If you were injured at work or became ill because of your job, you may be entitled to receive workers' comp benefits in Texas if your employer has workers' compensation insurance. But you need to follow certain steps to start the process of claiming those benefits, including reporting your injury and filing a formal claim. This article explains the process and deadlines for doing that.
Unlike almost all other states, Texas doesn't require most employers to have workers' comp insurance. Instead, the state allows private employers to decide whether or not they want to get insurance and participate in the Texas workers' compensation system. So if you have a work-related injury or illness, you need to find out if your employer has insurance coverage. Employers are legally required to give this information to all of their employees. But if you aren't sure, you can verify your employer's insurance status through the state's online database.
If your employer has coverage, you generally have to go through the workers' comp system in order to get any compensation for your injury. However, you may be able to sue your employer in certain situations, including when it doesn't have workers' comp insurance. (Learn more about when you can sue your employer for a work-related injury.)
The first step in the workers' comp process is to report your injury to your employer. Legally, you may lose your right to collect benefits if you don't give this notice within 30 days after the injury. But it's best to notify your employer as soon as possible. The insurance company might be skeptical of your claim if you wait more than a day or two to report an injury without good reason. If you have a medical condition that developed over time (like a repetitive stress injury or occupational illness), the 30-day period starts as soon as you learned that your condition was related to your work.
Once you report your injury, your employer should tell you how you can get medical care. If your employer has a contract with a workers' comp health care network, you will generally need to choose a doctor in that network. Otherwise, you can see any doctor on the list of physicians approved by the Texas Division of Workers' Compensation (DWC). At your first visit, be sure to tell the doctor that you were injured at work.
To start your official claim, you must file an Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC Form-041) with the DWC. You can file the form in person, by mail, or through the DWC's online filing system.
The claim form asks you to provide information about you, your injury, your work status, and your employer. At the end of the form, you can find more detailed instructions for how to answer each question. If you need assistance, you can contact the Office of Injured Employee Counsel, a separate state agency that helps employees with their workers' comp claims.
You must file the form within one year after your accident or after you learned about your work-related occupational illness. Once again, you could lose your right to benefits if you miss the deadline, unless you qualify for one of the limited exceptions.
Once the DWC receives your claim, it will notify your employer and its insurance company. The insurance company will then review your claim and decide whether to accept or deny it. (Learn about common reasons for denied workers' comp claims.)
If the insurance company denies your claim, you can challenge that decision through the DWC. You'll need to participate in a benefit review conference before you can get to a hearing before a workers' comp judge. (Learn more about the steps for appealing a decision in your Texas workers' comp case.) Because contested case hearings follow complex procedural rules, most injured employees will need to hire an experienced workers' comp lawyer in order to win at the hearing. Fortunately, workers' comp rules make it feasible to hire an attorney. For more information, see our article on how much workers' comp lawyers cost in Texas.