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A look at the rights and responsibilities of Texas workers and employers after a workplace accident
Workers' compensation is a form of insurance that pays medical expenses and lost wages to employees who are injured while doing their job.
Workers' compensation is particularly important in Texas given that 2 of the state's biggest industries—oil and agriculture—are also the most dangerous industries. Workplace injuries occur with greater frequency in the construction industry than in almost any other industry. Nevertheless, all industries are impacted, including agriculture, manufacturing, and transportation. In Texas, the oil and gas industry is particularly prone to workers' compensation claims.
However, Texas is unique in that it doesn't require all employers to carry workers' compensation insurance. This is an overview for injured workers summarizing their rights and responsibilities in the Lone Star State. Throughout the article, you'll see links to other articles containing additional information about the linked topic.
If you still have questions after reading this overview and the linked articles, consider getting in touch with an experienced workers' compensation attorney near you.
Texas workers' compensation laws
Workers' compensation laws are designed to ensure that employees who are injured at work receive compensation without having to file lawsuits against their employers.
Workers' compensation laws are also intended to provide employers with a certain level of protection by limiting the amount employees can recover and by prohibiting, in most cases, injured employees from suing their employers or co-workers.
The bulk of workers' compensation laws are codified (gathered) in Title 5 of the Texas Labor Code, also known as the Texas Workers Compensation Act.
The laws range from general provisions (chapter 401) to coverage (chapter 406) to the adjudication of disputes (chapter 410).
The Texas Department of Insurance administers the state's workers' compensation system.
Are you eligible for workers' compensation?
Unlike most states, Texas doesn't require private employers to carry workers' compensation insurance (all public employees must carry workers' compensation insurance). Instead, private employers can choose whether to "subscribe" or not.
How do you know if your employer subscribes to workers' compensation coverage?
Upon hiring each new employee, employers are required to notify the employee of coverage or non-coverage. The notice must also be posted alongside other required workplace posters. If an employer discontinues workers' compensation coverage at any point, the employer must inform employees and the Workers' Compensation Division of the Texas Department of Insurance.
What workplace injuries are covered in Texas?
Not every injury is covered under Texas' workers' compensation laws. In order to be covered, the injury or illness must first be "sustained in the course and scope of employment."
What does this mean, exactly?
Simply put, the injury must have been sustained while you were doing work for your employer.
For example, a bricklayer who throws out their back while lifting bricks for an assigned project has sustained an injury "in the course and scope of employment."
On the other hand, an employee who, during their lunch break, drives to the store for cigarettes and is involved in an accident has not sustained an injury "in the course and scope of employment."
Once it's certain the injury was sustained in the course and scope of employment, the question becomes whether the specific injury is covered under the policy.
The Texas Workers' Compensation Act defines "injury" as "damage or harm to the physical structure of the body and a disease or infection naturally resulting from the damage or harm." Therefore, under the law, most physical injuries would be covered (backaches, broken bones, burns, etc.).
It is, however, less clear whether an emotional injury would be covered.
Are emotional injuries covered by workers' compensation?
In State Employees Workers' Compensation Division v. Thomas Camarata, the Texas Court of Appeals recognized that an employee can recover for an injury due to mental trauma when there's evidence that the mental trauma can be traced to a "particular event."
For example, traumatic neurosis suffered by a worker on a scaffold after seeing a fellow worker fall to his death was compensable.
On the other hand, evidence that a truck driver's job was generally stressful wasn't sufficient enough to prove a compensable injury from a heart attack.
Workers' compensation benefits available in Texas
Texas workers' compensation pays the following benefits:
- Income benefits (sometimes called "wage loss benefits") are equal to a certain percentage of the average weekly wages lost as a result of a temporary or permanent disability.
- Medical benefits pay for reasonable and necessary medical care to treat your work-related injury or illness.
- Vocational rehabilitation benefits help the injured employee find alternative employment (if the employee can't return to their previous job).
- Death benefits equal to 75% of employee's average weekly wage can be paid to legal beneficiaries, along with up to $10,000 in burial expenses, if the employee dies from a work-related injury or illness.
Income benefits are calculated according to the type of injury you suffer. What's more, the amount can't exceed the state-determined maximum amount.
How to file a work injury claim
If you've been injured in a work-related accident in Texas and your employer carries workers' compensation insurance, there are several steps you need to take to file a workers' compensation claim:
- See a doctor. Under the Texas Workers' Compensation Act, you have a right to choose your treating doctor so long as you're not in a Workers' Compensation Health Care Network (WCHCN). If you are in a WCHCN, you have to choose your doctor from the network's treating doctor list. However, after seeing the doctor once, you can change your doctor to anyone willing to treat your injury.
- Report your injury to your employer within 30 days from the date you sustained your injury (or from the date you discovered your injury)
- Hire an attorney. Under Texas law, you have the right to hire an attorney to help with your workers' compensation claim. If you don't have an attorney, you can the right to receive help with your claim from the Office of Injured Employee Counsel. Visit or call your local office to set up an appointment.
- File the necessary paperwork. Within 1 year of the date of injury, fill out and submit a completed Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease form to the Texas Department of Insurance Division of Workers' Compensation. The form can be submitted in person, by mail, or through the Texas Department of Insurance filing system.
Appealing a workers' compensation denial
If a dispute arises concerning your injury or illness (your claim is denied or you don't receive the benefits you deserve), you can request dispute resolution through the Texas Department of Insurance.
There are several steps that might occur in the dispute resolution process:
- Benefit review conference. An informal meeting where you'll meet with someone from the insurance company to discuss the dispute and try to resolve the issues.
- Arbitration. If the dispute isn't resolved at the benefit review conference, you can agree to resolve the dispute through arbitration instead of a contested case hearing. In arbitration, an independent person hears both sides and makes a final (and unappealable) decision.
- Contested case hearing. Instead of arbitration, you can elect to have a formal hearing in front of an administrative law judge.
- Appeals panel. If you lose the contested case hearing, you can elect to appeal the decision to an appeals panel.
- Judicial review. If you disagree with the appeals panel decision, you can appeal the decision to a court of law.
Why would your claim be denied?
A workers' compensation claim can be denied for a host of reasons, including:
- You didn't notify your employer within 30 days of the injury
- You didn't file your claim within 1 year of the injury
- Your injury wasn't sustained in the course and scope of your employment
- Your injury isn't one of the "covered injuries" (for example, you were struck by lightning while at work)
- You were injured because you were intoxicated or fooling around
The workers' compensation claim process is complicated (and the appeals process is even more complicated). There are a number of deadlines that, if missed, can result in your claim being denied.
While it's not required that you hire an attorney to help with your claim, it's strongly recommended. Use our free online directory to locate an experienced Texas workers' compensation attorney.
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Did you know that workers' compensation law varies by state?
A personal injury lawyer helps individuals who have sustained injuries in accidents to recover financial compensation. These funds are often needed to pay for medical treatment, make up for lost wages and provide compensation for injuries suffered. Sometimes a case that seems simple at first may become more complicated. In these cases, consider hiring an experienced personal injury lawyer. Read more
What does an injury lawyer do?
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