What Is the Process for Workers’ Compensation Claims In Texas?

Getting injured at work disrupts more than your health. It can also lead to dire financial consequences. Workers’ compensation insurance is designed to reduce the financial impact of a workplace injury. It is required in all states except Texas. Even though Texas employers are not required to provide workers’ comp benefits, many do so voluntarily. These benefits are managed by the state Division of Workers’ Compensation.

Workers’ compensation insurance offers a lifeline to injured workers. You can expect to receive the following financial benefits after filing a claim:

• Medical benefits for as long as you need to recover
• Partial wage replacement
• Death and burial benefits

Steps for Filing a Workers’ Compensation Claim in Texas

You must file a claim to receive any benefits available through your employer’s workers’ comp policy. This is done by following the prescribed steps described below. Remember that although this is the preferred order, it is not definitive. For example, you may need to seek medical care before reporting your injury. 

Report Your Injury

Injuries should be reported to your employer within 30 days of their occurrence. In most cases, an accident and injury report is filed immediately after the incident. However, with serious accidents, it may be best to seek medical attention before completing the required paperwork. 

In some situations, you may not be aware of the injury until it starts to show symptoms. This is common in repetitive use injuries or hearing loss. In that case, you should report it to your employer as soon as you receive a diagnosis. 

If you are unfamiliar with them, talk to your employer about accident reporting procedures before you need them. This way, you know exactly what is expected of you in case an accident occurs.

Seek Medical Attention

You must seek medical care to receive workers’ compensation benefits. When you do so can vary depending on the type and severity of your injury. 

If you have sustained a severe injury, seek medical attention immediately. You may be taken to a hospital for emergency care if EMS is called. Otherwise, go to an ER or urgent care clinic for care. You can complete an accident report later. 

You can often visit a primary care doctor for minor injuries. While you should be seen as soon as possible after an injury, you may want to wait a few days to see if any symptoms subside. Be sure to mention that the injury happened at work and provide your employer with copies of a visit summary and notes. 

Repetitive use injuries, such as carpal tunnel syndrome, occur as the result of doing the same task repeatedly. Since there is no accident, you must take extra care documenting these claims. Reporting time limits generally apply from when symptoms first appear or when the condition is diagnosed.

File a Claim

Texas law stipulates that you have one year after an accident or injury to file a claim with the Division of Workers’ Compensation. If your claim is for a work-related injury but does not involve an accident, you have one year from when you knew (or should have known) about the condition. There are some exceptions, such as when an employer does not contest a claim or you have a good cause to delay filing.

The Texas DWC makes filing simple. You must complete and submit an Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease, DWC Form-041. This is available online as a fillable PDF document. Once received, the Division creates a claim, assigns a claim number, furnishes you with information about workers’ compensation laws in Texas and notifies your employer and their insurance provider of the claim.

Filing a workers comp claim is in addition to any employer-mandated reporting. It is a straightforward process, although you may want to seek legal counsel before going forward. 

Disputing Your Claim Decision

In some cases, you might not agree with your claim decision. This is generally the result of a claim being denied. Texas has an established dispute resolution process that must be followed regardless of who disputes a claim decision. 

There are five possible steps to resolving a dispute. These are:

• Call DWC customer service and speak to a staff member. The issue may be a misunderstanding that can be resolved over the phone.
• Request a benefit review conference. This is an informal meeting between you, your attorney, an insurance representative, and someone from the DWC. Agreements will be written up and signed, or you may escalate the dispute to a contested case hearing if an agreement is not reached. 
• Contested case hearings occur before a DWC administrative law judge who issues an opinion. You, your employer, or the insurance company may appeal this decision. 
• Appealed hearing decisions go to an appeals panel for review. The panel issues a written statement on the case after reviewing pertinent facts. This is the final step in the DWC process.
• If anyone wishes to pursue it further, the case can be brought to the court system for judicial review.

Texas DWC recommends speaking to an attorney before taking any steps in the dispute process. It is also advisable for your attorney to handle all communication with DWC staff, your employer, and the insurance carrier. 

Return to Work 

Another aspect of a workers’ comp claim is returning to work. According to the Texas Department of Insurance, employees who recover while working experience benefits that may include:

• Reduced financial strain
• Avoiding long-term disability
• Better emotional and physical well-being
• Maintaining job-related benefits
• Quicker healing

Unfortunately, a serious injury may make it impossible for you to return to your previous duties immediately. Return-to-work programs aim to serve as a bridge to get you back into the workforce at an appropriate time and in a suitable role. 

Talk to your doctor about what you can and cannot do. Then, discuss a possible return to work with your employer. It is important to be honest about job responsibilities and follow your doctor’s instructions at home and work. 

Your Rights and Responsibilities as an Injured Worker

You have rights and responsibilities as an injured worker seeking compensation. While these are specific to Texas, many states have established similar policies. 

Your rights as an injured worker include the following:

• To consult and hire an attorney to assist with your claim or to receive assistance from the Office of Injured Employee Counsel
• To have all information associated with your claim handled confidentially
• To choose your doctors (you may be limited to providers within a specified network)
• To receive income benefits while you are out of work
• To receive medical care for your injuries as long as is necessary for proper treatment

You also have established responsibilities, such as:

• Provide honest and factual information to your employer, the insurance company and medical personnel about the nature of your injuries
• To inform your employer if you file a workers’ compensation claim
• To notify the insurance company of any changes to your care, health status, or work status
• To file the appropriate form (DWC-041) with the division

Professional Legal Representation After a Work Injury

If you were injured at work, Fielding Law can help. We specialize in personal injury claims and have the knowledge and experience to help you successfully file your workers’ compensation claim. Contact us today to schedule a free, no-obligation case review.