What Qualifies You for Workers’ Compensation in Texas?

Getting hurt at work can lead to serious financial consequences. In addition to medical bills related to the injury, you may lose wages due to an inability to work. This can lead to significant medical debt. Luckily, most injuries and illnesses qualify for workers’ compensation benefits. This insurance serves to help injured workers recover by paying for certain injury-related expenses.

Your employer must purchase workers’ compensation insurance for your injury or illness to qualify for coverage. Texas is unique because it is the only U.S. state not requiring private employers to carry workers’ compensation insurance. However, public employers and those contracting with public agencies must purchase coverage. Employers must notify employees about any coverage. 

Texas Workers’ Compensation Benefits Explained

If your employer opts to purchase workers’ compensation insurance, you will receive comprehensive benefits after a covered injury or illness. Your employer must post a notice about coverage in a visible location to inform you if it is in place. This should contain the name of the insurance provider and its contact information. 

Income Replacement

There are four classifications within the category of income benefits. Each one is based on the severity of the injury and how long recovery will take. They are:

• Lifetime income benefits 
• Supplemental income benefits
• Impairment income benefits 
• Temporary income benefits 

You can receive up to 100% of your established wages, depending on the classification of your injury. Wages are calculated based on the average of your previous 13 weeks of pay plus certain employer-paid benefits. Calculations are slightly different for public school employees. Benefits are paid by check, direct deposit, or an access card. 

Medical Care Benefits

Workers’ compensation medical benefits cover the total cost of treatment for work-related illnesses or injuries. Therefore, you should not receive a bill for any covered services. 

Your employer’s insurance company may use a preferred network of providers. In this situation, you must utilize a doctor within the network to receive benefits. You may request an exception if appropriate care is unavailable within the network. You must notify DWC any time you change doctors.

Death and Funeral Benefits

Workers’ compensation may pay death benefits to your surviving spouse or certain dependents. Death benefits are payable for as long as the recipient remains qualified. Workers’ compensation also pays for a portion of funeral expenses. 

The U.S. Bureau of Labor Statistics reported over 5,100 workplace deaths in 2021. If your spouse or custodial parent was killed at work, you could be entitled to these benefits. 

Covered Injuries

Generally speaking, any work-related injury is potentially covered by workers’ compensation insurance. Let’s look at some common types of injuries that can qualify you for workers’ compensation. 

Injuries That Happen at Your Place of Work

If you are injured at your place of work, regardless of whether you were at fault for the accident, you likely qualify for workers’ comp. According to the National Safety Council, some common examples of workplace accidents include:

• Slip and fall
• Electrocution
• Contact with an object, such as a vehicle or piece of equipment
• Getting stuck between two objects

Not all injuries are accident related. You may also become injured, sometimes seriously, from things including exposure to the following:

• Harmful chemicals
• Radiation
• Noise
• Temperature extremes
• Rapid changes in air pressure

Additionally, you may receive a diagnosis for an injury that developed over time. For example, the NSC lists overexertion and bodily reaction as the second leading cause of workplace injuries. This type of injury can take years to present symptoms. However, once it does, you may find yourself unable to work due to pain and limited mobility.

Common examples of overexertion injuries include the following:

• Back pain or disc injury
• Carpal tunnel syndrome
• Trigger finger
• Rotator cuff injuries
• Tendonitis in other joints

Injuries That Happen at Other Locations

Not all jobs happen at set locations. For example, you could make deliveries or pick up supplies on a typical day. If you are involved in an auto accident during either situation, it could be filed as a workers’ comp claim. However, if you were in an accident while running personal errands during work hours, those injuries would not qualify. 

The rise in working from home also adds to this situation. Many at-home injuries can qualify you for workers’ compensation benefits if they occur while you are performing work duties. For example, you can develop a repetitive use injury from poor ergonomics at a home-office desk. You might also get injured in a slip-and-fall accident while performing work tasks.

The key to qualifying for workers’ compensation in these situations is your ability to show that you were engaging in work activities when the injury occurred. 

Work-Related Health Conditions

It is possible to successfully file a workers’ compensation claim for illnesses not associated with a specific incident. Like repetitive use injuries, these types of illnesses often develop over years. Some may not show symptoms until later in life, usually when you are no longer employed with the company in question. 

Because of their nature, work-related illnesses require special attention and care during the claims process. Therefore, it is imperative to keep exacting records of all communications between yourself and your doctors, employer, and insurance company to improve the likelihood of a successful claim. 

• Post-traumatic stress disorder after repeated exposure to traumatic events at work
• Hearing loss due to excessive noise levels or inadequate protection against it
• Radiation poisoning can develop after prolonged exposure to minute levels of radioactive material
• Lung disease may be a byproduct of poor air filtration and circulation
• Cancer can be a consequence of exposure to certain chemicals used in manufacturing

Limits on Injury Coverage

Not all work-related injuries are covered by workers’ comp, even if your employer has coverage in place. For example, the following type so injuries generally do not qualify for workers’ compensation benefits:

• Self-inflicted injuries
• Injuries that occurred while you were under the influence of drugs or alcohol
• Injuries resulting from failure to use required safety equipment 
• Injuries that happened outside of your work responsibilities if they happened off-site

Additionally, you cannot file a claim if your employer has opted out of purchasing workers’ compensation. However, in this situation, you may be able to sue the company for compensation related to your injury. An employer without insurance coverage is vulnerable to this type of lawsuit.

If you have been injured at work and had your claim denied, it’s wise to speak with an injury attorney. He can review your information and suggest what steps to take next. At Fielding Law, we will review your case for free, with no obligation to take action or use our services afterward. 

Have an Experienced Injury Attorney on Your Side

Texas statutes grant you the right to hire an attorney to help you file your claim and handle any appeals. After all, insurance companies have attorneys who navigate the workers’ compensation system on their behalf; you should have the same. 

Fielding Law specializes in personal injury cases. We can help you feel your claim for workers’ compensation and, if appropriate, seek additional compensation from your employer for negligence. Contact us to schedule a free, no-obligation case review. A staff member will review your information and get back to you with possible next steps.