To be eligible for wage benefits, the injured employee must be deemed disabled by a physician and must not have worked for a minimum of seven days.
- Waiting Period: There is a seven-day waiting period in Texas. If the disability continues for 14 days, the injured employee will be entitled to wage benefits for the first seven days.
- Initial Payment: The first payment of wage benefits is due to the injured employee on the 15th day following knowledge/proof of disability. These wage benefits will then be paid in weekly installments.
- Percentage of Wages: Weekly wage benefits are tax free and equate to 70 percent to 75 percent of your average weekly wage subject to a maximum rate.
- Maximum Rate: Weekly wage benefits are subject to a maximum of $850 as of this time.
If an employee sustains an injury or illness arising out of and during the course of employment, workers’ compensation will cover reasonable and medically necessary treatment for an injury. Injured employees are not responsible for any copays and should not have any out-of-pocket expenses.
- Choice of Physician: The injured employee has the right to select an initial choice of doctor, with the exception of doctors previously removed or denied admission to the TDI (Texas Department of Insurance) - DWC (Division of Workers' Compensation) former Approved Doctors List or sanctioned from practice by the TDI-DWC. Any request to change doctors must be approved by the local TDI-DWC handling your claim.
- Mileage Reimbursement: The injured employee is entitled to reimbursement for travel expenses in order to obtain reasonable and necessary medical care if the treatment is not reasonably available within 30 miles of the injured employee’s residence. The distance traveled to secure medical treatment must be greater than 30 miles one way and the injured employee must submit the request to the insurance carrier within one year of the date the injured employee incurred the expenses.
- Prescriptions: LUBA partners with PMOA to provide pharmacy benefits to injured employees. PMOA will issue a prescription card on behalf of LUBA for use at pharmacies to avoid any out-of-pocket expense for the injured employee. PMOA does offer mail-order prescriptions. Please contact your adjuster or PMOA directly to discuss this option.