Workers Compensation in Texas

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 Who Files a Workers’ Comp Claim in Texas?

If an individual has a work-related injury or illness, they may be entitled to Texas workers’ compensation benefits under the Texas Workers’ Compensation Act. These benefits may provide financial support as well as medical coverage while they are recovering from their injuries or illness.

Under Texas employment laws, the Texas workers’ compensation is a voluntary system. The majority of other states require employers to have workers’ compensation coverage.

If an employer has opted out of workers’ compensation insurance, the employee has a right to file a personal injury lawsuit.

If an individual’s Texas employer does have workers’ compensation insurance, they have specific rights and duties under the law. It is important to understand the Texas workers’ compensation system before filing a claim for benefits.

How Do I File a Workers’ Compensation Claim in Texas?

The majority of Texas employers have workers’ compensation insurance. An individual could suffer a work-related injury or illness. If that is the case, they should notify their employer of their condition and request benefits.

If an individual does not notify their employer within 30 days of their injury, they may be denied workers’ compensation benefits. An individual is required to file a Claim for Compensation with the Texas Division of Workers Compensation (DWC) within one year of their injury.

There are several steps for filing a workers’ compensation claim in Texas, including:

  • Reporting the injury;
  • Completing and submitting the necessary forms;
  • Following 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 as soon as possible about the work-related injury or illness. This should be done within 30 days of the incident or from the date they became aware of the work-related nature of the condition;
    • The employer will provide a DWC Form-041, Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease;
      • 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;
      • Sign and date the form;
    • 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 an individual has submitted the claim form, the TDI-DWC will assign a claim number to the case;
      • Keep this number for reference;
    • The TDI-DWC will notify the employer and their insurance company of the claim. They may also request additional information from the individual or their employer;
    • The employee may be scheduled for an Independent Medical Examination (IME) to assess the extent of their injury or illness;
      • 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 insurance company will investigate the claim. Usually, the insurance company will review:

  • The employee’s medical records;
  • Accident reports;
  • Other information.

If the company approves the individual’s claim, they should start receiving benefits. If an individual’s workers’ compensation claim is denied, they have the right to appeal.

Because appeals often require a detailed understanding of legal and medical issues, it may be helpful to consult with a local attorney in Texas before filing an appeal.

What Does Workers Compensation Cover?

Workers’ compensation benefits are provided to workers who suffer work-related injuries or illnesses. In order for an illness or injury to be work-related, an individual must show that their injuries or illness arose out of their employment.

A pre-existing condition may be covered if an individual can show that their work activities significantly aggravated the condition. Workers’ compensation will only be paid if an individual experiences an increase in pain from a pre-existing condition.

An individual will need medical evidence showing that their condition was aggravated or accelerated by work.

Can I Recover Any Damages Along With Workers Compensation?

Usually, workers’ compensation is the only remedy available to an employee. This means that an individual will not be able to sue their employer for negligence or request compensation for pain and suffering.

There are, however, some exceptions to the Texas exclusive remedy rule. An individual may be able to file a negligence lawsuit if:

  • Their employer did not have workers’ compensation insurance;
  • A third party was responsible for the individual’s injuries.

A fellow employee will not be considered a third party. Third-party claims may include:

It may be helpful to review an example. If a truck driver is injured when a negligent driver sideswiped his vehicle, he may receive workers’ compensation and file a personal injury lawsuit against the negligent driver.

What Type of Workers’ Compensation Benefits Can I Qualify For?

Workers’ compensation benefits may include coverage for:

  • Reasonable and necessary medical treatment;
  • Income benefits;
  • Burial benefits;
  • Death benefits.

Each Texas workers’ compensation claim is unique. An individual’s benefits may vary depending on the severity of their medical condition and their ability to return to work.

In Texas, there are four categories of income benefits that are available, including:

  1. Temporary
  2. Impairment
  3. Supplemental
  4. Lifetime

The state sets a maximum income benefit each year. In addition, there are minimum benefits for temporary, impairment, and lifetime benefits.

Temporary Income Benefits (TIB)

Temporary income benefits are paid if an individual is fully or partially disabled for more than seven days. Typically, TIB benefits are 70% of the difference between the worker’s average weekly wage and their pre-injury wages.

Low-wage earners, however, may be entitled to more benefits. TIB will be paid for no more than 104 weeks.

It may be helpful to review an example. Suppose a worker’s pre-injury average weekly wage was $500.

After a back injury, she is not able to work. Her weekly TIB payment will be $350, or 70% of $500.

Impairment Income Benefits (IIB)

Impairment benefits are paid when a worker has reached maximum medical improvement (MMI) and has a permanent impairment. Their doctor will set their impairment rating once they reach MMI.

For every percentage point, the individual will receive three weeks of IIB benefits. IIB benefits are 70% of the worker’s average weekly wage.

For example, suppose a worker is given a 25% impairment rating. If their average weekly wage was $500, they would be entitled to 75 weeks of IIB benefits with a weekly rate of $350.

Supplemental Income Benefits (SIB)

Supplemental benefits are additional monthly benefits that are paid to injured workers who:

  • Have at least a 15% impairment rating;
  • Have not returned to work or now earn less than 80% of their pre-injury average weekly wage;
  • Are doing a legitimate job search; and
  • Did not receive IIB benefits in a lump sum payment.

SIB payments are 80% of the difference between 80% of the worker’s average weekly wage and their post-injury weekly wages.

For example, suppose a worker’s pre-injury average weekly wage was $500. Following an injury, they earn $350 per week.

Their SIB benefits will be $160 per month based on the following:

  • 80% of pre-injury weekly wage = $400;
  • $400-350 post-injury earning = $50; and
  • 80% of $50 = $40 per week, or $160 per month.

Lifetime Income Benefits (LIB)

Lifetime income benefits are paid when a worker suffers a catastrophic injury, which may include:

  • Loss of vision in both eyes;
  • Loss of both feet;
  • Loss of both hands;
  • Loss of one hand and one foot;
  • Paralysis of two limbs;
  • Permanent insanity or imbecility;
  • Third-degree burns over 40% of their body that require grafting, or
  • Third-degree burns on both hands or on one hand and their face.

LIB payments are 75% of the worker’s average weekly wage with a 3% annual increase in benefits.

What Happens if an Employer Doesn’t Have Workers Compensation?

In the majority of states, an employer is required to obtain workers’ compensation insurance when they hire an employee. In other states, they are only required to obtain workers’ compensation insurance if they hire multiple employees, typically between two and five.

In Texas, most private employers are not required to have workers’ compensation. However, a private employer that contracts with the government must provide workers’ compensation coverage for the employees who are working on the project.

An individual’s employer may not be required to carry workers’ compensation insurance. In this case, the worker may still be able to recover compensation by filing a personal injury lawsuit against their employer.

Do I Need a Texas Lawyer?

You have issues, questions, or concerns related to workers’ compensation in Texas. If so, you should consult with a Texas workers’ compensation lawyer. Your lawyer can evaluate your claim and help you maximize your benefits.

If you need to file a claim, your lawyer will help you through the process and ensure your paperwork is completed and filed correctly. If you need to file a lawsuit in court, your lawyer will represent you throughout the process and help you obtain the most compensation possible.

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