Texas is one of the very few states in which employers are not required to carry workers’ compensation insurance. Private employers have the option to either carry workers’ comp coverage or post a bond (approved by the Texas Department of Insurance’s Division of Workers’ Compensation) to reimburse injured employees. If your employer has workers’ comp coverage, you must go through that process to be compensated for your injury.
The Texas Division of Workers’ Compensation has an online database that confirms your employer has acceptable coverage. It will tell you whether your employer has a commercial policy through an insurance company or is self-insured. If your employer is self-insured and you encounter any problems with being compensated, contact an experienced work injury attorney immediately!
DETERMINING YOUR ELIGIBILITY
There are two requirements you must meet before you apply for workers’ compensation benefits. Your employer must be covered in either manner outlined above, and you must have suffered an illness or injury that’s job-related.
Getting Medical Treatment
When you’ve been injured on the job, even if the accident was your fault, you must report your injury or illness to your employer within 30 days. It is then your employer’s obligation to file an Employer’s First Report of Injury or Illness with his insurance carrier within 8 days of your notification or absence from work.
After reporting your injury or illness, your employer should either tell you how to get medical care or, if self-insured (and if you do not need emergency treatment), may make arrangements for you. If your employer provides medical treatment through a workers’ comp health care network, you can choose a doctor in that network. But if you are allowed to pick your own doctor, make certain he or she is willing to treat workers’ comp injuries. When you arrive for that first visit, it is vital that you tell the doctor you were injured at work.
- Medical Treatment – You may receive full compensation to cover your medical expenses and treatment, but only for work-related injuries. The benefits are paid directly to the medical provider by whoever is covering those costs.
- Lost Wages – You may receive a portion of your lost wages through workers’ compensation income benefits. They are calculated by your average weekly wage (AWW), which is based on your average earnings for the prior 13 weeks if you’re a full-time employee.
If the insurance company denies your claim, you can challenge the ruling through the Texas Division of Workers’ Compensation. If you fail there, you can then request a workers’ comp hearing before a workers’ comp administrative judge. Because the workers’ comp dispute and hearing processes both follow complex procedural rules, you are best served by hiring an experienced workers’ comp lawyer to help win your dispute or subsequent hearing.
Supplementing Your Workers’ Comp Claim
If your work-related injury or illness keeps you from being able to return to work or forces you to adjust to new and different duties for a year or more, you may qualify for Social Security Disability (SSD) benefits.
The amount you can receive depends on how much money you made when you worked, whether you are receiving workers’ compensation, and how much. Benefits can range from $300 a month to around $2,000. They are calculated by the Social Security Administration, based on your income, your contributions to Social Security and, again, whether or not you are receiving workers’ comp.
Filing Workers’ Comp Lawsuits
If your employer is a nonsubscriber and doesn’t have workers’ compensation insurance, you may sue your employer for compensation for your injuries. Also, even though employers subscribe to workers’ comp insurance to shield them from employee lawsuits, there are a few provisions having to do with employer gross negligence or willful intent to injure you that exposes them to a civil lawsuit. And if a third party had any involvement in causing your work injury, you can bring a lawsuit directly against them as well.
Seasoned workers’ comp injury lawyers have experience in all three types of work injury-related lawsuits and can be a valuable asset in helping you recover the full amount of compensation you may be due.