Texas Workers Compensation Impairment Income Benefits Guide


Texas Labor Code (TLC) §§408.121 - 408.129
28 Texas Administrative Code (TAC) §§ 130.1 - 130.12

Impairment income benefits are paid for the damage done to your body as a result of your injury.  These benefits are based on your impairment rating.  You receive the impairment rating once you are certified as being at maximum medical improvement.  Maximum Medical Improvement (MMI) is reached when you are as well as you are going to be from the work-related injury or illness. This does not mean no future medical treatment will be needed for your work-related injury, that you will be completely pain free, or that you are released to return to work. When the health care provider determines you have reached MMI, the health care provider will determine if there is any permanent physical damage to your body as a result of your injury or illness. The health care provider will assign an impairment rating (IR) using the 4th Edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment. There are newer editions of these Guides, and some of these editions may provide a better impairment rating for your condition; however, Texas has never adopted the newer editions of the Guides, so they will not apply to your case. This is a question for you to discuss with your Texas legislator, as it is up to the Texas Legislature to adopt the newer edition of the Guides.  

The impairment rating describes the degree of permanent damage to your body as a whole.  This impairment rating is assigned as a percentage rating to your whole body as a whole.  For each percentage of impairment rating, you receive three weeks of impairment income benefit checks.  

For example:

If you receive a one percent (1%) impairment rating, you will receive three (3) weeks of impairment income benefit checks.  

If you receive a five percent (5%) impairment rating, you will receive fifteen (15) weeks of impairment income benefit checks.

If you receive a ten percent (10%) impairment rating, you will receive thirty (30) weeks of impairment income benefit checks. 

You can theoretically receive any number for the percentage of impairment rating, as long as it is allowed under the fourth edition of the Guides.  Whatever the number you receive, multiply it by 3 and you will have the number of weeks of checks that you should receive.

What happens to the temporary income benefit checks that you have been receiving?  They stop when you are certified as being at maximum medical improvement, and the impairment income benefit checks are paid instead, based on your percentage of impairment.  

If the injured employee has not previously reached maximum medical improvement, the workers' compensation law establishes that maximum medical improvement occurs 104 weeks from the date that income benefits began to accrue.   There are exceptions to this rule for spinal surgery cases.  An extension of the statutory maximum medical improvement date may be ordered by Texas Division of Workers Compensation if the employee has had, or has been approved to have, spinal surgery within twelve (12) weeks before the expiration of the 104-week period. Any order extending the date of maximum medical improvement will specify a date certain for maximum medical improvement.  There are specific rules regarding requesting the extension of maximum medical improvement and disputes of the Texas Division of Workers Compensation order regarding the extension of maximum medical improvement.  Our office needs to know the specific facts of your case in order to apply these rules to your situation.

If you have reached statutory maximum medical improvement, and your treating doctor has not assigned an impairment rating for you and does not respond to requests for an impairment rating, the Texas Division of Workers Compensation may assign a designated doctor to assign an impairment rating for you.  This is done upon the request of a party to the case.  

If you are at statutory maximum medical improvement and your treating doctor has not assigned an impairment rating to you, the insurance company may make as assessment as to what your impairment rating should be.  This is only as assessment and is not an impairment rating that can become final if not disputed within ninety days, because the assessment has not been assigned by a doctor certified to do impairment ratings and has not been assigned as a result of an examination of you in person by a doctor.  We sometimes receive phone calls from injured workers who have been told by the insurance company that the impairment rating assessed by the insurance company has become final because it was not disputed within ninety days, and this is incorrect information provided by the insurance company to the injured employee, as the law does not allow this situation to occur. 

There may be a question as to whether you are actually at clinical maximum medical improvement for your condition, based upon the treatment that you have received for your injuries.  If you have not received adequate treatment for your injuries, then whether you are at clinical maximum medical improvement may be in question.  This will depend upon the facts of your case.

The doctor that assigns your impairment rating must be certified by the Texas Department of Insurance, Division of Workers Compensation, to perform impairment rating examinations.  The doctor must make an assessment of permanent impairment on whether the work-related injury or illness has been resolved or not. 

If you disagree with the impairment rating that is assigned to you, you have a limited time period of ninety days to dispute the impairment rating. How this ninety day time period is calculated depends upon the facts of your case.  The dispute must be filed with the Texas Division of Workers Compensation timely.

The insurance company may also dispute your impairment rating.  There may be multiple disputes of multiple impairment ratings on your claim.  Your final impairment rating may have to be resolved through the Division of Workers Compensation dispute resolution process.

Amount of Impairment Income Benefits

Impairment Income Benefits equal 70 percent of your average weekly wage (AWW). There is a state maximum for impairment income benefits just as there is for temporary income benefits. The maximum for impairment income benefits is 70 percent of the state average weekly wage and depends upon the date of your injury.

For example, if the state average weekly wage were $773, the maximum IIBs rate would be $541.

State average weekly wage $773
70 percent of $773 (.70 x $773) = $541

If your average weekly wage were $700, your IIBs rate would be $490.

Average weekly wage $700
70 percent of $700 (.70 x $700) = $490

If your average weekly wage is higher than the state average weekly wage of $773, such as $925.50, you will not receive 70 percent of $925.50. Instead, you will receive $541 per week, the maximum IIBs rate allowed by law.

Average weekly wage $925.50
70 percent of $925.50 (.70 x $925.50)=$647.85 ($541 maximum limit for IIBs)

When Impairment Benefits End

The Impairment Income Benefits (IIBs) end after the total number of weeks of impairment income benefits due to you are paid out to you based upon a final impairment rating.  Because impairment income benefits begin the day after you reach maximum medical improvement (MMI), the start date of the impairment income benefits may be back dated to your date of maximum medical improvement.  This usually occurs when there is a delay between the date you are certified as being at maximum medical improvement and are assigned a rating, and the insurance company receives the certification.  The insurance company is allowed to take a credit for the fact that they have been paying temporary income benefits to you in the meantime.  This will result in an overpayment of temporary income benefits.  If the temporary income benefits are paid at a higher rate than the impairment income benefits, there may be money owed back to the insurance carrier for the overpaid temporary income benefits.  The insurance carrier may be allowed to take a credit for the overpaid income benefits.  Each of these situations depends upon the facts of the specific situation.  

Once the impairment income benefits paid based upon a final impairment rating end, you will not receive additional income benefits on the claim unless one of the following applies to you:

  • you have a substantial change in your condition, resulting in your lapsing out of maximum medical improvement and becoming entitled to additional temporary income benefits or impairment income benefits, or both; OR
  • you have a 15% or higher impairment rating, so that you become entitled to receive an additional income benefit paid to you, called supplemental income benefits.  Your initial entitlement to supplemental income benefits will be based upon your situation during the last three months that the impairment income benefits are paid.  This is one reason that your impairment rating is important as it affects your ability to obtain other benefits on your claim.
You are still entitled to lifetime reasonable and necessary medical benefits for your injury regardless of whether you are receiving income benefits.

For more information about impairment income benefits, impairment ratings, maximum medical improvement, substantial change of condition, or supplemental income benefits, please contact our office to discuss your specific situation and how the laws and rules specifically apply to your situation.

We are here to help.  Please feel free to call and ask a question.  Our office number is (817) 267-7770.  

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