Texas Mutual Insurance Company - Providers of Workers' Comp Insurance

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Texas workers' comp basics

This is a general overview of the basics of Texas workers' compensation benefits and provides some information about the types of available benefits for those injured workers with compensable claims.

Texas benefits are administered by the Texas Department of Insurance, Division of Workers' Compensation (DWC).

The Texas workers' compensation system is a state-regulated insurance program that:

  • Provides income benefits to replace some lost wages for workers with compensable injuries or illnesses,
  • Pays medical benefits for treatments related to the worker's compensable injury or illness, and
  • Provides some legal protection ("exclusive remedy") for employers.

To be considered compensable, an injury must have occurred within the worker's course and scope of employment. Generally, the term does not include injuries that occurred:

  • While the worker was intoxicated.
  • Due to the worker's willful attempt to injure himself or herself.
  • Due to the worker's willful attempt to unlawfully injure another person.
  • As a result of another person's intentional act to injure the worker for personal reasons.
  • While the worker voluntarily participated in an off-duty recreational, social, or athletic activity.
  • As a result of an act of God.
  • Due to the worker engaging in horseplay on the job.

An insurance carrier has 60 days from receipt of notice of a claim to investigate and determine if an injury is compensable.

Income Benefits

Income benefits, which are sometimes called indemnity or lost wages benefits, replace a portion of wages that are lost because of work-related injuries or illnesses. There are five types of income benefits:

Temporary income benefits

Injured workers who miss more than seven days of work are eligible to receive temporary income benefits (TIBs) of up to 75% of their pre-injury Average Weekly Wage (AWW), depending on their hourly pay and subject to the state established maximum and minimum amounts. After the first 26 weeks of TIBs, all workers receive a maximum of 70 percent of their AWW.

The injured worker continues to receive weekly TIBs until the worker reaches maximum medical improvement (MMI) or returns to full employment. TIBs may last as long as 104 weeks after the date the worker became eligible to receive income benefits, although some exceptions may apply.

For more information about temporary income benefits, click here.

Impairment income benefits

If the employee's injury results in a permanent impairment, the worker may receive impairment income benefits (IIBs) based on the percentage of the total body impairment. Doctors may only assign impairment ratings after the worker has reached maximum medical improvement (MMI).

IIBs are paid weekly at the rate of three weeks of IIBs for each percentage point of impairment. In some cases, if the injured worker has returned to work, the worker may elect to commute a portion of his or her IIBs.

For more information about impairment income benefits, click here.

Supplemental income benefits

An injured worker may receive supplemental income benefits (SIBs) after the expiration of the IIBs period if the worker has:

  • An impairment rating of 15 percent or more,
  • Not returned to work or has returned to work earning less than 80 percent of this or her previous average weekly wage due to the impairment,
  • Made a good faith effort to find work commensurate with his or her ability, and
  • Not received IIBs in a lump sum payment.

SIBs equal 80 percent of the difference between 80 percent of the worker's average weekly wage (earned prior to the work-related injury) and weekly wages (any earnings or offered wages during the 13-week period) after the work-related injury.

The injured worker must apply for these benefits quarterly and the benefits are paid monthly for each approved quarter.

The maximum time period that an injured worker may receive TIBs, IIBs and SIBs is 401 weeks from the date of injury.

For more information about supplemental income benefits, click here.

Lifetime income benefits

Certain work-related injuries may result in a condition that entitles a worker to income benefits for the rest of his/her life. Lifetime Income Benefits (LIBs) are paid if the worker incurs:

  • Total and permanent loss of sight in both eyes;
  • Loss of both feet at or above the ankle;
  • Loss of both hands at or above the wrist;
  • Loss of one foot at or above the ankle and the loss of one hand, at or above the wrist;
  • An injury to the spine that result in permanent and complete paralysis of both arms, both legs, or one arm and one leg;
  • A physically traumatic injury to the brain resulting in incurable insanity or imbecility; or
  • 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.

LIBs are paid weekly and equal 75% of the worker's average weekly wage, with a 3% cost of living increase each year.

For more information about lifetime income benefits, click here.

Death benefits

Death benefits replace a portion of lost family income for eligible beneficiaries of an employee who dies as a result of a compensable injury or illness. Death benefits pay up to 75 percent of the deceased worker's average weekly wage and may be paid if there is an eligible:

  • Surviving spouse,
  • Dependent child,
  • Dependent grandchild,
  • Other dependent family member, or
  • Non-Dependent Parents, when there are no surviving eligible dependent family members.

For more information about death benefits, click here.

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