How Disability Is Determined
No single person declares you disabled in a Texas workers' comp claim. Disability is decided from evidence: work status reports, medical records, and wage records. This page explains who weighs that evidence and when.
Disability is a conclusion drawn from evidence
Workers often wait for someone to rule on their disability the way a doctor rules on a diagnosis. That is not how the Texas system works. Disability, the inability to earn your pre-injury wage because of your compensable injury, is a conclusion drawn from evidence, and different people draw it at different stages of the claim. Disability in Texas Workers' Comp Claims defines the term; this page covers how the question actually gets answered.
Three kinds of evidence do most of the deciding.
1. The work status report. After each visit, your treating doctor completes form DWC073, the work status report, stating whether you can work and under what restrictions. This one document drives more disability decisions than any other. A DWC073 taking you off work, or restricting you to duties your employer cannot provide, supports disability. A DWC073 releasing you to full duty is the carrier's standard reason to stop the checks. 2. The medical records. The notes behind the DWC073 matter, because a checkbox unsupported by the visit notes is easy to attack, in either direction. 3. The wage records. Disability is measured against your pre-injury earnings, so your employer's wage statement, form DWC003, and any post-injury pay stubs complete the picture. Restrictions plus unchanged earnings is not disability; restrictions plus a smaller paycheck usually is.
Who decides at each stage
Your doctor does not decide disability; the doctor documents your ability to work. The insurance carrier makes the first practical decision, because it decides whether to start, continue, reduce, or stop temporary income benefits (TIBs, the weekly checks that replace lost wages) based on its reading of the evidence. If the carrier stops or reduces benefits, it must send you a notice, typically PLN-09 for a suspension or PLN-11 for a dispute, stating its reason.
The carrier's decision is not the final word. If you disagree, the Division of Workers' Compensation (DWC, the state agency that oversees comp claims) decides the question through its dispute process, ending with an administrative law judge if no agreement comes sooner. Dispute Resolution walks through those steps. Judges decide disability period by period: a claim can involve disability that started, ended, and started again, and each stretch is proved separately.
Why did they say I'm not disabled?
Because the carrier has concluded that your lost wages, if any, are not being caused by the compensable injury. That conclusion usually rests on one of a few standard grounds: a DWC073 releasing you to full duty; a medical opinion that your restrictions come from something other than the work injury; evidence that you are earning at or near your pre-injury wage; or an argument that something you did, such as quitting or refusing suitable work, broke the connection between the injury and the lost income.
The statement is a position, not a verdict, and it can be disputed. Start by finding the carrier's stated reason on the notice it sent you, then match it against your evidence. If the problem is a full-duty release you disagree with, see your doctor and say plainly what you cannot do, so the next DWC073 reflects reality. If the problem is a causation opinion, the dispute will turn on medical evidence connecting the wage loss to the injury. If the checks have already stopped, When Your Comp Checks Stop Coming covers the immediate steps, and a request for a benefit review conference, filed on form DWC045, formally opens the dispute.
Move promptly either way. A period of disability is easiest to prove while it is happening, when the doctor visits are current and the pay records are fresh. Workers who wait a year to contest a "not disabled" decision are reconstructing evidence that others could simply have collected.
What the determination is not
Disability is not your impairment rating, the percentage assigned for permanent damage after your recovery levels off, and it is not a finding about how badly you were hurt. A serious injury can produce little disability if your employer keeps paying full wages, and a modest injury can produce long disability if no work within your restrictions exists. The distinctions have their own page: Disability, Impairment, and Incapacity: Understanding the Differences. What decision-makers weigh, and how your own choices enter the calculation, are covered at Factors That Affect a Disability Determination and How Your Actions Can Affect a Disability Determination.
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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