Work Injury

Legal Requirements

In Texas, the Texas Workers’ Compensation program covers workers’ compensation insurance. Employers opt into the coverage. Employers can be subscribers, non-subscribers, or self-insured. Employers can also choose not to carry any insurance coverage for employee injuries.

• Subscribers have workers’ comp insurance.
• Non-subscribers may or may not have other insurance to cover injuries.
• Self-insured companies are their own insurers.
• Uninsured companies have no insurance.

Workers’ compensation can limit the amount and type of payment an employee can get. On the other hand, it is supposed to make personal injury claims easier for employees.

What If My Employer Is a Non-Subscriber?

If your employer is a non-subscriber, you can sue them under normal personal injury laws. They may or may not have other insurance coverage. Under personal injury, you can collect damages and attorney’s fees.

In Texas, being a non-subscriber means an employer can not use certain defenses usually available in personal injury cases. These defenses include

• Last clear chance
• Contributory negligence
• Assumption of the risk
• Co-worker negligence

Can I Recover If My Employer Does Not Have Workers’ Comp Coverage?

Yes. You can recover under their other insurance. Even if your employer does not have insurance, it does not mean you cannot recover for an injury. However, you may need to sue your employer directly.

What If My Employer Discontinued Workers’ Comp Coverage?

The law requires an employer to notify employees if it discontinues workers’ comp coverage.

Can I File a Personal Injury Claim If My Employer Has Workers’ Compensation Coverage?

Yes.

When the company hires you, it must notify you whether or not it has workers’ comp insurance. The company also needs to post that information in the workplace. You have five days to waive your right to workers’ comp. If you waive workers’ comp, you can sue your employer for a work-related injury. However, waiving workers’ comp means you give up benefits and income under the workers’ compensation law.

How Do I Start My Workers’ Comp Case?

You need to follow specific steps for your workers’ comp case. Your employer’s insurance company will usually dictate the actions you need to follow.

• Report the incident
• Get medical care
• Open the claim

Report the Incident

The first thing you need to do is report the incident. The incident can be an injury or exposure to an illness. It must occur during the course and scope of your employment. The incident can be acute or chronic.

During the course of your employment means that the injury happened while you were at work or doing your job. Most injuries that occur in the workplace are in the course of your employment. Generally, injuries that happen during a commute are not, but they might be if you have to drive as part of your job.

During the scope of your employment means that the incident happened while you were performing your job. Most workplace activities fall under the scope of employment.

Get Medical Care

You will need medical care to prove your workers’ compensation claim. If you get an acute workplace injury, you want to get treatment immediately. Your workplace may send you to a preferred provider. However, you can also get treatment from your own doctor.

Part of the medical care should be a treatment plan.

• Can treatment return you to your pre-injury state?
• How long will treatment take?
• What will treatment cost?

The treatment plan is one of the essential parts of your workers’ compensation claim. It helps determine how long you will get benefits.

Start Your Claim

You need to begin your claim officially. In most workplaces, you contact HR. HR then tells you what steps to follow for your claim. You may get an ombudsman to help you with your claim.

Workers have 30 days to file injury reports. You have up to a year to file your workers’ compensation claim. However, you may have to take action before that time. If you want to appeal an impairment rating, you have 90 days to do so.

Generally, the time starts running when the incident occurs. However, suppose you did not immediately know the nature of the illness or injury. In that case, the time starts running on the date you should have known.

When Does Workers’ Comp Not Apply?

Workers’ compensation covers most workplace incidents. However, it explicitly excludes injuries caused by

• Horseplay
• Self-injury
• Criminal acts
• Intoxication (drugs or alcohol)
• Off-duty recreational activities (workplace parties)
• Third-party criminal acts unrelated to work
• Acts of God

What Types of Benefits Can I Get Under Workers’ Comp?

Workers comp offers three types of benefits

• Medical benefits
• Income benefits
• Death benefits

Do I Have to Return to Work?

Workers’ compensation laws favor return-to-work programs. Your employer may want to put you on light-duty work. If you refuse to accept suitable light duty work, that can lead to stopping workers’ comp benefit payments.

What If My Employer Fires Me for Filing a Workers’ Compensation Claim

Retaliatory firing and discrimination are both prohibited by the law.

Do I Keep Getting Benefits While On Leave?

The law does not require your employer to allow you to get benefits like accruing PTO while on leave.

Can Other Laws Impact My Claim?

Absolutely. Other laws may apply depending on the nature and scope of your injury. The Family Medical Leave Act and the Anti-Discrimination Act frequently interact with personal injury cases.

Do I Keep My Health Insurance While on Workers’ Compensation Leave?

Some employers allow you to keep your health insurance while on leave. If yours does not, you will qualify for COBRA.

Can I Get Unemployment While On Workers’ Compensation Leave?

Sometimes. Workers’ comp usually disqualifies people from getting unemployment. However, if you have a permanent, partial disability, you may be able to get unemployment.

Is An Ombudsman the Same As an Attorney?

No. The Office of Injured Employee Counsel offers ombudsman services for injured employees. They can also help family members. Their job is to provide you with information. They also try to help resolve the dispute. They might even attend proceedings with you.

While an ombudsman might seem like an attorney, they do not represent you. They are not your counsel.

Ombudsmen are generally on the employee’s side. However, they are frequently underpaid and overworked. They may not be able to give your case the attention it deserves.

Reasons People Seek a Workers’ Comp Attorney

Theoretically, the workers’ comp system runs smoothly. It should cover employee medical costs and time off from work. However, insurers may try to underpay you. Plus, it can become very complicated.

Contact a workers’ comp lawyer if you have

• Been hurt on the job
• Missed 7 or more days from work
• Think your workers’ comp payments are too low
• Had your workers’ comp claim denied
• Had your job threatened if you made a claim

The Salazar Law Firm provides free, no-obligation workers’ compensation consultations. We can make sure you understand your rights and duties. With that information, you can make an informed decision about whether you need an attorney.