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.
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.
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.
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.
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.
Texas workers' compensation pays the following benefits:
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.
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:
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:
A workers' compensation claim can be denied for a host of reasons, including:
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.
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