THE LAW OFFICE OF ROBERT T. SAUNDERS​​​

WORKERS' COMPENSATION DISPUTES

CLAIM DENIALS
(Compensability Disputes) 

TIBs (Temporary Income Benefits) 

IIBs (Impairment Income Benefits) 

The insurance carrier has denied your claim, however,  it does not mean that there is no possible resolution. You can appeal the insurance carrier's decision by bringing the dispute before The Division of Workers' Compensation. You have the right to obtain services from an attorney to help you resolve the dispute. Your attorney might have to go through several dispute resolution proceedings before a final decision is made. These proceedings can consist of: 

Benefit Review Conferences (BRCs)
Contested Case Hearings (CCHs) 
You may be entitled to temporary income benefits if your injury has caused you to lose some or all of your pre-injury wages. The insurance carrier is responsible for commencing pay benefits after the 7th day of disability (missed time from work due to your injury). If the insurance carrier has denied payment on part or all of your income benefits, you have the right to appeal that decision. 
Impairment Income Benefits are paid after you have been determined to have reached Maximum Medical Improvement (MMI), which is when (1) no further healing or recovery from your injury can be expected, or (2) you were paid temporary income benefits for as long as the law allows. A certified doctor will provide a written report cerfitifying that you have reached Maximum Medical Improvement, however, you may not agree with the certifying doctor's decision, if so, you have the right to dispute it. Certifications should be disputed within 90 days from the date it was received. 

SIBs (Supplemental Income Benefits) 

LIBs (Lifetime Income Benefits) 

EXTENT OF INJURY DISPUTES

Texas law allows injured workers who have been severely injured to continue to receive income benefits for up to 7 1/2 years from the date of your injury. You may be entitled to such benefits if: 

(1) you were assigned an impairment rating of of 15% or more, (2) you have not returned to work or, if you did, you are earning less than 80% of your average weekly wage in your position due to your claimed injury, (3) show that you are looking for work; and (4) not accept a lump sum payment for your injury.

If you were denied supplemental income benefits you have the right to appeal that decision and be represented by an attorney. 
Lifetime income benefits are benefits that are paid for life to injured workers who: 

(1) total and permanent loss of sight in both eyes; (2) loss of both feet at or above the ankle; (3) loss of both hands at or above the wrist; (4) loss of one foot at or above the ankle, and loss of one hand, at or above the wrist; (5) an injury to the spine that results in permanent and complete paralysis of both arms, both legs, or one arm and one leg; (6) a physically traumatic injury to the brain resulting in incurable insanity or imbecility; (7) third degree burns that cover at least 40 percent of the body and require grafting, or
third degree burns covering the majority of either both hands or one hand and the face.

​If you were denied lifetime income benefits you have the right to appeal that decision and be represented by an attorney. 
​​ Insurance carriers often refuse to pay for medical treament based on their basis of only accepting certain injuries. If you believe that the injury for which the insurance carrier is not accepting as compensable was caused by your work-related injury you have the right to bring your dispute before the Division of Workers' Compensation. 
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