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There are Federal workers’ compensation laws and state workers’ compensation laws.  Federal law governs work injuries that occur while someone is working for a Federal government agency.  State workers’ compensation laws govern work injury claims that happen while working for a business in any given state.   Every state has different workers’ compensation laws.  Texas workers’ compensation law is no different.  That’s why one of the most searched questions related to Texas work injury cases is, “How does workers’ comp work in Texas?”

Filing A Texas Workers’ Comp Claim

If you get hurt at work, there are a few things you have to do to get a claim started.  First, get medical treatment immediately.  This establishes documentation of your injury and its severity.  After that, you have to protect yourself legally. 

As we discussed in our post about the Top 5 Texas workers’ compensation laws, you have to report your injury to your employer within 30 days.  This means that you have to notify a manager or HR person about your work injury.  It can be verbal or in writing.  Some employers have forms to fill out after a work accident.  Others pretend to listen and then ignore you later and act like you never told them anything.  So, putting it in writing can be helpful.  You should make sure to explain that you have an injury and that it occurred at work on a specific date.  Give some detail about how it happened.  That should take care of your responsibility to report the injury to your employer within 30 days.

The third thing you have to do is file a claim with the Division of Workers’ Compensation.  There is a specific form for this purpose.  It is form DWC-41 entitled, “Employee’s Claim For Compensation For A Work-Related Injury Or Occupational Disease.”   Fill it out and fax it to the number at the top of the form.  Keep the fax receipt to prove that you filed it.  Your deadline to file this form is one year from the date of the accident.

How does workers’ comp work in Texas?  It doesn’t unless you document your injury, report the injury to your employer and file a claim with the Division of Workers’ Compensation.  Don’t forget to do these 3 things immediately.

Medical Treatment For Texas Work Injuries

How does workers’ comp in Texas work?  This question often means, how do I get treatment for my work injury?   That’s not an easy question to answer.

For emergency care, you can go to any emergency room or urgent care center.  The same goes for initial care even if it’s not an emergency.  There are lots of occupational injury clinics as well where your employer will probably send you for an exam. 

In Texas, we have allowed insurance companies to set up medical treatment networks.  This is similar to your health insurance.  With health insurance, if you have Blue Cross/Blue Shield, then you can go to any doctor that takes Blue Cross/Blue Shield insurance.  Texas workers’ compensation insurance companies have networks of doctors as well.  The problem is that these insurance companies have limited the choice of doctor in these networks to the ones they like the best.  Not necessarily the ones you will like the best.  For instance, Texas Mutual has limited your choice of a treating doctor in Dallas to the “doc in a box” occupational clinics like CareNow.  Some of these types of places might be great for a sinus infection, but they really don’t’ seem to be set up for ongoing managed care of work injury claims.

If your workers’ comp insurance company does not have a network, then you can choose any doctor who treats patients in the workers’ compensation system.  They just have to agree to become your “treating doctor.”

How Does Workers’ Comp Work In Texas If I Can’t Work?

When someone asks, “How does workers’ comp work in Texas?”, they usually mean, “How do I get paid while I’m off work?”  According to Texas workers’ compensation law, you have disability if you lose wages because of your work injury.  When you sustain disability in this context, you are entitled to Temporary Income Benefits.  These benefits are paid weekly and are calculated based upon your average wages prior to your accident.  TIBs usually cover 70% of your lost wages.  You will receive these benefits until you are able to return to work and earn full wages or you reach your maximum medical improvement.  TIBs are one of the Top 4 Texas workers’ compensation benefits you need to know about.

Benefits For Permanent Impairment

When you reach maximum medical improvement, you will be assigned an impairment rating by a doctor.  This is a measurement of the permanent damage resulting from your work injury.  It is expressed as a percentage.  For instance, most back injuries receive a 5% impairment rating.  The workers’ compensation insurance company will owe you benefits when you get this impairment rating.  They have to pay you 3 weeks of benefits for every percentage of impairment.  So, a 5% impairment rating will result in 15 weeks of impairment income benefits.

What To Be Worried About

So, how does workers’ comp work in Texas?  There is a lot of responsibility placed on you, and little responsibility placed on the insurance company.  You now know that you have the responsibility to report your injury and file a claim.  If you don’t, then your claim can be denied outright. 

An insurance company doesn’t have very many responsibilities.  Some are good.  But others….They will stand in your way and block your medical treatment.  Insurance companies will refuse to pay benefits they owe.  They will send you to doctors who they pay to write reports that limit their liability.  They will hire investigators to follow you around and ask your neighbors to report on you.  They will work with your employer to deny you benefits.  I’ve even seen them sabotage injured workers’ attempts to return to work.

Unrepresented workers bear the brunt of this type of treatment.  That’s because they don’t have a way to defend themselves.  The answer for all of this mistreatment is to make the insurance company go to a hearing before a judge called a Contested Case Hearing.  Unrepresented workers do not do well in front of judges.  I can agree that a Texas workers’ compensation attorney is not necessary in every case.  However, if an insurance company is denying you the benefits that you are owed, then an attorney is necessary to give you any real chance at beating them in court.

How does workers’ comp work in Texas?  Not very well for injured workers.  But, there are ways to make things turn out in your favor.