In Texas, there are two types of benefits that can be denied by 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.
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.
For more information regarding your workers’ compensation claim, please follow the links below for specialized information or continue reading for a comprehensive overview:
Texas Workers’ Compensation Income Benefits:
In Texas there are four types of income benefits. Temporary Income Benefits (TIBs), Impairment Income Benefits (IIBs), Supplemental Income Benefits (SIBs) and Lifetime Income Benefits (LIBs). The maximum benefit amount allowed by state law is based on your average weekly wage (AWW). Contact Mayfield Law Office to find out if you are receiving the maximum amount of benefits allowed under Texas State Law.
- Temporary Income Benefits (TIBs)
You become eligible for Temporary income benefits after you have missed seven days of work. Your Temporary Income Benefits will be equivalent to 70 percent of the difference between your average weekly wage and the wages you are able to earn after your compensable injury.
- Impairment Income Benefits (IIBs)
You could be eligible for Impairment Benefits the day after you reach Maximum medical Improvement (MMI), if you suffer from a permanent impairment for your compensable injury, and you have a valid Impairment Rating. You should receive three weeks of IIBs for each percentage of your impairment rating (IR).
- Supplemental Income Benefits (SIBs)
You could be eligible for Supplemental Income Benefits (SIBs) the day after Impairment benefits 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. Contact us today to see if you could be eligible.
- Lifetime Income Benefits (LIBs)
If you have an injury that causes you to have a permanent impairment then you could be eligible for lifetime income benefits (LIBs). They are paid from the time it is determined that your injury meets one of the qualifying conditions listed for Lifetime Income Benefits.
Texas Workers’ Compensation Medical Benefits:
Medical Benefits are paid out by your employer’s 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. Mayfield Law Office is knowledgeable in all areas to help you understand your workers’ compensation medical benefits, the insurance companies terminology, and we can help you understand what to expect when dealing with the insurance company. Including but not limited too:
- Designated Doctor (DD)
- (RME) Required Medical Exam
- 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
- Medical Fee Dispute
Texas Workers Compensation Dispute Resolution:
Your claim can become complicated when dealing with Workers’ Compensation Insurance carriers, especially when a dispute arises. In many instances, it can be helpful to retain an attorney to handle the dispute resolution process for you. Mayfield Law Office can help you handle all proceedings involved in the dispute resolution process such as a Benefit Review Conference (BRC), Contested Case Hearing (CCH), Arbitration, Appeals Panel hearings, and/ or Judicial Review.
- Benefit Review Conference
A benefit Review Conference (BRC) is held in front of a Texas Department of Insurance, Division of Workers’ Compensation Benefit Review Officer. The insurance carrier and the injured party accompanied by his/her attorney (if you have one) will informally meet in front of the hearing officer 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 a Texas Department of Insurance, Division of Workers’ Compensation Contested Case Hearing Officer. 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 Hearing Officer to the Appeals Panel.
- Judicial Review
Should either party disagree with the Appeal Panel Decision, it would have the right to appeal to a Court at law for a new decision.
If you have a worker’s compensation problem or simply have questions, please contact us.