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 […]
Filing a Claim with DWC (C18)
Generally, an IE has one year to file a claim for compensation with DWC unless good cause exists or the employer or IC does not contest the claim. Texas Labor Code (TLC) Sections 409.003 and 409.004; 28 Texas Administrative Code (TAC) Sections 122.2 and 122.100. A claim for compensation does not necessarily have to be […]
Entitlement To and Amount of Burial Benefits (D06)
A burial benefit is not considered an income benefit. Texas Labor Code (TLC) Section 401.011(25). If the death of an IE results from a compensable injury that occurred before September 1, 1999, the IC shall pay the lesser of the actual costs incurred for reasonable burial expenses or $2,500. If the death of the IE […]
Abandonment of Medical (I18)
A finding that an IE has abandoned medical treatment, standing alone, is generally not in itself dispositive of anything. APD 950295. Normally, abandonment of medical treatment only serves to trigger an inquiry to the appropriate doctor as to whether MMI has been reached. APD 001587. Further, there is no provision in the Act or Rules […]
Entitlement to Commutation (I17)
An IE may elect to receive the remainder of IIBs to which he or she is entitled in a lump sum if the IE has returned to work for at least three months, earning at least 80% of the IE’s AWW. An IE who elects to receive the remainder of his or her IIBs in […]
Extraterritorial Injury (C19)
Coverage. An IE who is injured while working outside of Texas, or the IE’s legal beneficiary in appropriate cases, is entitled to Texas workers’ compensation benefits if the injury would be compensable had it occurred in Texas, and the IE has “significant contacts” with Texas or the employment is principally located in Texas. “Significant contacts” […]
Date Of Injury (C05)
[Cross reference: Compensability/Injury (Existence) (C06); Compensability/Occupational Disease (C14); Reporting Injury to Employer (C17).] The DOI for a specific injury is the date the IE sustained the injury. The DOI for an occupational disease, which includes a repetitive trauma injury, is the date the IE knew or should have known the disease may be related to […]
Contest by the Employer (C04)
[Cross Reference. Jurisdiction (P03)] An employer has the right to attend and present evidence at proceedings relating to an employee’s claim. But an employer may become a party in the DWC dispute resolution process and contest the compensability of an IE’s injury only if the IC “accepts liability for the payment of benefits.” TLC Section […]
Payment to Subsequent Injury Fund (D05)
Death benefits will be paid to the subsequent injury fund (SIF) if: the deceased employee has no living legal beneficiaries; if no claim for death benefits is made in a timely manner; or if all of the deceased employee’s legal beneficiaries cease to be eligible for death benefits before the expiration of the 364 full […]
Compensability/Occupational Disease (C14)
[Cross reference: Date of Injury (C05)] The term “injury” includes an occupational disease. Section 401.011(26). An occupational disease is defined as a disease arising out of and in the course of employment that causes damage or harm to the physical structure of the body, including a repetitive trauma injury. The term includes a disease or […]