- I’ve been injured on the job. What should I do?
Report your injury immediately to your supervisor and ask to fill out a First Report of Injury (DWC-1). Next find out if your employer is in a network. If they are, ask for a list of doctors and facilities where you can be treated. If not, you can be treated by any doctor and/or facility that takes workers compensation insurance.
- I’ve been seriously injured at work and need immediate medical attention. What should I do?
Go to the nearest emergency room. Be sure to tell them this is a workers compensation injury. Once you have received treatment, follow up with your employer about your status. If you haven’t already reported the injury to your employer, you’ll need to do so.
- I’ve reported my injury to my employer, but they won’t turn a claim in for me. What should I do?
You can contact TDI: Division of Workers Compensation at 1-800-252-7031 and report the injury. You can find out who your employer’s insurance carrier is from TDI and contact them as well.
- I don’t like the doctor my employer initially sent me to. What can I do?
If your employer is not in a network, you have the choice to see another doctor who accepts workers compensation. The doctor you choose will be the treating doctor on your claim, so make sure you are happy with your choice. If your employer is participating in a network, you can ask to see another doctor within that network.
- I’ve treated with my doctor several times and don’t feel he is helping me. Can I change doctors?
Yes. However, you will have to contact TDI: Division of Workers Compensation and request a Change of Treating Doctor form (DWC-53) in order to change doctors. The state requires that you complete this form and send it back to them. Upon their approval you will be allowed to switch doctors to the new one you have selected. Be sure this new doctor accepts workers comp insurance. If you are treating in our network, you will need to select a new doctor from those in the network.
- I received a notice to go see a Designated Doctor. Who is this doctor and why do I have to see him?
A Designated Doctor is a state doctor. Usually when you have been set up with a Designated Doctor, your adjuster has requested the visit. Although the adjuster requested the visit, the state picks the doctor you will see from a matrix (rotating list of doctors). Generally, you will see a doctor that is in a similar field to your treating doctor. The Designated Doctor does have presumptive weight over your doctor and any doctor you’ve seen at the request of your adjuster (for example a Required Medical Exam doctor).
- I’ve received a form stating I’m at Maximum Medical Improvement. What does that mean?
The form you’ve received is called DWC-69 Report of Medical Evaluation. It is the only form that can be used to issue Maximum Medical Improvement on a work related injury in the state of Texas. Per Labor Code Section 401.011 (30) Maximum Medical Improvement (referred to as MMI) means the earlier of:(A) the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated;
(B) the expiration of 104 weeks from the date on which income benefits begin to accrue; or
(C) the date determined as provided by Section 408.104 (MMI after spinal surgery).If you wish to discuss your recently received DWC-69 establishing your MMI in further detail, you can contact your adjuster at Service Lloyds or The Texas Department of Insurance at (800) 252-7031.
- What if I don’t agree with the impairment rating I was assigned or that I’ve reached MMI with my injury?
You will need to contact TDI: Division of Workers Compensation at (800) 252-7031 to file a dispute on record regarding your disagreement with the DWC-69 you’ve received. You will need to do this within 90 days of receiving the DWC-69 form. The DWC-69 will become final once 90 days has passed from the date you received the report of MMI.
- What is the difference between Temporary Income Benefits (TIBS) and Impairment Income Benefits (IIBS)?
Temporary Income Benefits are benefits designed to replace your wages while you are losing time from work. These benefits will be paid at 75% of your average weekly wage if you make below $8.50 an hour. At the 27th week of receiving these benefits they will automatically reduce to 70% of your average weekly wage for the duration of your lost time.
Impairment Income Benefits are benefits paid for the impairment rating you were assigned when you were deemed to be at Maximum Medical Improvement with your injury. These benefits are not a wage replacement but rather benefits for an impairment the injury warranted. IIBS are paid at 70% of your average weekly wage.
- Are there minimum and maximum amounts paid in workers compensation benefits?
Yes. These amounts depend on the date of your injury. The state raises these amounts annually so they will vary by your date of injury. For example, if you were injured on June 10, 2008, the minimum amount you can receive in Temporary Income Benefits is $107 weekly. The maximum amount is $712. If you receive an impairment rating those benefits max out at $498 weekly. The minimum amount is $107.
- If my weekly check is late or I haven’t received one at all, who do I contact?
You can call our office at (800) 299-2977 and ask to speak with your adjuster.
- My check is obviously lost because it is 10 days late. What can I do to get a replacement check?
See the answer to #11. Per Service Lloyd’s policy, a replacement check cannot be re-issued until 14 days have passed from the date the original check was mailed. At this point, once our bank has placed a “stop pay” on the missing check, your adjuster will be notified to re-issue the check.
- I don’t agree with the amount I’m being paid. I recently received a raise at work and I should be receiving more money than this.
Benefits are based on your average weekly wage as it is calculated from the wage statement your employer completes. See also the answer to question #9. Per State law, your wages are calculated from 13 weeks of wages prior to your date of injury. We cannot use wages consisting of your date of injury or wages past that point.
- My doctor gave me a prescription. Where do I go to fill it?
You can take your prescription to any pharmacy that accepts workers compensation insurance. Be sure to tell the pharmacy this is workers comp and give them our name, adjuster name, and number and your claim number if you have it. You can always call our office at (800) 299-6977 to obtain that information.