The Employer’s Guide to Disability
By Miriam Wilson, Senior Claims Adjuster
Disability or lost time from work is a crucial factor in any workers’ compensation claim for both the employer and the insurance carrier. Addressing disability and issuing benefits timely is part of the SORM claims department’s mission statement. It is also part of our legal and ethical responsibility to the injured worker. Let’s begin with a definition of disability.
Disability is defined by Texas workers’ compensation law as “A worker’s inability because of a compensable injury to obtain and retain employment at wages equivalent to the preinjury wage.” If a medical provider places an injured worker in an off-work status or applies restrictions that cannot be accommodated, the injured worker is unable to earn their pre-injury wages and has disability.
When an insurance carrier receives notice that an employee is losing time from work, it is the claims adjuster’s responsibility to address the lost time and issue income benefits that are owed. Employers play a key role here as they are often the first to know when an employee is not at work. Claims adjusters rely on our client agencies to alert them of a change in an injured worker’s work status. When an injured worker is losing time from work this can cause a significant amount of stress for them. Not only are they injured and trying to manage their symptoms, but it often creates distress over their income, their bills, the fear of losing their job, and the uncertainty of how they will continue working or how long they will be out of work. The sooner the claims adjuster is notified of lost time, the sooner we can act upon it and provide clarity and support to our injured workers. There are a couple of forms that should be filed when an injured worker has a change in their work status.
DWC-3 Employers’ Wage Statement – The wage information reported on a DWC-3 is how claims adjusters correctly calculate an injured worker’s average weekly wage and the rate at which they are paid their income benefits. Texas Department of Insurance – Division of Workers’ Compensation offers online training on how to complete the DWC-3. They are also available to answer any questions about the form. A link to the employer online FAQ can be found here: https://www.tdi.texas.gov/wc/employer/employerfaq.html. At the bottom of the page, you will find an overview of the DWC-3 form. You can also find the DWC-3 and the DWC-6 on TDI’s website here: https://www.tdi.texas.gov/forms/form20employer.html.
DWC-6 Employers Supplemental Report of Injury – The purpose of this form is to notify SORM when an injured worker has started missing work or has returned to work. The DWC-6 also has a section to include details such as whether it was light duty, full duty, and the date an injured worker has reached their 8th day of disability. There is also a section to put in additional comments or details such as whether the lost time is related to the compensable work injury, or if there is intermittent lost time.
SORM-90 Notification of Additional Information – This form can communicate several different things such as a change in an injured workers’ personal information, but it is mostly commonly used to report the expiration of an injured workers’ sick or annual leave and the date payment for state health insurance expires. Just like the DWC-6, there is a section of the form where additional comments or details can be placed. Please keep in mind that in workers’ compensation law, we cannot count other types of leave such as compensatory or holiday. Even if an injured worker elects to use those kinds of leave, SORM can only calculate when benefits are owed based on the available sick or annual leave an injured worker has elected to use.
When the SORM-90 form is used to report the expiration of available leave, the date should be consistent with the choices selected on an injured worker’s SORM-80 form.
There are other factors that can affect disability and income benefits, so please reach out to the handling adjuster if something is unclear or a unique situation arises. SORM appreciates your continued work, effort, and partnership to ensure our injured workers are supported throughout the workers’ compensation process and return to work safely and as soon as possible.