An injured worker may be paid TIBs if a compensable work-related injury or illness causes the employee to have disability (loss of all or some of their wages for more than 7 days). Disability is determined by the inability to earn an income. These payments begin to accrue on the 8th day of disability and may continue up to 104 weeks from that date.
(The State of Texas Workers’ Compensation Division sets the maximum and minimum temporary income weekly benefit amount.)

TIBs eligibility continues until:

• The date maximum medical improvement (MMI) is reached. This does not mean no future medical care will be needed for the work-related injury or that the injured worker is released to return to work.
• Maximum Medical Improvement (MMI) is the earlier of:
  • The date after which no further medical improvement is expected or
  • 104 weeks from the date you became eligible to receive temporary income benefits (Statutory MMI).
    • (Spinal surgery may result in an extension of the 104 weeks.)

An injured worker may be entitled to IIBs if they have a permanent impairment from a work-related injury or illness. A health care provider will assign an impairment rating using the 4th Edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment. The Impairment rating describes the degree of permanent impairment to the body as a whole. The impairment rating determines the eligibility to IIBs. Three weeks of IIBs are paid for each percentage of impairment.
Example, if the injured worker were to be assigned a 3% percent impairment rating, they would receive 9 weeks (3% = 3x3 = 9weeks of IIBs).
(The state sets a maximum weekly rate for impairment income benefits.)

SIBS are income benefits that the injury employee may apply for quarterly and are paid monthly if they meet specific eligibility requirements.
In order to be entitled to SIBs, the injured worker must meet the following requirements:

• Have an impairment rating of 15% or more.
• Have not returned to work because of their impairment or if they have returned to work - earning less than 80 percent of their average weekly wage because of the impairment.
• Have demonstrated an active effort to comply with Texas Department of Insurance, Division of Workers' Compensation work search requirements.
• The injured worker did not take their impairment income benefit in a lump sum payment.

Income benefits paid to eligible beneficiaries when an employee suffers a compensable fatality.

MMI is the earlier of:

• The date after which no further medical improvement is expected or
• 104 weeks from the date you became eligible to receive temporary income benefits (Statutory MMI).
  • (Spinal surgery may result in an extension of the 104 weeks.)

MMI does not mean no future medical care will be needed or provided for the work-related injury.

When an employee suffers an on-the-job injury that results in a leave of absence to recover and receive treatment, the injured employee will receive workers’ compensation pay that is up to 70% of the difference between  your average weekly wages and the wages you are able to earn after your injury, or up to 75% of the difference if you earned less than $10 an hour.  In addition to workers’ compensation pay, employees are required to use available leave accruals (referred to as supplemental pay) to make up the difference in regular earnings and workers’ compensation pay to bring their compensation whole (100%) while on leave.

A check for compensable temporary income benefits (TIBs) will be issued by the 15th day from TML-IRP's receipt of the claim. If you have not received your temporary income benefits check, please contact TML-IRP at 1(800)537-6655.

Yes: The TIBS (temporary income benefits) check is your workers’ compensation payment, which is only up to 70-75% of your regular pay, and the City paycheck is your supplemental pay using your leave accruals (sick, vacation, and compensatory leave accruals), which makes up the needed 25-35% difference to make your pay whole (what you would normally receive from the City).

No: If you are receiving your full pay from the City, then you are not entitled to workers’ compensation payment from TML-IRP.

Per the City of Carrollton’s Administrative Directive: Injury/Workers' Compensation (12), III: E., General, Injury/Workers' Compensation Provisions states: “When an employee is on leave from work due to an injury/Workers' Compensation case, an FMLA case will be automatically activated for the employee.”  All leave related to Workers Compensation runs concurrent with FMLA leave.

Note: FMLA CLAIMS ARE PROCESSED AND HANDLED BY WORK FORCE SERVICES.

Per the City of Carrollton's Administrative Directive: Injury/Workers' Compensation (12) IV:D, "In the event of an overpayment... the employee is obligated to repay the overpayment amount."

Note: An overpayment of income benefits would be indicated on your workers' compensation claim.  A voluntary reimbursement would resolve any overpayment,  should an overpayment remain, it may be applied to future income benefits.  If you have any questions regarding the overpayment, please contact your workers' compensation adjuster.

TML-IRP makes determinations of compensability on all workers' compensation claims, including a late reported claim.

Note: Per the City of Carrollton Administrative Directive: Injury Workers' Compensation (12) VI:A, "Employees are responsible for reporting any on-the-job injury/illness however minor, to their immediate/designated supervisor as soon as (physically) possible or no later than twenty-four hours after the injury or illness occurs."

If you do not treat with physicians in the Alliance Network, TML-IRP would not be responsible for payment of the medical bills.

The City of Carrollton is included in the direct contracting with health care providers as allowed by TLC Section 5.04.053.   The Political Subdivision Workers’ Compensation Alliance (PSWCA) was created for direct contracting with health care providers and the City of Carrollton is covered by this initiative.. The healthcare providers are listed on the website Political Subdivision Workers’ Compensation Alliance (PSWCA) at PSWCA.org.  

You should contact your workers’ comp adjuster, if you still don’t agree after speaking with your adjuster, you have 90 days from the date the doctor’s report to file a dispute.  To file a dispute, call the Texas Department of Insurance (TDI), Division of Workers’ Compensation at 1-800-252-7031.  The TDI Division of Workers’ Compensation has an Office of Injured Employee Counsel (OIEC) who may further assist an injured worker with questions and the workers’ compensation dispute resolution process.  The phone number and email address to contact the OIEC is 1-866-393-6432; OIECInbox@oiec.texas.gov

Yes, you can; however, ensure that you follow the guidelines below:

• You are in a Workers’ Compensation Health Care Network (network), and therefore you must choose a doctor from the network’s treating doctor list. You may change your treating doctor once without network approval. 
• As an employee of a political subdivision (e.g. city, county, school district,) you must follow its rules for choosing a treating doctor. It is important to follow all the rules in the workers’ compensation system. If you do not follow these rules, you may be held responsible for payment of medical bills. Your adjuster at TML-IRP or OIEC staff can help you to understand these rules.

Yes, you should contact your supervisor to see what light duty work is available.

Your TML-IRP adjuster is the most knowledgeable expert on your case. TML-IRP's phone number is 1(800)537-6655.

For assistance regarding your case, please contact your adjuster at TML-IRP at 1(800)537-6655 or Risk Management at (972)466-3091

Employees on inactive status cease to accrue vacation, sick, and holiday leave.

Following an accident at work, it is critical to report the accident to a supervisor as soon as possible. The time limits vary from state to state, but your claim may be denied if you don't report the injury. Even if you don't think you're injured, you should report workplace accidents to your employer. Report an accident as soon as possible and report injuries as soon as you become aware of them.

Yes, workers' compensation covers you for work-related injuries and occupational diseases.

Workers can develop a variety of illnesses that are related to their jobs. For example, workers who are exposed to a lot of car exhaust on the job may suffer from carbon monoxide poisoning or breathing problems. It really depends on what the particular hazards of the job are, and some people might develop illnesses as a result of them while others do not.

Part of the purpose of the workers' compensation system is to provide benefits to injured workers without the need to prove who was at fault for the accident. However, there are some instances when a worker won't receive benefits. For instance, a worker won't receive benefits for self-inflicted injuries, those that result from fighting or horseplay, or for injuries that occur when the employee is under the influence of alcohol or illegal drugs.

Yes, if your doctor is in the Alliance Network. To determine if your doctor is in the alliance network go to pswca.org.

Since you are in a Workers’ Compensation Health Care Network (network), you must choose your doctor from the network’s treating doctor list. You may change your treating doctor once without network approval. 

As an employee of a political subdivision (e.g. city, county, school district,) you must follow its rules for choosing a treating doctor. It is important to follow all the rules in the workers’ compensation system. If you do not follow these rules, you may be held responsible for payment of medical bills. OIEC staff can help you to understand these rules.

• Income Benefits: to replace a portion of any wages you lose because of a compensable work-related injury or illness, you may receive:
  • Temporary Income Benefits (TIBs)
  • Impairment Income Benefits (IIBs)
  • Supplemental Income Benefits (SIBs)
• Medical Benefits: pay reasonable and necessary medical care - including lifetime medical treatment - to treat your compensable work-related injury or illness.
• Burial Benefits: pay for some of the deceased employee's funeral expenses.
• Death Benefits: replace a portion of lost family income for eligible family members of employees killed on the job.

Yes, as long as you are:

1. complying with the guidelines and responsibilities of the TWCA
2. complying with the City's workers' compensation directives
3. have reached maximum medical improvement (MMI)
4. You are are able to perform the essential functions of the job

The City may re-activate the employee in the previously held position; or if an employee is unable to perform the essential functions of the job, the employee may be transferred into another position as a reasonable accommodation or utilize eligible FMLA leave to remain out of the workplace.

The employee will be paid according to the pay plan and compensation guidelines.

• Donated sick leave
• Eligibility for disability after all leave exhausted

Texas Municipal League Intergovernmental Risk Pool (TML-IRP).

Temporary Income Benefits are equal to 70 percent of the difference between your average weekly wage and the wages you are able to earn after your work related injury. *If you earned less than $10.00 per hour before you were injured, your temporary income benefits for the first 26 weeks of payments will equal 75 percent of the difference between your average weekly wage and the wages you are able to earn after your work-related injury.

(The amount of temporary income benefits is subject to maximum and minimum. Income benefits may not exceed the maximum weekly amount set by the State of Texas Workers' Compensation Law. Temporary income benefits, impairment income benefits, and lifetime income benefits are also subject to a minimum amount set by state law. Maximum and minimum benefit amounts are based on the state average weekly wage.)

If you are receiving medical bills for your treatment, that means TML-IRP is not! You should immediately forward any bill received to TML-IRP at workerscompensation@tmlirp.org; or email them to Risk Management at riskmgmtinjury@cityofcarrollton.com.