Sad disabled woman reading bad news in a letter sitting on a couch in the living room at home

Trying to decode correspondence from the Texas Department of Insurance regarding your Workers’ Compensation Claim can be a difficult task.

While the acronyms and terms that relate to your workers’ comp claim may vary, many abbreviations are system-wide. That means that a lot of the confusing information you’re seeing on your correspondence with the Texas Department of Insurance can easily be understood with the use of some definitions of some of the most commonly used terms.

 

As an injured worker, you might be referred to in your TDI paperwork as an “EE”, or simply put: “employee.” Your injured worker claim will require you to report to the TDI-DWC (Texas Department of Insurance, Division of Workers’ Compensation). At this time, you’re generally expected to report your injury to your treating doctor and to your employer. Once a claim is received by the TDI, the claim might be disputed. The BRC – Benefit Review Conference – will review your claim for potential benefits. During this time, some of the common forms that might be completed include the DWC Form-041 (Claim for Compensation for a Work-Related Injury or Occupational Disease); DWC Form-045 (Request to Schedule, Reschedule, or Cancel a Benefit Review Conference ((BRC)); and DWC Form-150 (Notice of Representation or Withdrawal of Representation).

 

After a BRC and if all of the parties do not agree to resolve the dispute during arbitration, a CCH, or Contested Case Hearing, is the next level of dispute resolution. These hearings are highly regulated in order to facilitate the orderly conduct of CCHs statewide.

 

One of the most common terms you will hear your adjuster or attorney repeating is MMI, or maximum medical improvement. During the process, a doctor may find that you have reached MMI, or your condition has improved as much as it’s going to with treatment. A treating doctor will determine whether an injured worker is permanently impaired (PI). Your IR, or impairment rating, comes after a doctor assigns an injured worker that has reached MMI a percentage for his or her permanent disability.

 

Talking about your benefits is an important part of the workers’ comp rhetoric, but it seems that adjusters rush over this information without giving a rookie to the workers’ comp system a chance to understand. An injured worker may be paid temporary income benefits, or TIBs, if the worker lost all or some wages for more than seven days. Another potential income benefit is called “IIBs,” or impaired income benefits. “SIBs,” or supplemental income benefits, come into play when a person has an IR (impairment rating) of 15% or more and other varying qualifications.  A person is generally eligible for LIBs when he or she suffers from certain life-altering circumstances, and a written request must be submitted. If the LIBs claim is denied, one might be asked to fill out DWC Form PLN-04 (Notice Regarding Eligibility for Lifetime Income Benefits).

 

The workers’ compensation system was built around many complex regulations and terms, but you don’t have to understand everything on your own. We have an entire department of workers’ compensation attorneys, paralegals and legal assistants ready to help you. Give us a call today.

 

Confused About Your WC Claim as an EE? Whether You’ve Had NLT or TTD, We Can Help You Navigate this Complex Workers’ Comp System

Oct 22, 2019 | Blog Posts