Performance Audits Uncover Unpaid Workers’ Compensation Benefits

Workers’ Comp Attorney Examines Problems in the System

The insurance companies responsible for providing workers’ compensation benefits are subject to annual audits. These audits aim to identify unpaid benefits that should have gone to injured workers.

Recently, a review headed by the Texas Department of Workers’ Compensation (DWC) found that over half of a million dollars in benefits never went to workers injured on the job. These underpaid/unpaid benefits ware uncovered by the Texas DWC. Ryan Brannan, the commissioner of the DWC, said he was glad to see his department’s work pay off for those shortchanged by insurance companies.

“[We are] pleased to see that claimants received monies owed to them,” Brannan said. “There may be other deserving claimants in the same situation. These results indicate that we need to continue these types of performance audits.”

Why Don’t Injured Workers Get All Their Workers’ Compensation Benefits?

Under Texas workers’ compensation law, an employer is obligated to meet specific requirements for the payment of benefits that they owe. Texas Labor Code §408.081 states that all insurers must pay claimants their due benefits. However, due to intentional denials or bureaucratic oversight, insurers often violate these laws.

An insurer is in violation of this statute if it:

  • Fails to pay 75 percent of a worker’s average weekly wage
  • Fails to obtain a complete wage statement
  • Fails to properly calculate average weekly wage
  • Fails to include non-pecuniary wages (such as health care premiums, rent for employee housing, etc) in the average weekly wage

Injured at Work – What Benefits Can I Receive?

In the state of Texas, workers’ compensation benefits are classified into four different categories: income, medical, death and burial benefits. Income benefits and medical benefits can each be paid on a lifetime basis for those whose injuries leave them incapable of working again due to a disability or other chronic injury. Income payments are paid on the basis of providing either lifetime or temporary benefits for those dealing with impairments or needing supplemental income.

However, not all businesses in Texas are required to cover workers’ compensation. Many choose to opt out of workers’ compensation coverage, which means that injured workers’ must pursue other legal avenues to receive benefits from non-subscriber employers.

By working with a workers’ compensation attorney who has a thorough understanding of Texas workers’ compensation law, a claimant can rectify any administrative errors that result in an insurer’s failure to pay the correct amount of benefits.