Impairment rating entitles worker to supplemental income benefits
Case name: Dallas National Insurance Co. v. Morales, No. 08-11-00197-CV (Tex. Ct. App. 12/27/12).
Ruling: The Texas Court of Appeals held that a worker was entitled to lifetime income benefits and supplemental income benefits.
What it means:
In Texas, a worker is entitled to receive supplemental income benefits if he has an impairment rating of 15 percent or greater.
Summary: A construction worker sustained work-related injuries to his neck, back, and shoulder when he fell from a moving pickup truck. His employer's workers' compensation insurer initially paid him supplemental earnings benefits but later denied payments. After surgeries, he was given a 27 percent impairment rating. He also had circulatory problems in his legs and was diagnosed with radiculopathy, radial tears, and a disk protrusion. He sought light-duty work but was unable to find work. The worker sought lifetime income benefits and supplemental income benefits. The Texas Court of Appeals held that he was entitled to benefits and attorney's fees.
Lifetime income benefits are awarded to a worker who loses both feet above the ankle. The insurer asserted that the worker was not entitled to lifetime income benefits because he only proved a general incapacity. The court disagreed, noting that he had difficulty walking, bending, stooping, squatting, and had a tendency to fall. His radiculopathy condition affected both of his legs. Also, numerous treating physicians restricted him from returning to work. A doctor noted that his condition would affect him for the rest of his life.
The court found that the worker was entitled to supplemental income benefits because he had an impairment rating greater than the required 15 percent. The worker said that he looked for work, but no employer made an offer to him. He also documented his job searches. The insurer did not provide evidence other than conclusory statements that the worker's searches did not constitute good-faith attempts to obtain employment.
Read more at the WorkersComp Forum homepage.
March 25, 2013
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