In Texas, there are two types of benefits that can be denied by workers compensation insurance companies: Income and Medical Benefits. If your insurance company has denied your compensation and/or medical coverage, Mayfield Law Office may be able to resolve the dispute and help you achieve a favorable outcome. We understand that a denial of any portion of your claim can have a harmful impact on your quality of life, your family and your future.
Income Benefits
In Texas, there are four types of Income Benefits. The maximum benefit allowed by state law is based on your average weekly wage (AWW).
Temporary Income Benefits (TIB’s): You become eligible for TIB’s after you have missed seven (7) days of work. Your TIB’s will be equivalent to 70% of the difference between your average weekly wage and the wages you are able to earn after your compensable injury.
Impairment Income Benefits (IIB’s): You could be eligible for IIB’s the day after you reach maximum medical improvement, if you suffer from a permanent impairment for your compensable injury, and you have a valid Impairment Rating. You should receive three weeks of IIB’s for each percentage of your Impairment Rating.
Supplemental Income Benefits (SIB’s): You could be eligible for SIB’s the day after IIB’s end. These income benefits are applied for quarterly and are based on the 13 weeks of job searches prior to the Supplemental Income Benefits Application. This is considered the qualifying period.
Lifetime Income Benefits (LIB’s): If you have an injury that causes you permanent impairment, in some cases you could be eligible for for LIB’s. They are paid from the time it is determined that your injury meets one of the qualifying conditions listed for Lifetime Income Benefits.
Medical Benefits
Medical Benefits are paid out by your employers workers’ compensation insurance carrier directly to your healthcare provider. Knowing your rights about medical benefits is an important factor when dealing with your insurance adjuster. Mr. Mayfield is knowledgeable in all areas. He can help you understand what your benefits are, terminology, and can help you know what to expect. Including, but not limited too: Designated Doctor (DD), Required Medical Exam (RME), Extent of Injury, Maximum Medical Improvement (MMI), Impairment Rating (IR), Compensable Injury, Occupational Injury Disease, Reimbursement for Travel Expenses, Reimbursement for Medical Expenses, Treating Doctors, and Medical Fee Dispute.
Dispute Resolution
Mayfield Law Office can help you handle all proceedings involved in the dispute resolution process.
Benefit Review Conference (BRC): The insurance carrier and the injured party accompanied by his/ her attorney (if you have one) will informally meet in front of an administrative law judge at your local Division of Workers’ Compensation office to discuss any disputed issues.
Contested Case Hearing (CCH): A contested case hearing will follow a BRC should a resolution not be made at the BRC. This will be a formal hearing in front of the administrative law judge. The outcome of this will be mailed out as a Decision and Order.
Arbitration: Can be chosen as an alternate to a contested case hearing if both parties agree to this.
Appeals Panel: Either party may choose to appeal the Decision and Order from the Texas Department of Insurance, Division of Workers’ Compensation Contested Case administrative law judge to the Appeals Panel.
Judicial Review: Should either party disagree with the Appeals Panel Decision, they would have the right to appeal to a Court at Law for a new decision.
The mission at Mayfield Law Office is to uphold and protect the rights of injured workers and to use our legal experience and tools to assist clients in receiving compensation and healthcare benefits. In certain circumstances, Mayfield Law Office may be able to bring a negligence cause of action against parties responsible for your injuries, and sue for damages at law.
Knowledge is power. Contact us for a comprehensive evaluation of your claim.