Texas Workers' Compensation Lawyers
Workplace injuries can be devastating. Physical injuries, pain, medical bills and lost wages–it can feel overwhelming. It’s easy feel lost and frustrated, especially if your employer tries to dictate your medical treatment. After suffering an injury on the job, you may be entitled to relief through the Texas workers’ compensation system. The Texas worker’s compensation system is also a complex and sometimes overwhelming system. An experienced Texas workers’ compensation lawyer can help you navigate this system and get you the help you need.
What is work comp?
Workers’ compensation, or work comp, is a system to take care of workers who suffer injuries on the job. Work comp applies to injuries that may be an acute or sudden injury, like a fall or car accident, or a chronic condition caused by repeated exposure or activity. Workers’ compensation pays for medical bills, lost wages and other losses related to the injury. It is paid for by work comp insurance carried by your employer under a state regulated work comp system. In Texas, employers are not required to carry workers’ compensation insurance. If your employer does not carry coverage you may have to pursue a personal injury claim against your employer or other responsible party.
What do I do after a workplace injury?
If you experience a workplace injury the first step is to report your workplace injury or illness to your employer. This begins a work comp claim with the employer and its insurance carrier. You must report as soon as possible after the injury or you become aware of a work-related injury or illness. Delaying reporting could jeopardize your claim.
Next, you need to seek medical attention if you have not already. In the case of an emergency or a chronic condition, you may have already sought treatment; however, you must also pursue medical care under workers’ compensation. Your employer may require you to see a specific provider or a provider in the workers’ comp health care network. It is important that you follow this request if made. If your employer does not request either, then you need to seek treatment with a physician approved by the Texas Division of Workers’ Compensation. No matter who you see for care, you need to advise them that your injury or illness occurred while on the job.
After establishing care you may file a claim with the Texas Division of Workers’ Compensation (DWC). The claim form asks for basic information including:
- Your employer
- Injury or occupational illness
- Work status
- Work comp physician
Under Texas work comp regulation, you must file your claim with the DWC within one year of:
- The date of the injury;
- The date you knew the injury or illness is work-related; or
- The date you should have known it is work-related.
If you fail to file your claim before the deadline, you may lose the right to pursue a work comp claim in Texas.
To avoid risking your work comp claim you should hire Texas work comp attorneys before filing your claim if possible. Having an experienced work comp attorney on your side from early in the process will help make sure your claim is timely filed and contains all the necessary information.
How do you I know if my employer has workers' compensation insurance?
Most of the time your employer will tell you they have work comp insurance when you report your injury or illness. They may have disclosed the carrier’s information in a handbook or posted in a breakroom or locker room. Most employers who have coverage want you to report the claim through work comp and decide who you need to see for medical care so they can send you to a friendly doctor.
Sometimes employers lie about having coverage to discourage you from filing the claim and hope you will give up. They may tell you that you don’t qualify for workers’ compensation. If your employer tells you it does not have coverage or that you do not qualify for it, you should talk to a workers’ compensation lawyer right away about your options. Your attorney can investigate coverage and assist you with your next steps.
Do I have to file a claim with work comp if my employer has insurance?
Generally, if your employer has work comp insurance you must file a claim if you need medical treatment or other benefits. If your employer or employment caused the injury or illness, in almost all cases work comp is your exclusive remedy. If a third party caused injury or illness while at work, you may have a case against the third party. You may want to pursue work comp and your case against the third party. Work comp will be able to recover from your third party case. Your workers’ compensation attorney can assess your situation and advise you on your options.
Are there exceptions to work comp claims?
If your employer subscribes to the workers’ compensation system, there are few circumstances where workers’ compensation will not pay for an employee’s work-related injury or illness. Generally, work comp claims are no-fault claims so you do not have to prove the employer caused it, merely that it occurred at work or from performing your job duties. Work comp generally pays claims even if your own carelessness caused your injury.
There are some exceptions. You cannot receive work comp benefits if you caused your own injury due to intoxication or because you engaged in a physical altercation with a coworker. You can pursue a claim against your employer outside of work comp if your employer intentionally caused injury. Your work comp attorney will assess your situation and help you understand your options.
Types of Texas workers' compensation benefits
Workers’ compensation pays for medical treatment as well as income benefits due to a short or long term inability to perform your job. Unlike a personal injury claim where you only recover at the end of your case from a settlement or trial, workers’ compensation pays benefits weekly so it can replace lost wages in real time. There are four types of benefits paid by Texas workers’ compensation:
You may receive some or all of these benefits over the course of your claim.
Temporary income benefits (TIBs)
Temporary income benefits, or TIBs, pays lost wages if your work-related illness or injury causes you to lose some or all of your wages for more than seven days. TIBs pays benefits weekly between a minimum and maximum rate. You may receive TIBs for up to 104 weeks; however, TIBs may stop earlier if you begin earning the same weekly wage from your employer as you did before the injury or illness (such as returning to work on light duty) or if the medical provider determines you reached maximum medical improvement (MMI). Maximum medical improvement means your provider assessed that you reached the best condition medical treatment can provide and no further recovery is expected.
Impairment income benefits (IIBs)
Impairment income benefits (IIBs) are paid when your injury or illness affects your entire body. If your medical provider determines you are at MMI and not completely healed, then you become eligible for IIBs. Your healthcare provider will give you an impairment rating which is a percentage of your normal bodily functions you can no longer perform as you did before the injury or illness.
IIBs also pay amounts calculated on a fixed scale dependent upon your impairment rating. You receive three weeks of IIBs for each percentage of impairment. After you reach the end of this time period IIB payments end.
When your IIBs end you may seek additional periodic benefits. Your workers’ compensation lawyer will discuss your options at this stage and advise you on your rights.
Supplemental income benefits (SIBs)
After IIBs end you may become eligible for supplemental income benefits (SIBs). Unlike TIBs and IIBs, SIBs are paid monthly and you must apply for them quarterly. To obtain SIBs you must meet several requirements:
- Received an impairment rating of 15% or more;
- Not returned to work or returned to work but in a position where you earn less than 80% of the average weekly rate of your position prior to the injury or illness;
- Prove you are currently seeking alternative employment; and
- Have not accepted a lump sum payment from workers’ compensation.
You begin receiving SIBs immediately after IIBs end if you qualify. SIBs expire 401 weeks from the date of injury or illness.
Lifetime income benefits (LIBs)
In the case of severe and permanent injuries, you may receive lifetime income benefits (LIBs). Workers’ compensation pays LIBs weekly for the remainder of your life if you qualify. The standard for LIBs is high and includes injuries such as:
- Loss of both hands or feet
- Permanent paralysis of limbs
- Total and permanent loss of sight in both eyes
Your work comp attorney can help you determine if you qualify for LIBs.
Burial and death benefits
If a workplace injury or illness caused a family member to pass away then the deceased worker’s dependent survivors may receive burial costs and wrongful death benefits from work comp.
Can I receive a settlement from work comp in Texas?
Under the Texas workers’ compensation statute, there are no settlements for work comp claims. You cannot receive a settlement in exchange for weekly income benefits, even for lifetime benefits. IIBs may be paid as a lump sum; however, this lump sum is not a settlement. It is a payment up front for the calculated weekly payments. In some states you can receive a settlement of future benefits when you reach MMI but Texas elected to prohibit settlements.
What happens if my employer disputes my work comp claim?
Your employer may dispute the validity of your claim from the outset, such as contesting whether your injury or illness was caused at work. It may also dispute an impairment rating or whether particular treatment is necessary or appropriate for the workplace injury or disease. Under the Texas workers’ compensation system disputes over medical treatment may be resolved through a designated doctor. A dispute may also require a hearing before an administrative judge. Your attorney will represent you in these disputes.
What if my employer retaliates for filing a work comp claim?
Under Chapter 451 of the Texas Labor Code it is illegal for your employer to fire you or otherwise retaliate against you for:
- Filing a work comp claim in good faith;
- Hiring a lawyer to represent you in your claim;
- Instituting a proceeding under the work comp system to resolve a dispute; or
- Testifying in a proceeding under the work comp system.
Your employer might discriminate against you by wrongful termination, creating a hostile work environment, or engaging in other retaliation. In a work comp retaliation claim you can recover more than just what the work comp claim allows. You can also receive reinstatement to your job, lost wages due to the retaliatory act, mental anguish and punitive damages.
Seek guidance from Texas workers' compensation lawyers
Although the Texas workers’ compensation claims system is designed to allow you to get treatment without hiring an attorney, your claim can quickly become more complicated if your employer contests your claim or necessary treatment. Often your employer or their insurance company will hire an attorney and experts to represent their side. You need an advocate on your side to protect your claim and help you get the relief you deserve. Talk to a Texas workers’ compensation lawyer about your claim as soon as possible after your injury or illness.