Workers' Compensation Claim in Texas

When you sustain severe injuries or a debilitating illness because of a workplace accident or environment in Texas, you may qualify for Texas workers' compensation benefits. However, there are several steps you need to take to begin the process of claiming these benefits. This includes notifying your employer of your injury as well as submitting a formal claim to the Texas Division of Workers' Compensation. 

Knowing what information you need and ensuring you've filled out these required Texas workers' compensation forms correctly can be challenging. But, if you or a loved one have gotten hurt on the job, contact the seasoned attorneys of Morgan & Morgan to help navigate the complex laws that regulate this process.  

First Steps: Determining Your Employer's Coverage

After getting injured while at work, you may be unsure what steps you need to take after being seen by a doctor for treatment. Because Texas doesn't make it a mandatory requirement for employers to carry workers' compensation policies, you should determine if your company has coverage. Employers are legally required to share their insurance information with you, but you can also verify if they do or not by using Texas' online database. 

If they don't have coverage, you may need to speak with an attorney about suing for damages if possible.

Required Texas Workers' Compensation Forms

Ensure that before you do anything else, you notify your employer about your injury as soon as possible. Texas law sets a 30-day deadline to do this from the date you get hurt. Failing to do so could result in you losing your right to receive workers' compensation benefits altogether. Once reported, your company's HR department or supervisor will let you know where you can get healthcare for your injuries. This is their legal right, and if they don't have preferred providers to choose from, you will have to select a doctor from the Texas Division of Workers' Compensation (TDWC) list of approved physicians. 

At this point, you will also need to file an Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease with the TDWC. This document can be filed either in person, online, or by mail and will require your personal details, including:

• Your identifying information
• Specifics about your injury (date you got hurt, diagnosis, etc.)
• What your current work status is 
• Employer details 

While it does provide detailed directions on what information is needed for each question, working with a highly-trained workers' compensation attorney at Morgan & Morgan is advisable. You want to ensure that any details you submit with any Texas workers' compensation forms are accurate and fully explain the nature and circumstances of your work-related injury. Our attorneys can assist you by evaluating your diagnosis, treatment, circumstances surrounding your injury, and other crucial information you may not think to include. 

You only have one year to file Form DWC-041 from the date of your accident or learned you had a work-related illness. Failing to meet this requirement could mean you won't qualify for the crucial benefits you need. Once submitted, the TDWC will notify your employer of your filing, as well as their insurer. At that point, your claim is under review by the insurance company to be approved or denied. 

Wrongful Death Benefit Form for a Texas Workmans' Compensation Claim

If your family has suffered the tragic loss of a loved one because of a work injury or occupational illness, you may be able to obtain death benefits from TWDC. To apply, you will need to complete and file DWC Form-042, Beneficiary Claim for Death Benefits. with TDWC. You can get this form from several sources, including the Texas Department of Insurance website, or request a physical copy via mail. 

While you can file yourself, be sure to submit it in person at your local TDWC office to get a time-stamped copy. However, an experienced workers' compensation attorney may be your better option. By allowing them to take on the burden of completing necessary Texas workers' compensation forms, evidence gathering, and dealing with the insurer, you can focus on grieving and healing. 

Wrongful death benefit claims with TDWC also have a one-year filing time limit from the date of your loved one's passing.

Receive Immediate Medical Treatment Benefits for TDWC Claims

After getting hurt at work, it's important to remember that you are eligible for medical treatment benefits right away. This includes essential healthcare services, such as:

• Doctor visits
• Diagnostic studies
• Physical therapy
• Surgery
• Related treatments deemed necessary and reasonable

When attending your first appointment, make sure to inform your treating physician that you suffered a workplace injury. Provide your employer's workers' compensation claim details if you have them. If it's a larger office associated with your local hospital, they might already have this information on file, as well. This is a crucial step to take when receiving medical care after getting hurt on the job because your medical provider will directly bill your employer or their insurer instead of you.

Keep in mind that your employer has the right to demand you seek care from a doctor within their preferred physician network.

Income Benefits of the TDWC System

One of the worst realities of on-the-job injuries is being unable to work temporarily or permanently. Texas workers' compensation law allows employees to receive compensation for lost wages under certain circumstances. Typically, the events of your workplace illness or accident will determine which of the four types of income benefits you will receive:

Temporary Income

Temporary income benefits are given to injured workers and unable to work for more than seven days. This means you could be eligible to receive payments on day eight of losing your wages. For workers who can return to work but in a limited capacity or at reduced hours, and their pay has suffered because of it, it's possible to still qualify for 70% of your lost income. 

These benefits are issued weekly until one of the below circumstances occurs: 

• You can earn income that equaled your pre-injury/illness wages 
• You've reached your Maximum Medical Improvement (MMI)
• 104 weeks have passed since first getting hurt and losing wages 

Impairment Income

Individuals permanently impaired by an occupational illness or workplace injury may also qualify for impairment income benefits. When you've reached your MMI, your doctor will rate your permanent impairment and determine the type of work restrictions you will need. These factors play a direct role in deciding how much of a monetary benefit you could receive. For each percentage point assigned to your impairment, you get three weeks of this much-needed income. It's important to remember that you will only receive up to 70% of your previous wages, and the total amount you could receive is subject to state maximums.  

Supplemental Income

Another form of lost wages benefits you may qualify to receive from TDWC is supplemental income. Typically, workers who have an impairment rating exceeding 15% and can't earn 80% or more of their previous income could be eligible for this benefit. Again, though, these payments only take effect once one's impairment income has ended. 

How your benefit amount is determined is highly complicated and revolves around your average weekly wages before you were injured and currently. The Texas Division of Workers' Compensation will calculate your payments based on 80% of the difference of these two amounts, but only towards 80% of that total. Additionally, the maximum amount of time a disabled employee could receive supplemental income is 401 weeks, and there is also a cap on how much you receive each week. 

Lifetime Income 

If you or a family member suffered a work-related illness or injury that is so severe it would affect you for the remainder of your life, then lifetime income benefits are another option to consider. This benefit program will pay an injured worker 75% of their average weekly wage before being hurt, and this amount is increased by 3% annually. These payments will continue for the rest of your life and have the same maximum weekly benefit cap as temporary income.