Average Weekly Wage

Hi, my name is Kim Wyatt, i’m the Managing Attorney of Bailey & Galyen’s Worker’s Comp department. Are you being paid the correct amount per week under your Worker’s Comp? The state average weekly rate right now is $938. This is calculated by what you made prior to your injury 13 weeks worth before taxes. You add it all up, divide by 13 and that is your average weekly wage. You want to make sure it contains bonuses, if your health insurance stopped you want to make sure they include that in your average weekly wage.

Give us a call today for a free initial phone evaluation of your case so that we can see how we might be able to help you.

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Light Duty – I was given an offer that I can’t refuse?

Confident factory workerSo the doctor has released you back to work, but with restrictions. What do you do now? First thing is to let your employer know by either faxing the work status report to them or bringing it to them in person. Your employer then must create a job for you that accommodates those restrictions, and that must be in writing. In 99% of the cases, that will NOT be the same day you hand them the work-status report. If they don’t have light duty, then the WC insurance carrier must pay you weekly temporary income benefits while you are off from work. There is no requirement that you go and seek work elsewhere, while you are on light duty. Now, if they do have a job you can do that is within the restrictions provided by your doctor, there are certain requirements that MUST be followed:

In accordance with Rule 129.6, the Bona Fide Offer of light duty MUST:

  • Have a copy attached of the work status report on which the offer is being based
  • State the location at which the employee will be working
  • State the schedule the employee will be working
  • State the wages that the employee will be paid
  • Provide a description of the physical and time requirements that the position will entail
  • Provide a statement that the employer will only assign tasks consistent with the employees, physical abilities, knowledge, and skills and provide training if necessary
  • Offer a position for a job at a location which is geographically accessible (129.6(e))

Until such time that they provide the offer of light duty that meets all of the above requirements, in most cases, you would not return back to work. Rule 129 was put in place to protect injured workers from returning back to work, just to be forced to do their regular work, and face worsening their injury. You must be very careful when the employer heads down this path of offers of light duty.

Your money benefits and physical-well being are on the line, and this would be a time to reach out to our Workers’ Compensation Department here at Bailey & Galyen so that we can advise you and protect you from possible re-injury.

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Light Duty- I was given an Offer that I can’t refuse?

So the doctor has released you back to work, but with restrictions. What do you do now? First thing is to let your Employer know by either faxing the work status report to them or bringing it to them in person. Your employer then must create a job for you that accommodates those restrictions, and that must be in writing. In 99% of the cases, that will NOT be the same day you hand them the work-status report. If they don’t have light duty, then the WC insurance carrier must pay you weekly temporary income benefits while you are off from work. There is no requirement that you go and seek work elsewhere, while you are on light duty. Now, if they do have a job you can do that is within the restrictions provided by your doctor, there are certain requirements that MUST be followed:

In accordance with Rule 129.6, the Bona Fide Offer of light duty MUST:

  • have a copy attached of the work status report on which the offer is being based
  • state the location at which the employee will be working
  • state the schedule the employee will be working
  • state the wages that the employee will be paid
  • provide a description of the physical and time requirements that the position will entail
  • provide a statement that the employer will only assign tasks consistent with the employees, physical abilities, knowledge, and skills and provide training if necessary
  • offer a position for a job at a location which is geographically accessible (129.6(e))

Until such time that they provide the offer of light duty that meets all of the above requirements, in most cases, you would not return back to work. Rule 129 was put in place to protect injured workers from returning back to work, just to be forced to do their regular work, and face worsening their injury. You must be very careful when the employer heads down this path of offers of light duty.

Your money benefits and physical-well being are on the line, and this would be a time to reach out to our Workers’ Compensation Department here at Bailey & Galyen so that we can advise you and protect you from possible re-injury.

I’ve Fallen, but I CAN Get Up: Why You Should Immediately Report All Work Injuries

warehouse workerSo you think you may have hurt yourself at work…well, you know you did. You might have the following thoughts: “It’s not that bad. Work through it and see if it gets worse. The weekend is here, so I’ll rest and see how I feel on Monday. I’m seeing my doctor next week, so I’ll just check on it then.” Stop! Report your work injury, no matter how minor you think it is, even if just “for the record.” If you get better on your own, great! I have seen many instances, though, where an injury starts out as minor but never gets better. A problem occurs when you report your work injuries later.

Report Your Work Injuries Immediately!

Your date of injury is very important, since you only have 30 days to report a work-related injury. Failure to report work injuries immediately, and seeking treatment on your own, makes the situation more suspect and gives the insurance carrier more reason to dispute your workers’ comp claim. It is more difficult for an attorney to assist you when an insurance company raises the defense that you failed to give notice of your injury within 30 days. In cases like that, the judge may not believe the injured worker, especially where the employer has multiple witnesses and the worker has none. Granted, we have won a lot of such cases, but don’t make the situation any harder than it needs to be. Focus on getting treatment for your injury and getting back to work. You might be trying to do right by the company and work through your injury on your own, only to find you’re unable to, and that the delay results in denial of your claim.

Don’t Fight Work Injuries Alone

If you have any doubts or concerns, reach out to the Workers’ Compensation department at Bailey & Galyen. We can answer your questions anonymously and give you information on the workers’ comp claim process. Never downplay your injury as ‘no big deal.’ At a minimum, make a record of the incident, even if no injury results from it.

What happens to my case if I move out of Texas?

Workers’ compensation claimSince you have lifetime medical benefits for the injuries that have been deemed accepted by the insurance carrier, you can pick up treatment wherever you move. You would need to locate a doctor that is willing to treat you for your workers’ compensation claim. Once you find a doctor, you would simply provide them with the insurance carrier’s information: Adjuster’s name, phone, fax, and claim number, so that they can submit their bills accordingly.

Of course, this is easier said than done, since it’s already hard enough to find doctor’s in Texas that will handle a workers’ compensation claim. It significantly helps if there are no disputes on your claim, which might make out-of-state doctors more apprehensive in becoming your treating physician. It’s also very important to make sure that all the injuries have been documented and accepted prior to moving if at all possible.

If there are disputes pending, or you are in the process of fighting to get your case accepted and for reasons out of your control you must move in order to be closer to your support group, you would be able to attend any hearings by phone. You would not be expected to return to Texas for your hearings. It would definitely be in your best interest to have an attorney be involved to assist you in these matters, especially when your money benefits or medical treatment can easily be disrupted by the insurance carrier during your move. Please call us today so you can understand your rights, and what to expect in this very trying time of your life.

Contact Us

To set up a free initial consultation, contact us online or call us at 844-402-2992. For your convenience, we answer our phones 24 hours a day, 7 days a week. We will meet with you evenings or weekends upon request.

I’ve Fallen, but I CAN Get Up: Why You Should Immediately Report All Work Injuries

warehouse workerSo you think you may have hurt yourself at work…well, you know you did. You might have the following thoughts: “It’s not that bad. Work through it and see if it gets worse. The weekend is here, so I’ll rest and see how I feel on Monday. I’m seeing my doctor next week, so I’ll just check on it then.” Stop! Report your work injury, no matter how minor you think it is, even if just “for the record.” If you get better on your own, great! I have seen many instances, though, where an injury starts out as minor but never gets better. A problem occurs when you report your work injuries later.

Report Your Work Injuries Immediately!

Your date of injury is very important, since you only have 30 days to report a work-related injury. Failure to report work injuries immediately, and seeking treatment on your own, makes the situation more suspect and gives the insurance carrier more reason to dispute your workers’ comp claim. It is more difficult for an attorney to assist you when an insurance company raises the defense that you failed to give notice of your injury within 30 days. In cases like that, the judge may not believe the injured worker, especially where the employer has multiple witnesses and the worker has none. Granted, we have won a lot of such cases, but don’t make the situation any harder than it needs to be. Focus on getting treatment for your injury and getting back to work. You might be trying to do right by the company and work through your injury on your own, only to find you’re unable to, and that the delay results in denial of your claim.

Don’t Fight Work Injuries Alone

If you have any doubts or concerns, reach out to the Workers’ Compensation department at Bailey & Galyen. We can answer your questions anonymously and give you information on the workers’ comp claim process. Never downplay your injury as ‘no big deal.’ At a minimum, make a record of the incident, even if no injury results from it.

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Light duty – I was given an offer that I can’t refuse?

Confident factory workerSo the doctor has released you back to work, but with restrictions. What do you do now? First thing is to let your employer know by either faxing the work status report to them or bringing it to them in person. Your employer then must create a job for you that accommodates those restrictions, and that must be in writing. In 99% of the cases, that will NOT be the same day you hand them the work-status report. If they don’t have light duty, then the WC insurance carrier must pay you weekly temporary income benefits while you are off from work. There is no requirement that you go and seek work elsewhere, while you are on light duty. Now, if they do have a job you can do that is within the restrictions provided by your doctor, there are certain requirements that MUST be followed:

In accordance with Rule 129.6, the Bona Fide Offer of light duty MUST:

  • Have a copy attached of the work status report on which the offer is being based
  • State the location at which the employee will be working
  • State the schedule the employee will be working
  • State the wages that the employee will be paid
  • Provide a description of the physical and time requirements that the position will entail
  • Provide a statement that the employer will only assign tasks consistent with the employees, physical abilities, knowledge, and skills and provide training if necessary
  • Offer a position for a job at a location which is geographically accessible (129.6(e))

Until such time that they provide the offer of light duty that meets all of the above requirements, in most cases, you would not return back to work. Rule 129 was put in place to protect injured workers from returning back to work, just to be forced to do their regular work, and face worsening their injury. You must be very careful when the employer heads down this path of offers of light duty.

Your money benefits and physical-well being are on the line, and this would be a time to reach out to our Workers’ Compensation Department here at Bailey & Galyen so that we can advise you and protect you from possible re-injury.

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Supplemental Income Benefits: You received an Impairment rating 15% or Higher

Workers’ Compensation - Woman injured in hospital bedWhen you have reached Maximum Medical Improvement and receive an impairment rating that is 15% or higher, you may be entitled to received Supplemental Income Benefits. SIBS are paid out monthly, which is calculated by using your Average Weekly Wage (AWW).You apply quarterly, so every 3 months you apply in order to receive monthly benefits for that Quarter.

There are a few ways to qualify, so please call us to discuss your case, to see which would be the best route for your to apply. Please refer to DWC form 52 for your SIBS application. The insurance carrier and/or Division of WC should have mailed this to you ahead of time.

If you are claiming a total inability to work, this one by far can be the most difficult since if any doctor states that you are able to perform some type of work, even if it’s sedentary, you must look for work. Please refer to form DWC 52. It is very important that you fill in each space regarding your job search. In addition please keep these objectives in mind: (a) Search for jobs that are within your work restrictions. For example, do not apply for a heavy labor position, if your restrictions state, “no lifting, bending, or kneeling.” (b) Be sure that the contact person is someone with hiring capabilities, meaning do not put a clerk or an employee that basically has no say-so regarding matters of hiring; (c) Be sure you have a number to the contact person, because the carrier will want to verify with that person that you did apply for a position with that particular company (please refer to form DWC 52); (d) Even if the company is not hiring at that time, leave a job application with them anyways. Be sure to check “not hiring” in the results column; (e) You MUST have the correct number of work searches each week. We can assist you in locating this information, please call us.

If in fact there are no doctors that indicate that you are able to work, your doctor must provide a narrative report that indicates the reasons that you have a total inability to work. If this letter is not sufficient, it may lead to a denial of your request.

Important: Please contact the Department of Assistive and Rehabilitative Services regarding any programs that you may be qualified for. If you refuse to cooperate with services offered by the DARS, you will lose entitlement to SIBs. Their number is 800-628-5115, please give them a call today, it costs nothing, and you can at least enroll and get your information in their system.

Although you may be eligible to apply, it is not an automatic right to receive SIBs. Often times you must fight for these benefits. Please feel free to contact my office if you have any questions or desire additional information.

Call Bailey & Galyen today at 844-402-2992 for a free initial phone consultation!

Fight Night!: He Started It!

Workers’ CompensationI often receive calls about injured workers who were involved in a fight at work. My first question is usually, “Who started it, and why?” This is important to determine because if an injury results from a dispute that arose from the injured worker’s duties, how the work was performed, or in self-defense, it might be considered within the course and scope of employment and be covered.

These claims fall under Section 406.032(1)(B), the “Willful Attempt to Injure Another of Self.” This area of law is determined by an Administrative Judge as a question of fact that he or she must decide when the insurance carrier raises an affirmative defense.

For example, verbal disputes occurring outside of the workplace between employees who do not get along, which later results in a brawl while at work, is not categorized as a work-related incident for either party. This is because whether employees like each other or do not get along is not related to the way the work is performed.

By contrast, injuries resulting from a confrontation between an employee and their foreman because the foreman belittles the employee on how the employee is performing the job, is categorized as work-related. In this example, there is no personal animosity and the injury arose from a disagreement related to the manner in which the injured worker was performing their duties. This would be deemed compensable, and the injuries would be covered. APD 962472

The bottom line is, do not bring personal drama into the workplace, even if you have an issue with a co-worker or management. In most circumstances, an altercation at work that results in a physical dispute arising from the manner in which you perform your job duties or in reasonable self-defense would be covered.

If you believe you were protecting yourself and had no part in starting a fight at work, you might be entitled to workers’ compensation coverage for your injuries. Be safe, but just in case, give us a call so we can review the specific facts to your situation and explain what your options are.

Contact Us

Email or call our offices at 844-402-2992 regarding any questions you may have regarding a work related injury.

My Employer Cancelled My Health Insurance

Man With Broken Arm Filling Health Insurance Claim FormHave you been off work due to an inury and discovered that the private personal health insurance you had with your company was cancelled or terminated? Here are a few useful tips that may help you with your claim moving forward.

Your employer must notify you that they plan to terminate your private health insurance and give you the option to purchase COBRA coverage, which must be paid out of your own pocket if you chose to maintain insurance.

This has no bearing on your workers’ compensation claim because that involves a separate/different insurance plan altogether. If your employer paid for any portion of your health insurance but has now stopped, this may factor into your average weekly wage for purposes of your indemnity benefits. As a result, your average weekly wage may increase a bit to include the amount of the health insurance that your employer was paying on your behalf.

Does this mean they can stop your private health insurance? The short answer is yes, they can (even though you are off work due to an injury sustained at work). This is most unfortunate for employees that depend on their private health insurance to cover chronic issues, regular medications to keep them healthy, or even coverage for their spouse and dependents. Most employees can not afford to pay for the COBRA cost to continue this health insurance since it’s usually more than what they get in workers’ compensation benefits!

What can you do? Give us a call today so that we can offer you an evaluation to see if the termination of the health insurance coverage would affect the amount of your average weekly wages for purposes of your weekly benefits.

Repetitive Trauma Injury

Repetitive Trauma InjuryA repetitive trauma injury, as opposed to a specific injury, occurs when there is repeated exposure to harmful activities in the work place. These might be any constant motions that you have to do for work each day every day. Examples are: data entry/key boarding, jobs that heavily rely on how many units or products you can crank out per hour, scanning/labeling/shipping, using certain tools that require squeezing/triggering.

In order to recover for an occupational disease of this type, an injured employee must prove that repetitious, physically traumatic activities occurred while on the job, and there is a casual connection between those activities and the harm or injury complained of. Proof of a repetitive trauma injury should consist of some presentation of the duration, frequency, and nature of the activated claimed to be traumatic.

To determine what your date of injury is, it’s the moment that a reasonably prudent person should have realized that the condition was work related. This isn’t when you first experienced symptoms! You may have had symptoms from a year ago but didn’t know they it was work related until you went to your doctor to discuss the reason for your symptoms. THAT doctor visit would be your date of injury, since that is when you realized that your condition was work related.

The date of injury is very important. If you didn’t report your injury within 30 days of knowing it was work related, your claim will quickly be denied. So its very important to know what your date of injury is. As soon as you find out that you have been injured on the job, give us a call for a free case evaluation over the phone.

What Does “Network” Doctor Mean in Workers’ Comp?

Work Comp Network DoctorThere has been much confusion as to what doctors an injured worker can or cannot visit for treatment. Many insurance companies offer network doctors that you must choose from in order to receive treatment under workers’ comp. Usually, the first doctor you see, if in network, becomes your doctor for all future treatments. Most networks allow for a one-time change, but it must be approved by the network or adjuster.

Finding a network doctor has been a huge headache and source of confusion for many injured workers. Often times, the list of doctors provided are only doc-in-the-box chains that are not equipped to handle ongoing issues or different levels of therapy. Unfortunately, not much can be done if you are stuck in the network scenario and unhappy with your medical provider. In order for a provider to be paid by the insurance carrier, he/she must be in the network.

If you have an insurance carrier that does not have a network, you may see any provider that accepts workers’ comp claims. You are allowed to change doctors, but you must submit a form to the workers’ comp division that must be approved before you start treatment with the new doctor.

Always ask the adjuster whether your case falls under a network, and, if so, ask for the name of the network. This information helps your attorney suggest other doctors in the network that may be able to treat you. Give Bailey & Galyen a call today if you need help understanding your workers’ comp case.

Tips for Reporting a Workplace Injury, No Matter How Minor

Workers’ Compensation InjuryAlways, always report any injury you sustain on the job—no matter how minor! A lot of people think, “Let me see if it will get better.” This is a bad idea. I had a client get scratched on the job, and he thought nothing of it. Weeks later, he was in the hospital with an uncontrollable infection that required amputation of the affected body part!

By law, you have 30 days to report a work-related injury to your employer from the date that you realized you sustained the injury, so the sooner you report your injury the better. If you wait too long, one of the first issues to arise will be, “What took you so long to report it?” If you fail to report your injury to your employer within 30 days of knowing about it, your worker’s comp claim will be barred. At that point, there is nothing an attorney can do to help you.

How do you go about reporting your injury? You must report it to someone who is higher up than you—not a co-worker at your same level. It must be a foreman, boss, supervisor, or HR representative. Keep proof of when, and to whom, you report the injury. If you make your report verbally, you risk having the employer come back later and say, “Nope, you never told me about it.” Then, without proof, it becomes a spitting contest as to who said what to whom.

Here are some ways to report your workplace injury, no matter how minor:
– Notify your employer in writing, in a way that provides you with proof of notification, such as fax, email, or any kind of mail service with delivery confirmation.
– Notify your employer in person, but make sure other people are present to “witness” it.
– If your injury requires a doctor’s visit, bring the doctor’s note to your employer, using one of the above methods to ensure you have proof of delivery and notification.

When you provide notice of your injury, you must clearly indicate that it was sustained on the job. It’s not sufficient to state, “My back hurt this morning, so I am going to see the doctor,” or call in sick the next day. Your notice must specifically state what happened, and when, where, and how it happened. Never assume your employer will or should know what you mean. You must spell everything out.

These are just a few things to follow to be sure you effectively notify your employer of any workplace injury. If you have questions, keep us in mind, as we are always here to help!

Tips for Reporting a Workplace Injury, No Matter How Minor

Workers’ Compensation InjuryAlways, always report any injury you sustain on the job—no matter how minor! A lot of people think, “Let me see if it will get better.” This is a bad idea. I had a client get scratched on the job, and he thought nothing of it. Weeks later, he was in the hospital with an uncontrollable infection that required amputation of the affected body part!

By law, you have 30 days to report a work-related injury to your employer from the date that you realized you sustained the injury, so the sooner you report your injury the better. If you wait too long, one of the first issues to arise will be, “What took you so long to report it?” If you fail to report your injury to your employer within 30 days of knowing about it, your worker’s comp claim will be barred. At that point, there is nothing an attorney can do to help you.

How do you go about reporting your injury? You must report it to someone who is higher up than you—not a co-worker at your same level. It must be a foreman, boss, supervisor, or HR representative. Keep proof of when, and to whom, you report the injury. If you make your report verbally, you risk having the employer come back later and say, “Nope, you never told me about it.” Then, without proof, it becomes a spitting contest as to who said what to whom.

Here are some ways to report your workplace injury, no matter how minor:

  • Notify your employer in writing, in a way that provides you with proof of notification, such as fax, email, or any kind of mail service with delivery confirmation.
  • Notify your employer in person, but make sure other people are present to “witness” it.
  • If your injury requires a doctor’s visit, bring the doctor’s note to your employer, using one of the above methods to ensure you have proof of delivery and notification.

When you provide notice of your injury, you must clearly indicate that it was sustained on the job. It’s not sufficient to state, “My back hurt this morning, so I am going to see the doctor,” or call in sick the next day. Your notice must specifically state what happened, and when, where, and how it happened. Never assume your employer will or should know what you mean. You must spell everything out.

These are just a few things to follow to be sure you effectively notify your employer of any workplace injury. If you have questions, keep us in mind, as we are always here to help!

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