There are many variables to establishing a claim for Texas workers’ compensation injuries. If you are injured at work in the state of Texas, how will you be taken care of? Your employer may carry workers’ compensation insurance, or they may be a non-subscriber to the workers’ compensation system. Deciding how a claim for your injury will be handled is like a course in journalism. You need to ask: who; what; when; where, why and how the injury occurred.
For a person to be covered under the employer’s workers’ compensation policy, the person must be an employee, an independent contractor that is under the employer’s control, a borrowed servant, or a have a relationship on the insurance policy that would include the injured worker.
What happened to the worker to cause the Texas workers’ compensation injuries? Injury means damage or harm to the physical structure of the body. It can also be a disease or infection naturally resulting from the damage or harm. Pain in and of itself is not considered an injury. There must be some form of diagnosis to establish an injury like a sprain or a strain. Some injuries are clear at the time of the accident (like a broken arm, hurt back or head injury). However, other forms of injury (like RSD, a herniated disc, or psychological conditions), may not become apparent for years after the injury event.
“Compensable” injury means an injury that arises out of and in the course and scope of employment. To be considered in the course and scope of employment, an injured worker must show that the accident occurred while performing activities furthering the business of the employer. Most workplace injuries occur while you are performing your regular job duties, but a compensable injury can also occur during a company picnic, while at break or entering or leaving the employer’s property.
An injured worker will have their injuries covered, even if they are not on the clock, when the accident occurs in an area controlled by the employer.
The Texas Workers’ Compensation system does not look at fault or negligence. As long as the injury did not occur as a result of the workers’ willful attempt to injure themselves or another person, while in a state of intoxication, or while the worker was involved in horseplay, the injuries will be covered.
There are specific event injuries, occupational diseases, and repetitive motion injuries. Work related injuries can include an aggravation of a pre-existing condition. Additionally, the employment need not be the sole and only cause of the injury. You must establish that the employment is a producing cause of the injury – a significant factor in causing the injury.
“Work related” in Texas can be a very difficult concept to understand. There are subscriber and non-subscriber employers. There are networks that may require that an injured worker treat with certain doctors and not others. You should consult with a professional who understands Texas work injuries and has your best interest at heart.
For more information on how to file a claim and establish liability, download our FREE book, The Ultimate Survival Guide For Texas Injured Workers.