Skip to Top Main Navigation Skip to Left Navigation Skip to Content Area Skip to Footer
Topics:   A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All

Workers' Compensation Income and Medical Benefits

Payment methods | 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 Ext. 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.


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

TDI-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. TDI-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: 7/19/2018