How Your Actions Can Affect a Disability Determination
In a Texas workers' comp claim, your own decisions can end your disability benefits as surely as any doctor's opinion. This page covers the actions that hurt, the ones that help, and the ones you cannot take back.
The carrier is watching what you do, not what you say
Disability means your injury keeps you from earning your pre-injury wage. When a carrier disputes it, the strongest evidence is rarely an argument about medicine. It is something the worker did: a job quit, an offer refused, a release requested, a form signed. Adjusters build disability disputes out of conduct, because conduct is documented and hard to explain away later. Knowing which actions carry that risk, before you take them, is worth more than any amount of repair work afterward.
Can quitting or refusing work end my benefits?
Yes, both can, and they are the two most common self-inflicted ends to disability benefits. If you quit your job during the claim, the carrier will argue your lost earnings now come from your resignation rather than your injury. If you refuse a valid written light-duty offer, called a bona fide offer of employment, the carrier is allowed to treat the wages you turned down as wages you earned, which can shrink your checks to nothing.
Neither action is automatically fatal. A resignation the injury forced, or an offer that did not actually fit your restrictions, can be answered. But you will be answering, with your benefits stopped in the meantime. Before quitting, read Quitting Your Job While You're on Workers' Comp. Before refusing any written offer, read When Your Employer Offers Light Duty: The Bona Fide Offer (BFOE) and Evaluating a Light-Duty Job Offer, and get advice on that specific offer.
Two actions you cannot undo
Two decisions from real claims deserve their own warnings, because both felt reasonable at the time and both cost the workers money for the rest of their claims.
Asking your doctor to lift your restrictions. Money runs short, and a worker asks the doctor to release him so he can go earn a paycheck. That release is nearly impossible to undo. Once a full-duty release exists in your file, every later restriction looks negotiated rather than medical, and the carrier will point to the release in every dispute that follows. If you need to work, the conversation with your doctor is about what you can safely do within restrictions, not about making the restrictions disappear. Medical Clearance and Returning to Work covers this decision fully.
Taking a short-term job you cannot actually do. In one claim our firm handled, a worker in a long income gap took a new job and lasted two days of training before being let go; the position was beyond his restrictions from the start. Those two days followed him through the claim. Any post-injury period of full-duty work, however brief, becomes the carrier's evidence that you could work all along, argued in every later dispute. And the wages themselves reduced his back pay dollar for dollar. A desperation job usually pays a few hundred dollars and costs far more. If you are considering one because the checks have stopped, the better target is the stopped checks themselves: When Your Comp Checks Stop Coming.
Other actions that carriers use
- Certifying for unemployment benefits. Unemployment requires you to state you are able and available for work. The carrier reads that statement as an admission against disability. The conflict can be managed, but not casually; see Unemployment Benefits and Workers' Comp.
- Retiring. Retirement invites the argument that you left the workforce voluntarily; see Retirement.
- Missing medical appointments. Gaps in treatment read as recovery; see Why Missing Medical Appointments Hurts Your Claim.
- Posting on social media. Photographs of physical activity, even old ones reposted, are collected and used; see Social Media During Your Claim.
Actions that help
The protective actions are not complicated. Follow your restrictions everywhere, including at home, since surveillance does not distinguish between a job site and a driveway. Deliver every new work status report, form DWC073, to your employer yourself, and ask in writing whether they can accommodate it. Keep every pay stub. Show up to every appointment. When you are unsure whether a decision will read as evidence against you, ask before acting, not after.
Attorney notes regarding income benefits
Income benefits can become one of the most confusing parts of a Texas workers’ compensation claim. Even when the insurance carrier is sending checks, that does not necessarily mean the right benefits are being paid, in the right amount, or for the right length of time.
A few warning signs deserve attention:
- Your checks suddenly stop or decrease: There should be a reason, and that reason may be disputed.
- Your wages look wrong: An incorrect Average Weekly Wage can affect the amount of benefits you receive.
- You return to work for less money: You may still have rights to income benefits in some situations.
- Your impairment rating seems too low: A lower rating can mean fewer weeks of Impairment Income Benefits.
- You receive a denial: Eligibility for SIBs, LIBs, or other income benefits can involve detailed rules that are easy to misunderstand.
- The carrier claims it overpaid you: Do not assume that a demand for repayment is automatically correct.
At Abbott, Clay & Bedoy, we review benefit payments, wage calculations, medical evidence, work status, impairment ratings, and carrier decisions to determine whether our clients are receiving the income benefits Texas law provides.
Workers’ compensation checks can affect your ability to pay the mortgage, buy groceries, and support your family while you recover. Getting the amount wrong matters.
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