| Understanding the Texas workers’ compensation system can be difficult from every perspective, especially from that of the injured worker. We will attempt to highlight the processes so that you may gain a better idea of what to expect. Upon injury the employer should be notified and a written report take place on an initial notice of injury form that the employer’s human resource department should have if the employer is a Texas workers’ comp subscriber or the equivalent form if non subscriber and operating under their own policies. If the employer refuses or claims to have no evidence of an injury the injured worker can have this filed on their behalf by their legal or medical office. Once there has been a claim established a claim number and adjuster is assigned. The adjuster is responsible for the payment of financial benefits called temporary income benefits (TIBS) as well as medical benefits. A case manager may be assigned as well. The case manager is responsible for issues regarding return to work. Usually, case managers are involved with injuries that require extended time lost from work. The injured worker has the right to choose any doctor that accepts workers’ compensation for non-network insurers and can still choose network doctors but only specific to the list provided by the insurance or employer. When the injured worker goes to the doctor, the doctor is required to fill out a job ability determination upon initial visit and at least every 30 days until released. The options for the doctor are full duty, light duty or off work. This is usually determined by a physical performance evaluation (PPE) or functional capacity evaluation (FCE). This test allows for an objective comparison between the injured worker’s job duties and their current physical status. Therapy is typically ordered for up to 12 sessions in a month for most musculoskeletal injuries. After this, a comparison evaluation is usually performed to determine the injured worker’s current status and potentially a referral for pain management or further imaging or even a surgical consult. A Texas workers’ compensation claim is considered open up to 102 weeks from date of injury or at the establishment of maximum medical improvement (MMI) whichever comes first. The establishment of MMI can be performed by either the treating doctor or the State appointed designated doctor. Once the MMI is established the case is effectively closed for further benefits unless there is a change of condition such that is objectively documented (beyond pain) or a chronic pain program criteria is met or an election to proceed to surgery. If surgery is pursued the process effectively starts over again. We hope this discussion brings value to you and wish you an efficient and expeditious recovery. |
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