Texas is one of the only states that does not require employers to carry workers’ compensation insurance. Instead, the state allows private employers to decide whether they want to carry workers’ comp coverage. If your employer has coverage, you must typically go through workers’ comp in order to get compensation for your injury. This article explains the process of filing a claim through the Texas workers’ compensation system.
If you were injured at work in Texas, you can seek compensation from your employer. However, first you need to find out whether your employer has workers’ comp insurance. If it does, your only option for recovery is to file a workers’ compensation claim. If it does not have insurance, you can sue your employer in court. (Although it generally takes longer to sue in court, workers are eligible for larger awards. For more information, see Workplace Injury: When You Can Sue Outside of Workers’ Compensation.)
The Texas Division of Workers’ Compensation has an online database where you can verify whether your employer has coverage. Your employer might be covered by an individual commercial policy through an insurance company or it might be self-insured.
The first step to making a workers’ comp claim is to report your injury to your employer. You have 30 days to give your employer notice without losing your right to collect benefits. However, it’s best to give notice as soon as possible. Your employer and its insurance company might be skeptical of your claim if you wait more than a day or two to report it without good reason.
Once you report your injury, your employer should tell you how you can get medical care. If your employer provides medical treatment through a workers’ comp health care network, you will need to choose a doctor in the network. Otherwise, you can see any doctor who is willing to treat workers’ comp injuries. 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 Texas Division of Workers’ Compensation (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 of your accident or injury. If your injury developed over time, you must file the form within one year of the date that you knew or should have known that your injury was work-related.
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. (For common grounds for a denial, see Denied Workers’ Compensation Claims.)
If the insurance company denies your claim, you can challenge that decision through the DWC. If you are not able to resolve the dispute through informal negotiations, you can request a workers’ comp hearing before a judge. Because workers’ comp hearings follow complex procedural rules, most workers 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 How Much Does a Workers’ Compensation Lawyer Charge?