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Call us atAccording to a 2021 report by the Texas Department of Insurance, Division of Workers’ Compensation, in cooperation with the U.S. Department of Labor, Bureau of Labor Statistics, there were 178,900 cases of nonfatal workplace illnesses and injuries in the state. Workers’ compensation in Texas is an insurance program that pays for an employee’s medical bills and income loss due to their job-related illness or injury. It aims to protect employers from lawsuits by injured employees. However, employers can be sued if a worker dies due to negligence. This article provides an overview of the workers’ compensation system in Texas, including eligibility requirements, benefits, and procedures for filing claims.
Texas does not require most private employers in the state to have workers’ compensation insurance. However, those employers who contract with government entities must provide coverage for employees working on a project. Some employers may also be required to have workers’ comp insurance for independent contractors and subcontractors.
If an employer does not have workers’ compensation insurance, they must:
An employer may provide workers’ compensation insurance to their employees in several ways, such as:
To be required for workers’ compensation insurance, they must have at least one employee, even if they work part-time.
They may also obtain the policy to cover executive officers of a business that has no other employees or contractors who do not have workers’ compensation.
Employees in Texas who have been hurt on the job have the right to receive income benefits if they meet certain requirements, obtain medical care to treat their work-related illness or injury, keep their claim private, and choose a doctor for their treatment.
A worker also has the right to a legal review of any disputes on their claim, hire an attorney at any time, and ask for help from the Office of the Injured Employee Counsel.
The benefits that an injured worker may receive are:
Income benefits replace some of the money the worker has lost due to their job-related illness or injury.
The amount an employee gets is based on their average weekly wage, which is the average amount of money they got each week from their work in the 13 weeks before they were injured, including overtime or other special pay.
An employee may receive temporary income benefits if they have lost money from their job for more than seven days due to a work-related injury. The days do not have to be in the same week.
The two types of maximum medical improvement are clinical and statutory. The former is the date when the doctor says no further healing or recovery from the injury is expected, which is based on examining the patient and looking at treatments they have had.
By law, an employee is only able to receive temporary income benefits for up to 104 weeks.
A worker may receive impairment income benefits if they have sustained permanent damage to their body due to their injury. An employee may receive these benefits even if they have returned to work.
The doctor may give an impairment rating if they examine the patient and find that no further healing or recovery from their injury is expected.
An employee gets three weeks of impairment income benefits for each percentage point of their rating. For example, if they have an impairment rating of 3%, they will receive a total of nine weeks of benefits.
An employee may receive supplemental income benefits if they have sustained plenty of permanent bodily damage due to their injury and still have not returned to work after their impairment income benefits end.
To receive supplemental income benefits, an employee must:
An employee may receive lifetime income benefits if they sustain certain serious injuries, such as complete blindness or loss of limbs. The benefits are 75% of the worker’s average weekly wage with a 3% cost of living increase each year. Unlike other benefits, they do not have a time limit.
Effective September 1, 2023, changes have been made regarding eligibility requirements for all injured employees seeking lifetime income benefits under HB 2468. A worker may receive benefits if they have:
To receive these benefits, an employee must send a request in writing to the insurance company. It has 60 days to reply to the request.
If they say a worker may not be able to get LIBs, the company must send a letter explaining why. If an employee does not agree with the decision, they may request a benefit review conference.
A worker may receive medical benefits to pay for the costs of treating their job-related injury. Their employer’s insurance company pays for these benefits to the healthcare provider who treats the patient.
An employer must tell their worker if their claim is in a healthcare network so they can use a doctor who belongs there. If an employee gets treatment from a doctor who is not in the network without getting approval, they could pay for the medical costs.
The DWC must approve any change in doctors if a worker’s claim is not in a healthcare network. If an employee or their doctor relocates or becomes unavailable, the worker may choose another doctor without getting permission from the division.
A deceased employee’s surviving beneficiaries may receive payment for their funeral expenses up to $10,000, depending on the date the injury happened.
To file a claim for burial benefits, the beneficiary must contact the insurance company in writing within 12 months of the date of the worker’s death and attach copies of related bills. After the carrier receives the request, they have seven calendar days to act.
The amount depends on the date the injury happened:
A deceased worker’s surviving family may receive compensation to replace some of the money lost due to the employee’s job-related illness or injury and eventual death. Spouses may get these benefits for life even if they remarry (for marriages on or after September 2017).
Death benefits may be paid to:
The legal beneficiary may start receiving death benefits the day after the worker’s death. The benefits are paid until the beneficiary no longer meets the requirements.
To get the due benefits, an employer must have workers’ compensation insurance. The Texas Department of Insurance Division of Workers’ Compensation regulates the benefits in the state.
They help injured employees file claims and complaints in case of violations of Title 5, Subtitle A, of the Texas Labor Code or Texas Department of Insurance, Division of Workers' Compensation rules. They also resolve disputes between workers and their employers and insurers. To ask for assistance regarding workers’ compensation claims, one may call the Division at 800-252-7031, option 1.
There are different deadlines that an employee must know before filing workers’ compensation claims. These are the following:
This section breaks down the key steps injured employees need to take to have their claim approved and obtain the maximum benefits they deserve.
The worker must report their injury to their employer within 30 days from the date they were injured or knew their job-related illness or injury. If they miss the deadline, they may lose their right to claim benefits.
The employee must send a completed Form-041 or the Employer’s Claim for Compensation for a Work-Related Injury or Occupational Disease to the Texas Department of Insurance Division of Workers’ Compensation within one year of the date of the injury.
To file a claim for death benefits, eligible beneficiaries must complete Form-042 or the Claim for Workers’ Compensation Death Benefits and send it to the DWC or insurance company within one year from the date the worker passed away.
They must include a copy of the deceased employee’s death certificate and other documents to prove their legal beneficiary status.
The employee must provide their doctor with information about how they got injured at work and their medical care.
The worker must inform the DWC and the insurance company about any changes in their pay or work that they do.
They must also let them know if they have changed their mailing address or phone number so they can receive the benefit payments and important letters and reports.
To get a copy of their workers’ compensation claim file, the employee must complete and submit Form-153 or Request for Record Check or Copies of Confidential Claim Information. They may also call 800-252-7031 to ask for a blank form to be mailed to them.
If they have multiple claims, they must return a separate form for each claim they want a copy of. They may submit the form by attaching it to an open records request at https://www.tdi.texas.gov/open-records.html, faxing it to the DWC Legal Services department at 512-804-4276, mailing it, or personally delivering it.
If an employee’s application has been denied and they disagree with the decision, they may call their insurance adjuster to talk about their claims. If the problem is not resolved, they may contact the DWC customer service at 800-252-7031.
They may request a Benefit Review Conference by submitting a completed Form-045. They may also proceed directly to a contested case hearing.
This section describes three organizations that aim to help low-income clients with their workers’ compensation claims and protect their rights against denials or reductions by providing pro bono legal representation.
The Legal Aid of Northwest Texas is a nonprofit organization providing free civil legal help through advocacy and representation to low-income people in 114 counties throughout the state. It comprises over 150 attorneys, supported by a staff of more than 100 paralegals and social workers. It represents clients with income up to 125% of the U.S. poverty guidelines and from different sectors of the community, including minimum wage earners and single parents. The LANT aims to preserve and protect employees’ rights in the workplace and helps eligible workers obtain and regain benefits and other financial assistance. To obtain legal assistance, one may fill out the intake form on their website.
The Volunteer Legal Services of Central Texas is a nonprofit organization helping low-income people in the state obtain free legal advice by providing them with volunteer attorneys. It represents hard-working minimum wage earners with dependents as well as those with fixed incomes. VLS helps with various civil legal matters, such as employment law-related issues. To obtain legal assistance, one may visit their office in person or apply online.
The Lone Star Legal Aid is an organization providing free legal services to low-income people in Texas through advocacy, community education, and representation. It focuses on various practice areas, including employment law. It helps clients understand complex laws, including those related to workplace safety issues. To obtain legal assistance, one may apply online, visit their office in person, or call (800) 733-8394.
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