| When you get hurt at work it can be frustrating to say the least but believe it or not you do have rights. You are entitled to healthcare benefits as well as financial benefits based on your ability to work or not. Perhaps the most important right you have is the right to choose your own doctor. While the employer may encourage or even insist that you go to their company doctor for initial evaluation, you have the right to select any doctor that accepts workers' compensation patients. The partial exception to that is if your employer's insurance company is associated with a network plan then you would need to select a doctor who is in that plan. You also have the right to change treating doctors one time. Please note that going initially to the emergency room or the company doctor does not count as a change of doctor should you decide to go elsewhere unless you have been there for at least 60 days. While changing treating doctors can involve your relocation or the doctor's relocation, the most common reason for changing doctors is that you're just not getting better. Perhaps your doctor is not communicating with you about exploring other treatment options or not referring you to a specialist to find out why you are not getting better. Texas Labor Code 408.021 states that you as the injured worker has the right to any and all healthcare that promotes, cures or relieves the naturally occurring effects of the compensable occupational injury. Evidenced based medical guidelines for treatment recommendations and timeframes have been established called the Official Disability Guidelines (ODG). Unfortunately for you and all injured workers the ODG has been eagerly supported by the insurance carriers as a form of significant cost containment through effectively limiting the amount of treatment available, which on average is about half as much as in years past for therapy as well as completely denying some treatment options. Financial benefits are also available to you if you have been injured on the job and cannot return to work based on your doctor's recommendation. The following criteria must be met: (1) Your doctor must complete an official form stating that you can or can't return safely to perform job duties either restricted or any duties. (2) If it is determined that you can perform restricted or limited duties safely then your employer must be able to comply with the doctor's restrictions or you are to remain off work. If the criteria is established to be off of work then your checks are to begin after 7 working days from report of injury upon receipt of your doctor's documentation. These checks are called temporary income benefits (TIBS) and are to be paid weekly at 70 percent of your weekly average income up to a capped amount of approximately 2500 per month. You are entitled to TIBS as long as you are off of work under the written advice of your doctor which must be established with doctor examinations every 30 days. This will last up to a maximum of 102 weeks from date of injury or at a time in which your doctor, the insurance doctor and ultimately the State of Texas appointed designated doctor determines that you are at maximum medical improvement. At this point you or your doctor has 90 days to appeal this decision if further obvious medical care is pending due to the nature and severity of your injury, such as a pending surgery. Once you have completed all health care per the accepted guidelines for your type of injury then the impairment rating will be established. Whatever your injury rating, is then multiplied by 3 and that is the amount of weekly checks to be paid to you in the form of a disability settlement if warranted. For example, if you suffer a low back disc injury with radiculopathy then your impairment may be a 5%, multiplied by 3 would be 15 weeks of pay. |
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