How to Get More Money Than Just
Your Workers Comp Check
Increase Your Temporary Income Benefits (TIBS)
Your Temporary Income Benefits (TIBS) are what most people refer to as a Comp Check. These are the checks that you receive for up to 105 weeks when you are unable to work. Insurance companies often figure these Comp Checks too low or in their favor. Does this surprise you? Call us and see if your Comp check is too low. Your weekly check is supposed to be calculated based on the 13 weeks of wages before your date of accident, including overtime and any job benefits that have stopped. If you worked less than 40 hours during any of these 13 weeks, we may be able to exclude those weeks. If you were employed for less than 13 weeks, your Comp check should be calculated based on a “same or similar” employee working for at least 13 weeks, using his pay and benefits!
Increase Your Impairment Income Benefits (IIBS)
Impairment Income Benefits (IIBS) start if you receive an impairment rating. When IIBS start TIBS permanently stop. The maximum rate for IIBS benefits is less than the maximum rate for TIBS, and you should never rush into getting an impairment rating because you may cut your comp check, sometimes significantly. However, the most important thing is to make sure that your TIBS check is the correct amount and that you are not being underpaid for Temporary Income Benefits. Once your average weekly wage is established it will be used for TIBS benefits, IIBS benefits and SIBS benefits. Your treating doctor is very important in establishing your impairment rating, and if you make a bad choice of treating doctors, you will suffer in two ways. First, you will suffer in loss of income due to a low impairment rating, and second, you will suffer from inadequate medical care. Doctors who normally give low impairment ratings also release injured workers to return to work much earlier than normal doctors. A number of doctors put insurance companies first over the interests of their patients, and the insurance companies and employers will do their best to send you to one of these doctors. Sometimes it’s the injured workers that make the mistake of choosing the wrong doctor out of ignorance or loyalty to a family doctor. It is always a mistake to go to a doctor for a workers comp injury without consulting a workers compensation lawyer.
Increase Your Supplemental Income Benefits (SIBS)
Supplemental Income Benefits (SIBS) are paid to injured workers whose impairment rating is at least 15%. Bad workers comp doctors seem to give a lot of 14% impairment ratings so that the insurance company can avoid paying SIBS. Here again, it is of utmost importance to get help in choosing your doctor for a workers compensation injury. Supplemental Income Benefits can be paid up to 401 weeks from the date of injury and this usually involves more comp payments or comp checks than TIBS and IIBS combined.
Collect Unpaid and Underpaid Comp (TIBS, IIBS & SIBS)
If your Texas Workers Compensation Check is less than $773.00 per week there’s a chance you are being underpaid by the Workers Comp Insurance Carrier. How could this happen? First of all, your employer must furnish correct wage information to the insurance carrier and calculate your average weekly wage based on a Texas Department of Insurance, Workers Compensation Division formula. It’s very complicated and non-lawyers, including the accounting people at your company and claims adjusters, get confused. However, in our experience they seem to almost always make mistakes in their favor and not in the injured worker’s favor. We will leave the conclusion of this to you. Call us and we will calculate what you should be receiving, right over the phone, in just a few minutes. This is free and there is no obligation at all. We will even do this for you anonymously.
Advances from the Workers Comp Insurance Carrier
Did you know that you could apply for an advance at the Division of Workers Compensation? You must use the appropriate form and know the rules, but it is possible. Did the insurance carrier tell you about this? To get a TIBS advance you must get the DWC to approve the request, at which time they order the workers comp insurance carrier to pay. The DWC will want medical documentation showing that the injured worker is likely to be entitled to sufficient income benefits to allow the carrier to recover the amount ordered. If you are receiving regular comp checks (TIBS) the medical provider needs to provide a letter showing the injured worker is expected to be off work long enough to recover the advance. If you are receiving Impairment Income Benefits or Supplemental Income Benefits we will comply with the rules for you.
Commutation of Impairment Income Benefits – Lump Sum
Did the workers compensation insurance carrier, your employer, your doctor or the DWC tell you that you are entitled to apply to receive your Impairment Income Benefits in a Lump Sum? The reason you are not told everything is because these organizations do not represent your interest. Even the DWC doesn’t represent your interest, and they are not your legal representative. The DWC must be “impartial” (whatever that means) to the employer, the carrier and the worker. What’s that old saying about trying to serve 2 masters? Well this is trying to serve 3 or more masters and it can’t be done. The only way for you to receive good representation is to hire a lawyer like the Ogletree Abbott Law Firm. We represent you and fight for you.
You have the Right to elect to commute your Impairment Income Benefits to a lump sum if you have returned to work for at least ninety days and are earning at least 80% of your pre-injury wages. We would send a formal request to the workers compensation insurance carrier to commute your IIBS benefits. You should never send this request to the DWC. If the carrier (or when the carrier) denies your request we would request a conference at the DWC office that is handling your claim. Our lawyers travel to every DWC office in the State of Texas.
Third Party Workers Comp Claims
A worker may become injured through no fault of his or her own but there are cases where the injured worker was injured due to some negligence of another person working for a different company. This situation is called a third party claim. A good example of a third-party claim is when an employee of a Company “A” is involved in a vehicle accident in which the employee was not at fault. The other driver, either an individual or someone working for Company “B” is at fault and becomes the third party. A third party claim is in addition to any workers’ compensation claim (subject to workers compensation carrier subrogation).
An injured worker can collect workers compensation benefits and also pursue a claim for damages against a third party. The injured worker must understand a few things. First the workers’ compensation insurance carrier has the right to subrogate against any third party claim a person may have. This simply means that the insurance carrier has the right to be reimbursed for all benefits they have paid to the injured worker under their workers’ compensation claim. Another thing is that the insurance carrier’s subrogation interest is limited to the amount of the total benefits paid or assumed by the insurance carrier to the injured worker or the legal beneficiary, less the amount by which the court reduces the judgment based on the percentage of responsibility determined by the trier of fact.
The net amount recovered by an injured worker in a third-party case is again recoverable by the insurance carrier, but you should know that if the amount recovered exceeds the amount of the reimbursement it will be treated as an advance against any future benefits, including medical benefits, that the injured worker is entitled to receive. If the advance is adequate to cover all future benefits, the insurance carrier is not required to resume benefit payments. If the advance is insufficient, the insurance carrier shall resume the payment of benefits when the advance is exhausted.
An injured worker should first have a good workers compensation attorney that knows and understands the ins and outs of the workers compensation system and also one that knows how to detect and handle a potential third-party case.
Get All of Your Medical Bills Paid – Avoid Getting Billed for Medical Care
Sometimes injured workers do not report every part of their body that was injured because, like most everyone, they concentrate on what hurts the most. Many times after a few days, a few weeks or even a few months, the injured workers discover other body parts that were injured. When this happens the workers’ compensation insurance carrier and the employer almost always fight the claim. In order to minimize its exposure to liability, the insurance company will often accept the most minor of injuries and will also try to minimize the severity of the injury. A workers’ compensation extent of injury dispute can arise in a number of different ways. First, an insurance company may agree that only one body part was injured, instead of accepting the full injury. For example, an insurance company may confirm that they are accepting a lumbar injury only but dispute that the cervical was injured or that they are liable for medical treatment to the cervical. Secondly, an insurance company may agree that the lumbar spine was injured in the accident but will only accept a very minor injury. For example, although an MRI might have been taken of the lumbar spine that revealed disc herniations or other disc pathology, the insurance company will only accept a sprain/strain. In either situation, whenever an extent of injury dispute arises in a claim, the dispute must be resolved in order for an injured worker to have access to medical treatment.
There are several ways in which you can discover if there is a workers’ comp extent of injury dispute in your case. The easiest way is if a letter is received from an insurance carrier that notifies you of the type or nature of the injury they are accepting. Usually, these letters, also referred to as Plain Language Notices, may describe the injury that the insurance carrier is accepting. Unfortunately, although the letters are referred to by the Division of Workers’ Compensation as “plain language notices,” sometimes the wording used in those letters is anything but plain. You will want to review the language in those notices carefully in order to be sure that the full severity of your injury will be paid for by the insurance company. Sometimes, the insurance company does not even send out a “plain language notice.” Instead, the way that an injured worker discovers that there is an extent of injury dispute in their case is when medical treatment is denied. If your doctor’s office is having trouble getting approval for medical treatment, such as diagnostic testing, injections, surgery, or even prescription medication, it may be a sign that the insurance carrier is not accepting your complete injury.
If there is a workers comp extent of injury dispute on your claim, it must be resolved as quickly as possible. Unfortunately, under the workers’ compensation system in Texas, it is the burden of the injured worker (or their representative) to pursue an extent of injury dispute. Basically, what this means is that in order for the dispute to be resolved, the injured worker must move forward through the dispute resolution process. The insurance carrier is not required to take any action once they have notified the injured worker that there is an extent dispute on their claim.
A workers’ compensation extent of injury dispute can dramatically impact your case. First and foremost, an extent dispute will usually result in a denial of medical treatment. For example, if the insurance carrier has explained that they are only accepting a lumbar sprain/strain and your pain management doctor has diagnosed you with a disc herniation and is requesting a lumbar epidural steroid injection, it will almost surely be denied. The reason is that the medical treatment necessary for a lumbar sprain/strain, which is likened to a pulled muscle, is drastically different than the treatment required for a disc herniation. The more time that passes before an extent dispute is resolved, the longer an injured worker will probably have to go without medical treatment. Unfortunately, a delay in medical treatment means not only that an injured worker is not able to return to work as quickly, but it may also result in a worsening of your medical condition. Secondly, an outstanding extent of injury dispute can also result in a lower impairment rating for your claim. At some point in every claim, the injured worker will receive what is known as an MMI certification and an Impairment Rating. The Impairment Rating is a percentage, from zero to one hundred and is given to compensate an injured worker for the permanent impairment they have as a result of injury. When an impairment rating is given, the law requires that the certifying doctor only give a rating for the body parts and diagnoses that the insurance company has accepted. So, in our earlier example, if the insurance company has only accepted a lumbar injury, but is denying a cervical injury, then a rating will only be given for the lumbar. Obviously, the exclusion of diagnoses can result in a drastically lower impairment rating than the one actually deserved.
If your doctors are experiencing difficulties in getting treatment approved, or if you have already received a letter from the insurance carrier notifying you that they are only accepting part of your injury, then contact our office immediately to discuss your claim in more detail.
Social Security Disability Income Claims
When workers comp injuries become permanent you may qualify for Social Security Disability Income Benefits. Social Security Disability is a federal program that pays income benefits if you’re disabled and unable to earn income on your own. Benefits are based on money that you have contributed to the program throughout your employment history. About one-half of all claims for Social Security Disability are denied and about one-half of those are appealed and won. Do not give up if you lost the first time around. As a matter of fact, please call us if you’ve already lost one appeal. The Ogletree Abbott Law Firm is a Social Security Disability Law Firm that handles appeals for those whose claim has been denied. We represent clients for a percentage of what we can recover for you. You do not need money to hire us. If we do not recover benefits, you owe us nothing. There is no cost or obligation to speak with us about your appeal.
If you have been denied, do not listen to the people at the Social Security office if they say that you are not entitled to benefits or if they try to discourage you from talking to a Social Security Disability lawyer to appeal the decision. Remember, we only get paid if we win the appeal, so let us make the decision as to whether or not you have a good chance at winning your appeal.
You should hire a Social Security Disability attorney for the appeals process due to the complexities of the law, changing Social Security rules, the ability of an attorney to choose which evidence is heard and that which does not need to be heard, and because an attorney can quickly react to questions by the hearing examiner due to his or her knowledge and experience. Claimants have little or no experience with Social Security Disability Appeals.
If your Social Security Disability attorneys are successful, they are paid from the award. This may bother you somewhat but it’s better than walking away with nothing. Social Security Disability Attorney’s fees are set by the Social Security Administration as follows: “No attorney’s fees are collected if your social security disability claim is not won. The attorney’s fees are always 25% of all past due benefits subject to a maximum amount determined by the Social Security Administration.
Unpaid Overtime Claims
If your employer has said he does not have to pay you overtime for working over 40 hours a week, you should call us and find out if the law says something different. It is likely that you may be entitled to up to three years back pay for unpaid overtime wages. This could be a lot of money and it’s yours if federal law says it is yours.
Every day employees are cheated out of overtime pay by their employers. It is not right for companies to cheat their employees, especially after those employees have worked so many hours to make these companies profitable. This is not about you taking advantage of them, it is about you getting paid for the time you have worked. It is also about stopping them from stealing from other people who may be worse off than you.
If it is determined that your employer willfully violated the law for paying overtime to you, then you may receive up to two times the amount of overtime pay that you earned but did not receive. This two times is to punish an employer so that they will stop violating the law and hurting workers and their families. Additionally, your employer is required to pay your attorneys fees.
Worried about your employer firing you if you ask to be paid for your hours? Federal law prohibits your employer from terminating you or retaliating against you in any way for filing an overtime claim.
We can help collect unpaid overtime, even if you didn’t ask for it. It’s the employer’s duty to pay overtime. Call us for more information at 713-223-1234.