If you have been injured on the job in Texas, you are entitled to benefits that compensate you for medical costs and lost wages. When you have severe injuries that affect your whole body or reduce your ability to function normally, you are also entitled to benefits that compensate you for this long-term impairment.
The length of time that you receive these additional benefits is determined by an “impairment calculation.” Texas impairment calculations are complex, and not always correct. This guide will explain the Texas impairment rating calculator, and how it affects workers’ compensation benefits.
How is the Texas Impairment Rating Calculated?
In order to understand Texas impairment ratings, it is first necessary to explain Texas’ MMI, or Maximum Medical Improvement. Impairment ratings are calculated after you reach MMI.
What is Maximum Medical Improvement?
After an illness or injury, when you receive medical treatment, medication, and therapy, your condition gradually improves. When being treated for a cold, or a sprained wrist, you may expect to be fully recovered in a matter of weeks, and resume your activities as normal.
However, for many severe injuries, like back and shoulder injuries, even the best medical care in the world may not return you to completely normal functioning. Some injuries have long-term (or permanent) effects, and continued medication, therapies, and treatments will not provide further benefits.
When a doctor determines that future medical care will not further improve a person’s functionality or recovery, they are said to have reached Maximum Medical Improvement, or MMI.
How is MMI Determined?
Under Texas law, MMI can be determined in a few different ways. Here are the ways a patient may reach MMI:
- The patient recovers. When a patient is fully healed and recovered, no further care is necessary
- A doctor makes the decision. A doctor may decide that further medical care won’t cause any improvement, and report their findings to workers’ comp
- A set time has passed. According to workers’ comp guidelines, a patient must reach MMI by 104 weeks or sooner. You cannot keep receiving medical treatment and collecting temporary benefits indefinitely
Why Does MMI Matter?
MMI matters because it marks the transition from workers’ comp Temporary Income Benefits (TIBS) to workers’ comp Impairment Income Benefits (IIBS). While you are still undergoing treatment, you receive Temporary Income Benefits. If you are still impaired after undergoing medical care, as determined by the MMI, you are entitled to longer-term Impairment Income Benefits.
What is an Impairment Rating?
An Impairment Rating is a medical determination of the percent of function you have lost due to the injury, and your medical prognosis. For example, if you have ongoing numbness in your elbow, you may have lost 1% of your normal function. If you have permanently lost range of motion in your neck, you may have lost 30% of your normal function.
This percentage assessment is made by a doctor, who assigns you an impairment rating and reports their findings to workers’ comp.
How is an Impairment Rating Calculated in Texas?
The impairment rating calculator is used during a special exam, performed by your own medical care provider, or by a state-appointed doctor. During the exam, the physician measures and evaluates several factors, including:
- Your strength
- Your range of motion
- Loss of feeling or sensitivity
- Pain thresholds
The findings of this examination are then compared to the American Medical Association’s Guides to the Evaluation of Permanent Impairment, and a percentage calculation is assessed and assigned.
In that sense, the term “calculator” is a bit of a misnomer: there is no actual calculator involved. It is simply a percentage rating assigned by a doctor.
Why Does My Texas Workers’ Compensation Impairment Rating Matter?
In Texas, the impairment rating calculator determines how many weeks of workers’ comp impairment benefits you receive. Your impairment benefits are equal to three weeks of benefits for each percentage point of impairment. In the example above, a 1% assessment for the elbow is equal to 3 weeks of IIRS after MMI. A 30% assessment for the neck is equal to 90 weeks of benefits after MMI.
Why the Guide May Not Be a Valid Way to Assess Your Injury
Every edition of the Guide to the Evaluation of Permanent Impairment has been greeted with some debate and controversy.
The truth is, although the Guide seeks to establish objective, consistent guidelines that apply to all patients in all cases, the process of assessing and rating impairment is highly subjective, based on the judgment of a single physician, and heavily influenced by region, specialty, training, and other factors.
In a 2000 report by the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group, there were dramatic inconsistencies in impairment ratings within the state of Texas — for example, in Fort Worth, only 17% of patients with Carpal Tunnel Syndrome were rated 10% or higher, while the same diagnosis is rated 10% or higher 34% of the time in Houston. Furthermore, many US states require doctors to specifically undergo impairment rating training before making these calculations, while Texas does not.
What if I Disagree with the Impairment Rating?
If you disagree with your Texas workers’ compensation impairment rating, you can dispute the decision.
People dispute their impairment ratings for a variety of reasons, including disagreeing with the calculation, disagreeing with their MMI status, feeling that their examination was not comprehensive, and other factors.
The exact procedure for disputing your rating depends on your reason for the dispute. For example, you may be entitled to request an examination by a different physician, or request a review of your benefits amount. If you still disagree with the new findings, you may also file an appeal, and take your case to court.
Why You Need a Lawyer to Help You Fight Your Unfair Impairment Rating in Texas
If you disagree with the impairment rating calculator or have other problems with Texas workers’ compensation after an injury, it is important to talk with an attorney right away. There are several reasons why you need expert legal advice to fight on your side, including:
- Time limits. At every stage of the workers’ compensation process, you have statutory time limits in which to file your paperwork and make your claims. When you or a loved one are recovering from an injury, it can be difficult to monitor all these deadlines and ensure you file everything correctly and on time.
- Expert advice and guidance. Even minor injuries can have long-term effects, and you may not be aware of all the benefits available to you, and the legal proceedings to claim the compensation you deserve. A Texas workers’ comp attorney understands aspects that you may not be aware of.
- Fight any opposition. As you pursue your rightful benefits and compensation, you may find opposition from insurance, your employer, workers’ comp, or other parties involved in your injury. They may try to reduce your benefits or get you to sign a quick settlement that doesn’t give you all the compensation you deserve.
Aaron Allison believes in fighting for injured and impaired workers, and his law firm has decades of expertise in getting workers all the benefits they deserve. Aaron Allison offers free consultations, and the attorney fees are covered by your settlement, so you pay nothing upfront. If you or a loved one have been injured in a Texas workplace, contact us today.