The Texas Workers’ Compensation Act is a set of laws in Texas that deal with compensation for workers who are injured on the job. The Act provides various rights for both employers and employees in dealing with issues related to workers’ compensation for job-related injury and illness.
Generally, it is up to the employer, not the employee, to decide whether or not they will participate in the Texas workers’ compensation system. In most states, participation in the state’s workers’ compensation is mandatory and not voluntary. But in Texas, participation by an employer is the employer’s choice.
An employer may participate in the Texas workers’ compensation system. If so, an employee who is injured within the course and scope of their employment would file a claim with the workers’ compensation system.
An employer could have opted not to participate in the workers’ compensation insurance system. In that case, the employee has a right to seek compensation for the losses by filing a personal injury lawsuit in a civil court of general jurisdiction.
The Texas Workforce Commission is a state agency that handles complaints from workers about issues related to their employment other than those related to workplace injuries and illnesses. Of course, there are many other Texas employment laws that deal with a range of other issues related to employment and the workplace, e.g., workplace disputes.
The federal Equal Employment Opportunity Commission (EEOC) is another agency that enforces federal laws relating to employment, especially the federal Civil Rights Act and the Age Discrimination in Employment Act. Again, if a worker has some issue in their place of work relating to discrimination, they would contact the EEOC.
How Does the Texas Worker’s Compensation Act Work?
For employees who work with a company that participates in the Texas Workers’ Compensation system, there are various benefits. For instance, the employee is provided with some amount of insurance compensation coverage for work-related or on-the-job injuries. This coverage includes compensation for the reasonable expenses associated with the treatment of an injury, such as necessary hospital bills and other losses. The employee usually needs to prove that they were injured while performing their job.
Also, employees may be entitled to lost wages for work they miss due to their injury. This may sometimes cover only a percentage of the lost wages, depending on the type of injury.
For employers, the benefit is mostly that the employee forfeits their right to sue the employer in exchange for the insurance and other benefits. This is especially true for pain and suffering and other non-economic damages. That is, the employee cannot sue their employer in a civil court of law but must claim their benefits under the Texas Workers Compensation Act.
Thus, both employers and employees need to be fully informed before taking up benefits from the Act. Future workers should inquire during the hiring phase if the company will be operating under the Act.
How Do I Make a Claim for Workers Compensation in Texas?
The majority of Texas employers have workers’ compensation insurance. A person who suffers a work-related injury or illness should first notify their employer of their condition and request compensation. A person who does not notify their employer within 30 days of their injury or when they discover their injury or illness may be denied workers’ compensation benefits.
A person then has to file a claim for compensation with the Texas Division of Workers Compensation (DWC), which is part of the Texas Department of Insurance. This must be done within 1 year of the date of their injury. There are several steps to filing a workers’ compensation claim in Texas as follows:
- First, report the injury to the employer within 30 days;
- Submit the necessary claim forms with the DWC within 1 year;
- Follow up with the Division of Workers’ Compensation (DWC).
The following is a detailed guide for filing a workers’ compensation claim in Texas:
- Report the injury:
- Inform an employer of the work-related injury or illness within 30 days of the incident or of the date on which they become aware of the work-related nature of the condition;
- The employer should provide the employee with a DWC Form-041, “Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease”;
- The employee should complete the form accurately and submit it to the employer;
- Complete and submit the DWC Form-041:
- Gather all relevant information, including:
- Personal details;
- Employment details;
- Description of the injury or illness;
- Dates of injury or illness;
- Names of witnesses; and
- Medical records;
- Fill out the DWC Form-041 carefully, ensuring all fields are complete and accurate;
- Submit the completed DWC Form-041 to the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) within one year of the date of injury or the date the individual learned of an occupational illness;
- Follow up with the TDI-DWC:
- Once a person has filed their claim form, the TDI-DWC assigns a claim number to the case;
- A person wants to hold onto this number for future reference;
- The TDI-DWC notifies the employer and their insurance company of the claim. They may also request additional information from the worker or their employer;
- The employee may be scheduled for an Independent Medical Examination (IME) to assess the extent of their injury or illness;
- A person should cooperate fully with the IME process;
- Regularly check the claim status online or by contacting the TDI-DWC; and
- Keep track of any documentation and communications related to the claim.
Once an employee has made a claim for benefits, their employer’s workers compensation insurance company investigates the claim. Usually, the insurance company reviews:
- The employee’s medical records;
- Accident reports;
- Other information.
If the employer approves a person’s claim, they should start receiving benefits. If a person’s workers’ compensation claim is denied, they have the right to appeal.
Appeals often require a detailed understanding of legal and medical issues, so it may be helpful to consult with a local attorney in Texas before filing an appeal.
What if I Have a Dispute Over the Texas Workers’ Compensation Act?
As mentioned, a worker usually forfeits their right to sue in a civil court for a work-related injury if they make a claim under the Workers’ Compensation Act. On the other hand, the employer may be involved in a violation of the terms of the Texas Workers’ Compensation Act.
For instance, if the employer intentionally fails to inform the worker of their rights under the Act, it could lead to liability on the part of the employer for harm done to the employee. In such instances, it may be necessary to file a private civil lawsuit in a court of law and not a workers’ compensation claim against the employer. Alternatively, the worker can file a claim with a government agency such as the EEOC or the Texas Workforce Commission.
Do I Need a Lawyer for Help With the Texas Worker’s Compensation Act?
Claiming benefits under the Texas Workers Compensation Act can become complicated. You want to consult a Texas workers compensation lawyer if you need assistance with your workplace injury claim. Your attorney can help you with the filing process and can represent you during any legal proceedings as needed.