most scenarios, you will NOT HAVE TO PAY ANY ATTORNEY'S FEES for this dispute. Because of the complicated nature of the disputes and the potential for free legal help we strongly recommend that you talk to an attorney if you are ever "served" or sued by an insurance company. Please note that you have a very short time period for answering or filing a law suit, so please contact an attorney quickly.

What are the medical benefits offered by the Texas Workers' Compensation system?

In Texas injured workers are entitled to both medical benefits and lost wage protection. You are entitled to medical care which is considered reasonable and necessary and promote the healing of your injury. Normally you are entitled to see any doctor who is willing to treat you. A list of providers who accept workers compensation can be found following the link provided.

Click here to find a doctor that accepts workers compensation.

Our office would be happy to provide you with doctor referrals for all over the state of Texas. Injured workers in Texas should NEVER pay for medical care or pay co-payments or down payments. One hundred percent of all of your medical expenses should be paid for by the insurance company. If you have been asked to pay for any part of your medical care contact the TDI-DWC or an attorney.

How much money does workers' compensation pay for lost wages?

Injured workers are entitled to receive 70-75% of the wages they received prior to their injuries. Most injured workers are entitled to receive a weekly check for the entire period they are off work, and this income is non-taxable income and not reported to the IRS. There is a complicated method and set of rules for calculating the actual amount and our attorneys routinely check this for our clients and assist them in getting their weekly check increased.

Am I entitled to see any doctor I want to?

Yes, you are entitled to see any doctor you wish, so long as the doctor is willing to agree to accept workers' compensation insurance. The problem in Texas is that doctors are treated so unfairly by insurance companies that many have stopped taking workers' compensation cases. Please contact our office for guidance in choosing your doctor.

Can I change doctors?

Yes, Texas law allows you to change doctors. If you have been referred to your doctor by your employer or by an insurance adjuster you can change to another doctor. You do not need permission from the insurance company to do so, you must simply file a form with the Division of Workers' Compensation.

What if my company does NOT have workers' compensation?

Even if your employer does not have workers compensation insurance you may still be able to recover for your injuries. Many companies have private insurance or liability policies which cover its employees. Many of these companies are referred to as "non-subscribers". If you receive information from an insurance company but not the Texas Department of Insurance Workers' Compensation Division then it is likely that your company does not have workers' compensation. You can pursue this private insurance and possibly pursue a negligence action to receive benefits for your injuries and pain and suffering. This would be covered under our web page entitled "Personal Injury FAQ " which can be found by clicking here.

What are the stages to workers' compensation?

Workers' Compensation provides three stages of benefits to injured workers.

Stage 1 is Temporary Income Benefits (TIBS)

TIBS is meant to replace your lost wages for the period of time you are off work. There are many problems and catches to this system and injured workers need to be cautious of insurance companies actions during this stage. The maximum you may receive changes each year but is currently at least $540 per week.

Stage 2 is Impairment Income Benefits (IIBS)

IIBS provides benefits based on an Impairment Rating assigned by either your treating doctor or a Designated Doctor when you have reached Maximum Medical Improvement (MMI). There are rules for challenging a Rating and collecting the Rating in a lump sum. The most critical time period is that you may only have 90 days to challenge your Rating once you have received it. We encourage all injured workers to contact an attorney after receiving a Rating so that it can be reviewed for potential problems. The maximum you may receive during this stage also changes each year but is currently at least $378 per week.

Stage 3 is Supplemental Income Benefits (SIBS)

SIBS provides for a monthly check for injured workers who qualify. To be eligible, you must have an Impairment Rating of 15% or higher. This is the most complicated of the three stages and provides four methods of qualification. Injured workers can qualify by (1) being unable to work; (2) looking for a job; (3) working, but earning less than your pre-injury wage; or (4) being fully enrolled in a re-education program with the Department of Assistive and Rehabilitative Services (DARS) formally called the Texas Rehabilitation Commission (TRC). Often times insurance companies are required to pay the injured worker's attorney in SIBS cases so the injured worker gets free legal assistance. Please contact us for more information regarding this matter.

What is an Impairment Rating and Maximum Medical Improvement (MMI)?

When your doctor or the Designated Doctor believe that you have gotten as good as you can get they will normally assign you an Impairment Rating. When you have completed the majority of your medical care and are not going to get significantly better you are at Maximum Medical Improvement (MMI). Maximum Medical Improvement can also be defined as a point in your treatment where you have reached a medical plateau and further recovery can no longer be anticipated.

This is a complicated percentage point system which provides specific numbers for specific injuries. THIS RATING IS EXTREMELY CRITICAL as it can lead to eligibility for Supplemental Income Benefits (SIBS) and can provide income to you even if you return to work. Insurance companies very often request Designated Doctors to provide you a Rating even before you are ready. These Ratings can be disputed, but you must do so in a timely manner and we recommend that you contact an attorney as soon as you get an Impairment Rating so that it can be reviewed.

What is a Designated Doctor?

A Designated Doctor is an independent doctor appointed by the Division of Workers' Compensation to issue an opinion as to whether you are at Maximum Medical Improvement (MMI) and ready for an Impairment Rating. This system is imperfect at its best and very often unfair and biased doctors are assigned to be Designated Doctors. If you receive an Impairment Rating from a Designated Doctor that you or your doctor disagree with, we encourage you to contact an attorney immediately so that it can be disputed.

What is a Required Medical Exam (RME) and do I have to go?

A Required Medical Exam (RME) is a physical examination requested by the insurance company. This exam is often called an Independent Medical Examination (IME), but it is not by an independent doctor. An RME exam is done by a doctor hand-picked by the insurance company to see you and give his opinion. These doctors can often have an impact on your course of medical care and denials by the insurance company. Failure to attend an RME appointment can cause your benefits to be stopped and a fine to be imposed and therefore we never recommend you miss the appointment.

What does it cost to hire an attorney?

Attorneys are regulated by State law and Texas Department of Insurance Division of Workers' Compensation and their fees must be approved by the Division of Workers' Compensation. Attorneys work based on an hourly fee and a contingency fee basis. Client's NEVER pay the attorney directly and the attorney is only paid if the injured worker receives benefits. Miller & Bicklein offers a risk free consultation where we can meet and talk about your case specifically and if we are not hired there is NO CHARGE. There is also a chance that you will NEVER have to pay attorney's fees if you are involved in a SIBS dispute.

Can I sue the person or company responsible for my injuries?

The answer to this question is not so simple. In Texas, if your employer has workers compensation insurance, your employer can not be sued. Your employer is protected from lawsuits in all cases except for some cases involving the death of an employee. You can however sue a third party. If a company or person who is not your employer is responsible for your injuries, you can pursue a third-party action against that party. So while you cannot sue your own company, you may be able to sue a third party who is responsible. The facts of each case will greatly affect your ability to do this and the amount you will recover and legal assistance is extremely beneficial in pursuing your rights because of the workers' compensation coverage which creates a lien against your recovery from the third party. The attorneys at Miller & Bicklein handle third-party cases every week and can help protect your rights and provide you with the protection you need.