Existence of Employment Relationship (C02)
To be eligible for benefits under the Act, the IE must have been an employee of an employer that carries workers’ compensation insurance coverage at the time the work-related injury occurred. Section 406.031. [Cross reference. Course and Scope of Employment (C00)]. A dispute about an IE’s employment status is one of compensability and is subject […]
Income Benefit Rate Calculation (I01)
Income benefits are calculated based upon the IW’s AWW. The Division computes the State maximum and minimum income benefit amounts on an annual basis. See Sections 408.061 and 408.062. In general, income benefits have a maximum and minimum weekly amount. See Section 130.102(f) dealing with the calculation of SIBs. Note that it doesn’t mention a […]
Multiple Employment Employee (W06)
[Cross-references: Amount of AWW (W01); Entitlement to Multi-Employer Benefits (I25)] When an IE is employed by more than one employer on the DOI, the IC shall calculate the AWW for that IE using the wages from all of the employers. For this purpose, the IE is required to submit a Multiple Employment Wage Statement (DWC […]
Entitlement to Multi-Employer Benefits (I25)
[Cross-references:Amount of AWW (W01);Multiple Employment Employee (W06)] When an IE is employed by more than one employer on the DOI, the IC shall calculate the AWW for that IE using the wages from all of the employers. For this purpose, the IE is required to submit a Multiple Employment Wage Statement (DWC Form-003ME) to the […]
Amount of AWW (W01)
The IW’s AWW shall be calculated using gross wages. Section 128.1(d). The amount of income benefits and death benefits an IW or an IW’s legal beneficiaries are entitled to be paid is based upon the IW’s AWW. Except as provided by Section 128.7 regarding school district employees, the IW’s gross wages include all pecuniary and […]
Existence of Coverage (C01)
Actual coverage of an IE is a threshold requirement for establishing the liability of an IC. APD 022268-s; TLC Section 401.011(44) lists three methods to provide workers’ compensation insurance coverage: purchasing an insurance policy; providing certified self-insurance or group self-insurance; or coverage provided by a governmental entity. See also TLC Section 406.003. Under Chapter 91 […]
Jurisdiction (P03)
Benefits for a compensable injury are defined as medical benefits, income benefits, death benefits, or burial benefits. TLC Section 401.011(5). The AP has jurisdiction in cases involving disputes over income benefits, death benefits, and burial benefits. 28 TAC Section 140.1(1) and (2). The AP also has jurisdiction to determine whether an IE is entitled to […]
Dispute of Designated Doctor Impairment Rating (I11)
[Cross-references: Date of MMI (I06); Impairment Rating (I07).] Only an IC, IE, IE’s attorney, or IE’s representative defined under 28 Texas Administrative Code (TAC) Section 150.3(a) may dispute a first valid assigned IR. 28 TAC Section 130.12(b)(1). Under 28 TAC Section 130.12(b)(1), where a designated doctor (DD) has not been appointed to address MMI and […]
Dispute of Designated Doctor MMI Date (I10)
[Cross-references: Date of MMI (I06); Impairment Rating (I07); Dispute of Designated Doctor MMI Date (I11).] Only an IC, an IE, an IE’s attorney, or an IE’s representative defined under 28 Texas Administrative Code (TAC) Section 150.3(a) may dispute a first valid certified MMI date. 28 TAC Section 130.12(b)(1). Under 28 TAC Section 130.12(b)(1), where a […]
Election of Remedies (C20)
Election of remedies is an affirmative defense raised by ICs to an IE’s claim under the Texas Workers’ Compensation Act. Allstate Ins. Co. v. Perez, 783 S.W.2d 779 (Tex. App.-Corpus Christi 1990, no writ). The IC has the burden of proof on this issue. APD 032585. In such cases, the IC must prove that the […]