The University of Texas System Workers' Compensation Insurance (WCI) benefits may include medical, income or death benefits for an employee's work-related injuries.
Medical Benefits
If an employee's work-related injury is compensable under the workers' compensation insurance program, the employee is entitled to health care reasonably required by the nature of the compensable injury.
What is the process of choosing a doctor?
The injured employee is initially entitled to choose a primary physician for medical treatment. The doctor's information must be documented on the Employer's First Report of Injury Form (DWC-1).
What is the process of changing the primary physician?
The employee may not change treating doctors without authorization from The Texas Department of Insurance, Division of Workers' Compensation (DWC). If the employee changes treating doctors without authorization from DWC, the employee may become personally responsible for any medical treatment rendered by the unauthorized physician. The DWC may provide any further information regarding changing doctors for injured employees.
What is the process of purchasing prescription medication?
When purchasing prescription drugs for work-related injuries, the employee will not use group health plan cards. Most pharmacies will bill WCI directly upon verification of coverage. Personal and non-prescription items are generally not covered by the workers' compensation program.
What payments are expected of employees?
Unless the injured employee has received medical treatment from an unauthorized physician, the employee will not be billed directly for health care intended to treat a work-related injury. If the employee receives a bill from a health care provider, the employee must send the invoice to WCI immediately. All medical related expenses are subject to fee guidelines established by DWC.
Income Benefits
Benefit payments for the injured employee are generally expressed in terms of "weeks of compensation." One week's benefit is equal to seventy percent (70%) of the employee's average weekly wage. The benefits will be equal to seventy-five percent (75%) of the employee's average weekly wage for the first twenty-six weeks(26) of disability if the employee earns less than $8.50 per hour.
An income benefit for an employee who is employed on less than a full working basis not to exceed sixty percent (60%) of the employee's average weekly wage. The average weekly wage is calculated from the Employer's Wage Statement using a formula defined in the law. The weekly benefit is subject to a statutory minimum and maximum payment.
What happens during the first week of absence?
No compensation accrues during the first seven days (7) of absence
from work due to a work-related injury. During this waiting period, the employee must utilize accrued sick leave, vacation leave or placed on leave without pay status. If the disability continues for two weeks, the waiting period then becomes payable provided the employee was not in a paid leave status for that time.
What if the absence is longer than seven days?
If the employee is absent beyond seven days (7), the employee may continue to receive full wages under accrued sick or vacation leave or receive weekly compensation benefits. If weekly compensation benefits are paid, the employee must be placed on leave without pay until the employee returns to work.
What is the next step after choosing a leave status?
The injured employee must inform the employer of use of accrued leave or leave without pay status. The employer must update WCI with employee leave status. The employee may also be responsible for maintaining other insurance coverage while on leave without pay.
What is the maximum for weekly compensation benefit payments?
Payment of weekly compensation benefits for work-related injuries or occupational disease will not extend beyond 401 weeks except in very limited circumstances.
Death Benefits
If the injury or occupational disease results in the death of the employee, current statute provides a funeral expense benefit not to exceed $2,500.
What is a beneficiary?
A beneficiary is any surviving individual or individuals who are eligible to receive compensation upon the death of an employee of The University of Texas System. The beneficiary is appointed by an employee preceding death.
What benefits are surviving family members eligible for?
The surviving spouse is eligible for a weekly benefit payable until remarriage or death. In the event of remarriage, a one-time payment equal to the benefits due for a period of two years will be paid to the surviving spouse. Surviving children may be eligible to share a portion of weekly death benefits.
Who is the beneficiary?
Any beneficiary entitled to receive death benefits must first file a "Statement of Beneficiary" form with WCI and DWC. Please contact WCI for further information regarding death benefit claims.
How are benefits paid?
Medical benefits for compensable injuries are payable from the date of injury. For more information regarding benefits, please refer to the Benefits Schedule.
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