Texas Workers’ Compensation Laws – All You Need to Know

The workers’ compensation laws in each state aim to provide financial security to workers injured on the job. Unlike most other states, Texas Workers’ Compensation Laws do not require employers to carry workers’ compensation insurance. While this may seem to present problems to injured workers, any employer that decides not to purchase this insurance coverage can face problems as well if an employee suffers any type of injury at work.

Workers’ compensation aims to benefit both workers and their employers. When it comes to the benefits of workers, they have a streamlined recovery process readily available to them after sustaining an injury at work. For employers, workers’ compensation insurance typically prevents them from facing civil liability for injured workers’ damages. If an employer does not have workers’ compensation insurance, their employee could not file a workers’ compensation claim in response to a workplace injury, but they could file a personal injury suit against their employer instead.

How to File a Workers’ Compensation Claim

If your employer has workers’ compensation insurance and you suffer an injury while working, you have the right to pursue compensation for your damages through the workers’ compensation claim filing process. This is similar to almost any other type of insurance claim, but the claimant faces an additional layer of complexity due to the involvement of their employer in the process.

After an injury at work, your first concern should be your health and well-being. It’s essential to seek medical care, even if you think your injury is minor. You should also report the injury to your supervisor, and they are legally required to create an incident report of the injury. If the employer has workers’ compensation insurance, they are also required to furnish you with the materials needed to file your claim for benefits.

Once the insurance company receives your claim, they will investigate the incident in question and determine your eligibility for benefits. If the claim is approved, the injured claimant can potentially recover full repayment of all their medical expenses along with ongoing disability benefits until they are able to return to work. Not all workers’ compensation policies are alike, so it’s crucial for an injured worker to seek legal counsel they can trust to help them maximize their claim payout.

Filing a Personal Injury Claim Against a Texas Employer

Unfortunately, not all injured workers have the ability to file workers’ compensation claims in response to their injuries on the job. If your employer does not have workers’ compensation insurance and you suffer an injury at work, you likely have the ability to file a personal injury claim against your employer. This type of civil action is more complex and demanding than a worker’s compensation claim, but you stand to gain far more of a recovery than you would through workers’ compensation.

Under Texas’ personal injury statutes, the plaintiff has the right to claim compensation for economic damages such as medical expenses, lost income, and property damage. They may also seek compensation for long-term medical treatment costs they are likely to incur, diminished future earning capacity, and their pain and suffering. Many plaintiffs are not fully aware of the various types of compensation available to them until they secure reliable legal counsel.

If you must file a personal injury claim against your employer, this can be a daunting situation, and many people faced with this choice are intimidated by the prospect of facing their employer’s in-house legal team and/or facing adverse treatment from their employer. However, if you intend to file a personal injury claim in good faith, your employer may not retaliate against you. If they do, you can potentially hold them accountable for further damages, and they may face punitive damages as well.

Legal Considerations, Dispute Resolution, and Appeals Process

What happens when things don’t go smoothly with your workers’ compensation claim? Unfortunately, denied workers’ comp claims are more common than you might think. Insurance carriers may deny claims for various reasons – missed deadlines, disputes about whether the injury was work-related, disagreements about the severity of the injury, or even simple paperwork errors.

The Appeals Process for Denied Claims

If your claim gets denied, don’t panic! The appeals process for denied claims in Texas is structured to give you multiple opportunities to make your case. First, you’ll need to file a Dispute Resolution Request with the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC). This kicks off what’s called the “benefit review conference” (BRC) – essentially an informal meeting where you, your employer’s insurance carrier, and a benefit review officer try to resolve the dispute.

Many cases are resolved at this stage, but if yours isn’t, the next step in the dispute resolution for workers’ comp is typically a “contested case hearing” (CCH). This is more formal than the BRC – think of it as a mini-trial where both sides present evidence and witnesses. An administrative law judge will hear the case and issue a written decision.

Still not satisfied? You can appeal to the Appeals Panel, which reviews the CCH decision. After that, your next step would be taking the case to the civil court system, which is a whole different ballgame.

When to Consider Legal Assistance

Here’s the thing about navigating this process, while you can represent yourself, the system is complex. Legal assistance for workers’ comp cases can make a significant difference in your outcome. An attorney who specializes in workers’ compensation can help gather medical evidence, prepare for hearings, and navigate the procedural requirements that might trip up someone unfamiliar with the system.

When should you consider getting a lawyer? I’d strongly recommend consulting one if your claim involves severe injuries, permanent disability, pre-existing conditions that complicate your case, or if your claim has been denied and you’re heading into the dispute resolution process. Many workers’ comp attorneys work on a contingency fee basis, meaning they only get paid if you win your case.

The TDI-DWC offers detailed information about the dispute resolution process on their official website. This is an excellent resource for understanding the formal procedures and timelines involved. For additional perspective on workers’ rights during disputes, the U.S. Department of Labor also provides valuable information.

Remember, deadlines in the appeals process are strict and missing them can permanently affect your rights. If you receive a denial letter, pay close attention to the appeal deadlines mentioned and act quickly to protect your interests.

Special Topics & Additional Considerations

Not everyone falls neatly into the standard workers’ compensation system in Texas. Let’s talk about some special situations that might apply to you or someone you know.

Exemptions from Coverage

First up: exemptions from coverage in Texas. Certain types of employees aren’t automatically covered by workers’ compensation, even if their employer is a subscriber. These typically include domestic workers, casual workers hired for short periods, and some farm and ranch workers. Also exempt are most volunteers and certain real estate agents.

Non-Subscribers in Texas Workers’ Comp

What about non-subscribers in Texas workers’ comp? As I mentioned earlier, Texas is unique in allowing employers to opt out of the workers’ compensation system entirely. These “non-subscribers” make up about 40% of Texas employers (though they tend to be smaller companies, so they employ fewer than 40% of workers).

If you work for a non-subscriber and get hurt on the job, you can’t file a workers’ comp claim. Instead, you’d need to pursue a personal injury lawsuit to recover damages. The upside? Non-subscribers don’t have the same legal protections as subscribers, meaning you might potentially recover more money through a lawsuit than you would through workers’ comp benefits. The downside? You’ll need to prove the employer was negligent, which isn’t required in workers’ comp claims.

Self-Insured Employers

Some larger companies choose to become self-insured employers and handle their own workers’ compensation claims rather than purchasing insurance. The requirements for self-insured employers are stringent – they must prove financial stability and ability to pay claims, and they’re subject to regular monitoring by the Texas Department of Insurance.

Occupational Diseases Coverage

Occupational diseases coverage can be particularly tricky. Unlike injuries that happen suddenly, occupational diseases develop over time due to work conditions – think carpal tunnel syndrome from repetitive motions or respiratory issues from chemical exposure. These claims often face more scrutiny because it can be harder to prove the direct connection to work activities, especially if you have pre-existing conditions.

Independent Contractors and Workers’ Comp

Speaking of complicated situations, let’s talk about independent contractors and workers’ comp. True independent contractors aren’t eligible for workers’ compensation benefits because they’re not considered employees. But here’s where it gets messy – sometimes employers misclassify workers as independent contractors to avoid providing benefits. Just because your employer calls you an independent contractor doesn’t necessarily make it legally true! The actual nature of your working relationship determines your status.

Industry-Specific Considerations

Industry-specific considerations also come into play. Construction workers in Texas face particular challenges – while most construction companies subscribe to workers’ compensation, the industry has a higher-than-average rate of non-subscribers. Oil and gas industry workers often deal with unique hazards that can complicate claims.

For official information about exemptions and special cases, check the Texas Department of Insurance website. And for insights into industry-specific safety regulations that might affect your workers’ comp claim, OSHA’s website is an invaluable resource.

FAQs About Texas Workers’ Compensation Law

Is workers’ compensation insurance mandatory for employers in Texas?

No. Texas is the only state where workers’ compensation insurance is completely voluntary for private employers. Companies that opt out are called “non-subscribers” and lose important legal protections if employees sue for injuries.

What benefits does Texas workers’ compensation provide?

Workers’ comp in Texas typically covers medical treatment, income benefits (usually 70% of your average weekly wage), and death benefits for families of workers killed on the job. The specific amounts depend on your injury severity and duration.

How long do I have to report a workplace injury in Texas?

30 days. You must report your injury to your employer within 30 days, and you have one year to file a claim with the Division of Workers’ Compensation. Missing these deadlines usually means losing your right to benefits.

Can I choose my own doctor for a workers’ comp injury in Texas?

Depends. If your employer participates in a workers’ compensation health care network, you must choose a doctor from that network. Outside a network, you generally have more freedom to select your treating physician.

What Happens If an Employer Does Not Have Workers’ Compensation Insurance in Texas?

If an injury occurs in the workplace and the employer does not have workers’ compensation insurance, the injured worker has the right to file a civil suit directly against the employer. In a personal injury claim, the plaintiff must identify the party or parties responsible for their damages, prove the full scope of those damages, and go on to prove they are the direct results of the defendant’s actions.

Can I Be Disqualified From Filing a Claim for Workers’ Compensation Benefits?

Most workplace injuries are covered under workers’ compensation insurance, but there are exceptions. For example, if you caused the injury because you were working while intoxicated by drugs or alcohol, this may preclude you from seeking workers’ compensation benefits. If you are concerned about your eligibility to file a workers’ compensation claim in Texas, it is crucial to speak with an experienced attorney as soon as possible.

What Happens If a Work Injury Is Fatal?

In the event that a fatal injury occurs in a Texas workplace, the victim’s family may have the ability to claim death benefits from the employer’s insurance carrier. Alternatively, if the employer does not have workers’ compensation insurance that includes death benefits, the victim’s family may be able to file a wrongful death claim instead. While similar to a personal injury case in several ways, a wrongful death claim demands experienced legal counsel familiar with the state’s wrongful death statutes.

How Much Does It Cost to Hire an Attorney for a Workers’ Compensation Claim?

Most of the attorneys who accept workers’ compensation cases and personal injury claims against employers operate on a contingency fee basis. With this type of billing arrangement, the plaintiff pays nothing upfront for the cost of legal counsel and only parts with a percentage of their final case award to pay their attorney. This ensures legal representation is accessible and affordable to those who need it most.

The attorneys at Stevenson & Murray understand how distressed and uncertain the victim of any workplace injury may be in the aftermath of their experience. We have helped many Texas clients navigate complex workers’ compensation claims and civil suits against their employers. Whatever your case entails, we will leverage our professional experience to your benefit and help you recover as fully as the law allows. Contact us today and schedule a consultation with our team to learn more about the ways we can assist you.