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Workers’ Comp and On the Job Injuries FAQ

Please be advised that the laws and rules related to on the job injuries and Texas Workers’ Compensation are complex and continually changing.  The answers provided in response to frequently asked questions is not meant to be considered legal advice and in no way constitutes a lawyer-client relationship.  To receive specific legal advice concerning the facts of your injury contact the office of Allison & Ward Attorneys at Law.

I have been injured on the job. What should I do?

The first thing to do when you have been injured at work is to seek emergency medical attention, then notify your employer. Tell your supervisor and human resources that you were injured at work. For example, “I hurt my back lifting a box here at work.” If your employer is not covered by Texas Workers’ Compensation insurance, you may have a much shorter deadline to tell your employer and receive benefits under your employer’s occupational injury plan. Some plans require notice within 24 hours or less. Then, contact us. The attorneys as Allison & Ward can help you locate a doctor who will treat you for workers compensation and on the job injuries.

The Insurance Company has denied my claim what can I do?

The attorneys at Allison & Ward have forty years of combined experience assisting injured workers with insurance claim denials. We routinely represent claimants before the Texas Department of Insurance Division of Workers’ Compensation in Benefit Review Conferences, Contested Case Hearings and write appeals to the Texas Department of Insurance Division of Workers’ Compensation Appeals Panel. Contact us to speak to a lawyer about representing you to resolve insurance claim denials.

The Insurance Company has accepted my claim but keeps denying medical treatment. What can I do?

Our attorneys are experienced in helping our clients get the medically reasonable and necessary medical treatment related to their on the job injury.  The Texas Workers’ Compensation system has a separate dispute process for medical claims denied on the basis that the medical treatment is not medically reasonable and necessary.  This system of resolving medical disputes at the Texas Department of Insurance Division of Workers’ Compensation has strict time deadlines.
If the Texas Workers’ Compensation Insurance company is denying medical treatment, or if you are unsure if your employer has Texas Workers’ Compensation insurance, contact Allison & Ward and we will help you find out.

My lost wage checks stopped but I still can’t return to work. What can I do?

When your employer has Texas Workers’ Compensation insurance, the Texas Workers’ Compensation Act allows you to recover a portion of your lost wages.  These lost wage benefits are called Temporary Income Benefits or TIBS.  TIBS are available when you are earning less than your pre-injury gross average weekly wage due to your compensable workers’ compensation injury.  Generally, Temporary Income Benefits stop when your doctor returns you back to work full duty, you reach maximum medical improvement as certified by a doctor, or when 104 weeks after your eighth day of missing work has passed.  There are other reasons an insurance carrier can stop TIBs.  Contact the lawyers at Allison & Ward and we will help you determine why your checks have stopped and assist you with receiving the lost wage benefits you are entitled to receive according to the Texas Workers’ Compensation Act.

If you have stopped receiving Supplemental Income Benefits, please contact the attorneys at Allison & Ward to discuss the specific details of your Texas Workers’ Compensation claim so we can assist you.

A doctor says I am at Maximum Medical Improvement but I am too hurt to return to work. What should I do?

Our lawyers will assist you with determining if you can change the date of maximum medical improvement for your Texas Workers’ Compensation claim. Maximum medical improvement (MMI) means that a doctor believes medicine can no longer greatly improve the damage your body suffered as a result of your workers’ compensation injury.  MMI does not always mean you are completely healed or that you can return to the job you were doing when you were injured at work. Contact a lawyer at Allison & Ward to determine if we can assist you with changing the date of maximum medical improvement and with getting additional income benefits from the Texas Workers’ Compensation insurance carrier.

A doctor has given me an impairment rating. What does impairment rating mean?

If the treating doctor believes you have permanent impairment as a result of your workers compensation injury, the doctor will use a guide book written by the American Medical Association to determine what percentage of your body is permanently impaired.  The attorneys at Allison & Ward have forty years of combined experience in reviewing and disputing impairment ratings.  The lawyers at Allison & Ward help their clients understand impairment ratings and how to dispute an incorrect impairment rating.  If you have received an impairment rating contact our office as soon as possible—there are time deadlines to dispute incorrect impairment ratings before they become final.

Can I sue my employer when I get hurt on the job?

The answer to this question depends on whether your employer purchased Texas Workers’ Compensation Insurance provided under the Texas Labor Code. Our office will assist you with determining if you are covered under Texas Workers’ Compensation insurance.

If your employer is a subscriber to the Texas Workers’ Compensation system, Texas law does not allow you to sue your employer for negligence in causing your injuries.  Your family can sue your employer if you are killed on the job.  Contact Allison & Ward if a family member has died as the result of an on the job injury and an attorney will speak with you regarding the specific facts of your family member’s death to determine if our attorneys can represent you.

If your employer is not a subscriber to the Texas Workers’ Compensation system, you can sue your employer for negligence in causing your injuries.  You must file a law suit within two years from the date of the negligence or you will be barred by the Statute of Limitations from bringing any claim or law suit for compensation for your injuries.  The attorneys at Allison & Ward have been handling on the job injury claims for a combined forty years.  Contact our office to speak with an attorney about your on the job injury case.

Can I sue someone who is not my employer for on the job injuries?

If someone other than your employer or a co-employee was negligent and caused you to suffer an on the job injury, you may be able to sue the responsible person for negligence in causing your injuries.  In Texas workers’ compensation cases, where the injured worker is receiving benefits under the Texas Workers’ Compensation system, these are called “third party” claims. Third party claims are complex and involve issues like settlement credits, subrogation interests and borrowed servant doctrine.  The attorneys at Allison & Ward have been working together since 1995 representing workers’ compensation claimants in third party claims.  Contact our office today to speak with a lawyer if you believe someone other than your employer was negligent in causing your on the job injury.

If your employer is not covered under Texas Workers Compensation insurance, and your employer, a co-employee, or someone else was negligent in causing your injuries contact Allison & Ward Attorneys at Law and a lawyer will review the specific facts of your case with you to determine if our attorneys can assist you in recovering damages for your on the job injuries.

What or who is a designated doctor?

Within the Texas Workers’ Compensation system, a designated doctor is a doctor appointed by the Texas Department of Insurance Division of Workers’ Compensation to examine you for the purpose of answering specific questions asked of the designated doctor.  A designated doctor is not a treating physician and there is no doctor-patient relationship between a designated doctor and the injured claimant the doctor is examining.  The designated doctor is asked whether the injured worker is at maximum medical improvement and if so, what is the percentage of permanent impairment, whether the claimed medical conditions are part of the compensable workers’ compensation injury, and the disability and work restrictions applicable to an injured worker as a result of the compensable on the job injury.  A designated doctor can be appointed upon the request of the insurance company, an injured worker, or by the hearing officer or presiding officer of the Texas Department of Insurance Division of Workers Compensation.  If you receive a notice to attend a designated doctor’s appointment or a report from a designated doctor, contact the attorneys at Allison & Ward so that we can review your case with you to determine if we can assist you with your Texas Workers’ Compensation case.

How do attorneys who handle Texas workers’ compensation claims get paid?

Texas law establishes how attorneys who represent injured workers within the Texas Workers’ Compensation system get paid.  The law as of 2015, provides that attorneys are paid an hourly rate of $150.00 per hour.  The attorney is limited by the Texas Department of Insurance Division of Workers’ Compensation as to how many hours can be billed per month and what the attorney can bill for.  Once the attorney’s fees are approved by the Texas Department of Insurance Division of Workers’ Compensation, the fees are sent to the Texas workers’ compensation insurance carrier.  The Texas workers’ compensation insurance carrier will issue checks for attorney’s fees to the attorney out of any checks the claimant is receiving, up to a maximum of 25% of each check to pay the attorney fees.  Attorneys who accept Texas workers compensation cases can never accept payment for their fees directly from their clients.  If a Texas workers compensation claimant is not receiving checks from an insurance company the attorney fees are not paid even if it means the attorney never receives payment for the time the attorney spent working on the claim.  The attorneys at Allison & Ward often work for claimants who are not currently receiving checks from an insurance company because the attorney believes they can get additional income benefit checks for the claimant and once the injured worker is receiving checks the attorney will be paid.  Contact Allison & Ward to discuss the specific facts of your case with an attorney who will review the facts of your case to determine if our office can represent you.

What is a nurse case manager?

A nurse case manager is a healthcare professional hired by the Texas workers’ compensation insurance company to assist the insurance carrier with your claim.  You have the right to refuse to allow the nurse case manager to attend your doctor appointments with you.  If you are concerned by a nurse case manager, contact the attorneys at Allison & Ward for assistance.

What is a non subscriber?

Texas allows employers to choose whether they will be covered under Texas Workers’ Compensation insurance and participate in the Texas Workers’ Compensation system or whether they will not subscribe to the Texas Workers’ Compensation system.  A non subscriber is an employer who has chosen not to participate in the Texas Workers’ Compensation system and who does not have Texas Workers’ Compensation insurance.  Some very large companies, many hospitals and many small employers do not subscribe to the Texas Workers’ Compensation system.  This means their workers are not covered by Texas Workers’ Compensation Insurance.  To determine if your employer is a non subscriber contact the office of Allison & Ward.  Our attorneys have forty years of combined experience handling employers who are covered under the Texas Workers’ Compensation system and those who are non subscribers.