I handled a CCH today in Fort Worth on a Texas workers' compensation claim with a 1999 date of injury.  Now, I can't do something with every old claim that walks in the door, but some folks were seriously underpaid.  There are a lot of reasons why a claim would have been underpaid, and there is usually a solution, even if the claim is ten years old.

In this particular case, I was able to determine that the impairment rating was not properly calculated.  The designated doctor had screwed it up.  I was able to get the workers' comp insurance company to accept a higher impairment rating of 15%.  This made my client eligible for supplemental income benefits, and we were able to get a settlement on the unpaid SIBs too.  My client ended up getting more than a years' worth of benefits out of the agreement.

Before 2005, impairment rating methods and calculations were one of the most common mistakes made in a Texas work comp claim.  These mistakes can still be corrected today in many cases.  There aren't that many attorneys that represent injured workers today who had a lot of experience in impairment ratings prior to 2005.  If you can find one, you might see if you can get your older claim reviewed too.

 

I got a call today from a client that was alarming.  The adjuster had mailed a form to my client behind my back offering to pay her 37% impairment rating in a lump sum if she would just "sign the enclosed form."  The form was a DWC-51, Employee's Election For Commuted (Lump Sum) Impairment Income Benefits.

That sounds great and all.  Who wouldn't want to get 111 weeks of benefits paid in one lump sum?  The problem is the effects of electing to commute impairment income benefits.

Commuting benefits in the Texas workers' compensation system is a big deal, especially if the impairment rating is over 15%.  Remember, anyone that has an impairment rating of at least 15% is eligible to apply for supplemental income benefits - payments that can go on for up to about 7.5 years from the date of injury (401 weeks).  Commuting benefits means that the injured worker accepts the lump sum payment and then is no longer eligible for any additional income benefits.  There is no way out of it once the commutation is made.  There is no coming back later and saying, "I didn't know what that meant," or "I thought I was healed and wouldn't need benefits later but now I do." 

Once the impairment income benefits are commuted, that is the last payment ever on the claim.  End of story.

The reason I was so alarmed is because the client that received the form from the adjuster is being scheduled for surgery - her third one.  There is no telling what benefits this client would be giving up if she signed the form and sent it back.  It is clear though that it would probably cost her a lot of future benefits to commute the IIBs.

Thank goodness my client called me when she got the letter from the adjuster.  While there are criteria in place to be eligible to commute benefits, it is not uncommon for a commutation to occur without a claimant meeting the eligibility criteria.  It only takes a signature to get approved.

Anyone who receives such a letter from an adjuster should consult an attorney immediately.  Maybe commuting impairment income benefits is good for you, but a free consultation with a Texas workers' compensation attorney could keep you from making a big mistake just because you didn't understand the effects of an adjuster recommended action.

 

I haven't posted anything in awhile and I want to change that and get a little more regular with this blog.  In addition to the issue-oriented posts, I will start to mix in more regular observations of things that I see in the Texas workers' compensation system.

In case you don't know, Texas uses a book called the AMA Guides To The Evaluation of Permanent Impairment, 4^th Edition, to assess impairment ratings resulting from on-the-job injuries.  I mention this because today I received the new catalog from the AMA for impairment related texts.  They have all sorts of books available:  the AMA Guides themselves, books about the AMA Guides, books about legal issues and the AMA Guides, books about functional ability, etc.  You can buy all of these books as they relate to both the 5^th Edition of the AMA Guides and now the 6^th Edition of the AMA Guides.  BUT, the catalog had nothing at all related to the 4^th Edition, including the 4^th Edition itself.

Does that make you wonder a little bit?

I had a gentleman come in to see me about handling his Texas workers' compensation claim.  He was injured 5 months ago...and he has yet to see a doctor. 

Getting to a doctor to document your physical condition, diagnose your injuries and comment on your work ability should be one of the very first things you do if you have been injured.  Failing to do so can cause many problems with your claim.  For instance, the insurance carrier might argue that you really weren't hurt.  If you were hurt, you would have gone to the doctor!  Isn't that what a reasonable person would do?

Additionally, there will be no evidence about what your initial complaints were.  What if you injured your shoulder and low back and the insurance company says a witness did note that you complained of low back pain after an injury event but you never mentioned your shoulder to the employer?  Well, you didn't go see a doctor and tell him either!  That makes it real hard to show what the full extent of your injuries are.

If you have been injured at work in Texas and have a Texas workers' comp claim, make sure you see a doctor as soon as possible.  And remember, you have the right to choose your own doctor...you don't have to see a company doctor.