Understanding Workers' Compensation Payments in Texas

How Texas Calculates Workers' Compensation Payments

In Texas, workers' compensation benefits are determined by the injured employee's average weekly wage (AWW) and the nature of the injury. The state uses a standard formula: 60% of the AWW for non‑temporary total disability, 70% for temporary total disability, and 55% for temporary partial disability. The AWW is the gross weekly earnings earned during the last 12 months before the injury, including overtime and commissions, but excluding bonuses and other non‑salary compensation.

Payment Timeline and Key Deadlines

After a claim is filed, the employer's insurance carrier must review and approve it within 15 business days. Once approved, the employee typically receives the first benefit payment within 30 to 45 days. Subsequent payments are issued monthly until the disability is resolved or the maximum benefit period—usually 104 weeks for total disability—expires.

Maximum Benefit Periods and Caps

Texas limits the duration of benefits to a maximum of 104 weeks for total disability and 52 weeks for partial disability. Additionally, the total amount paid cannot exceed the employee's AWW multiplied by 104 weeks. These caps ensure that payments remain within a predictable range for employers while providing a safety net for workers.

Appealing a Denied Claim

If an insurer denies a claim, the employee has 30 days to file a written appeal. The appeal must include evidence such as medical records, a physician's statement, and a detailed account of the injury. The Texas Department of Insurance will review the appeal, and if it finds the denial unjustified, it will order the insurer to pay the benefits.

Common Mistakes to Avoid

1. Failing to report injuries promptly: Employers must report workplace injuries within 10 days to avoid penalties. 2. Inaccurate wage reporting: Underreporting wages can reduce benefits; overreporting can trigger audits. 3. Ignoring medical follow‑ups: Skipping required medical visits can result in benefit reductions or denials.

How Backlink Acquisition Helps Workers' Compensation Law Firms

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