What Is the Texas Workers' Compensation Act?
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Texas Workers' Compensation Act?
If you or someone you know has gotten hurt on the job in Texas, the Texas Workers' Compensation Act provides legal avenues to seek compensation for those injuries. This legislation aims to protect both the employer and their workers before, during, and after the claims process. It also manages how an employee and the employer's insurer conduct the claims process.
Unfortunately, Texas doesn't make it mandatory for companies with employees to provide workers' compensation insurance coverage. This reality often makes an already tragic situation even more devastating for the injured worker and their family.
Workers' Compensation Law Vs. Non-Subscriber Law
Depending on whether your employer has workers' comp coverage, one of two areas of law will apply to your injury claim: workers' compensation law or non-subscriber law. Each of these legal categories come with their own set of rules and criteria that can directly impact your right to pursue compensation after getting hurt on the job.
Before determining which applies to you, finding out whether or not your company provides workers' comp insurance is crucial. This can be done in one of three ways, usually:
- Ask your employer; they are legally required to give you this information
- Check the state's online subscriber database
- Contact a skilled workmans' comp attorney to investigate
If coverage is in place, there are some crucial details to know before filing your claim. The first being that the Texas Workers' Compensation Act benefits your employer. By going through their insurance, you won't be able to sue them civilly. In addition, their insurer could cover all of your necessary medical care costs from your work-related injury or illness. This benefit should also include lost income and possibly burial costs, if applicable.
This legislation also benefits hurt or sickened employees as well by minimizing the chance they receive nothing at all for their damages. There have been countless cases where unsubscribed employers don't pay a dime in compensation because they simply didn't have the finances to afford it. This is why unsubscriber law allows injured employees to sue their employers for damages if negligence is a factor and in cases of third-party fault.
When it comes to lost wages, there are limitations under state law you should remember. Often, the amount of time you can receive workers' comp benefits is limited by the severity of your injuries and any impairment ratings your doctor gives you. In addition, state law has also put caps on the income amount you can receive.
As you can see, the Texas Workers' Compensation Act intends to ensure injured employees can recover damages for injuries sustained on the job. Unfortunately, this is harder to enforce. It's a well-known fact that companies will go out of their way to cut corners and avoid increased premiums because of workplace injuries and occupational illnesses.
This means they resort to all sorts of manipulative tactics that are bad faith in nature and often illegal. Because the act allows them to choose a network of physicians they want you to see for care, they will select providers sympathetic to their own interests and not yours. When faced with these challenges in obtaining workers' comp in Texas, many opt to hire personal counsel to represent their best interests and fight for the maximum compensation possible under the law.
Steps to File a Workers' Comp Claim in Texas
If you've determined your employer has workers' compensation insurance, you may be wondering how you go about filing a claim for your injuries. The Texas Workers' Compensation Act outlines these steps, as well as the statute of limitations for each.
When initially hurt, you are legally required to report your injury to your company within 30 days of it happening. However, conditions like carpal tunnel syndrome or exposure to dangerous chemicals can delay symptoms. So the Texas Division of Workers' Compensation starts the clock running from when you found out or should have known about your injuries.
There are several pieces of information you must include in this notice:
- The date of the injury
- That it occurred at work
- The circumstances causing the harm
- What parts of your body sustained injury
While you can submit this verbally or written, it's best to put it in writing to prove you did give notice in the required time frame. Once you've taken this step, you will need to file a DWC-041 (Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease). This document needs to be completely filled out and filed with the TDWC branch in your area. While you can submit it online or by mail, doing so in person allows you to get a time-stamped copy for your own records. You also only have a year to submit this form or risk losing your right to workers' comp benefits.
Texas Third Party Work Injury Claims
While this isn't always the case, there are occasions where you may need to file a claim against a third party in addition to a workmans' comp claim against your employer. Remember, your employer's insurance only protects them from you suing them for negligence, not outside entities that contributed to your injuries. So, for example, if a defective machine mangled your hand at your job, you may have grounds to pursue a personal injury case against the manufacturer.
Typically, these types of suits cover more than workers' compensation, including:
- Past and future medical costs
- Pain and suffering
- Transportation costs to your medical treatments
- Lost wages
- Diminished work capacity
- Loss of consortium
- Disfigurement (burns, amputations, scarring)
- Wrongful death
- Burial costs
It's also possible another company's employee may have hurt you while you were working. This would mean using that worker's employer for your damages. As you can see, while workers' comp claims and personal injury suits are very different legal actions, they can easily be intertwined. Make sure to speak with a highly-trained attorney that has demonstrated practice in both these areas of law.
Work Injury Personal Injury Suits and Texas Modified Comparative Fault
If your employer doesn't carry workers' comp insurance or a third party contributed to your accident, your attorney will likely recommend filing a personal injury suit if negligence was involved. These case types require you to prove several things:
- The liable party had a duty of care
- They breached this duty
- This breach caused your injuries
- These injuries caused you damages
Texas uses modified comparative fault when determining if compensation is paid for a work injury resulting from negligence. This means that all parties are held responsible for the part they played in the circumstances leading to the injuries you are demanding compensation for. State law currently imposes a threshold that will determine if the plaintiff can recover any monetary awards or not. If you have more than 50% liability for the injuries or illness you sustained while at work, your case will be permanently dismissed by the court. If you hold 50% or less liability, your award will be reduced by the amount you're responsible for.
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What Is Network vs. Non-Network Claims in a Texas Workmans' Comp Case?
Under the Texas Workers' Compensation Act, employers can have a predetermined list of network providers available for an injured employee to choose from for treatment. However, on occasions where an employer doesn't have such a list in their workers' comp policy. When this is the case, it's known as a non-network claim, and you're allowed to see any doctor you want that treats workman's compensation injuries.
Most employers do carry policies that have a specified network of medical providers you must choose from, though. These are considered network claims, and for your claim to be eligible, you will need to see a physician for treatment on their preferred provider list.
What Type of Income Benefits Can I Receive from a Workers' Compensation Claim in Texas?
The Texas Workers' Compensation Act provides several different types of income benefits determined based on the level of impairment you have and wages you've lost. The most frequently received compensation is Temporary Income Benefits (TIB). For example, should you be unable to go back to work for more than seven days, you could receive up to 70% of your average weekly wages beginning on your eighth day missed. These benefits can be paid for up to two years and end when you can start working again, reach your maximum medical improvement (MMI), or have been unable to get back to work for two years, whichever occurs first. If you are not able to earn your previous wages, you can qualify for Temporary Income Benefits.
In situations where you've reached your MMI and treatment is done, you will be given an impairment rating by your doctor. This comes in the form of a percentage, and for each percentage point you received, you'll receive impairment income for three weeks. So, a 50% rating would mean 150 payments.
Supplemental Income and Lifetime Income are also available for those who either can return to work but in a permanently limited capacity making less money or those who will never be able to perform any work ever again. Again, the experienced work injury attorneys of Morgan & Morgan are available to discuss these different coverages with you and determine which best fits your situation.
The Insurance Company Denied My Workers' Comp Claim. Now What?
In short, fight. The Texas Workers' Compensation Act provides several avenues to resolve disputed workplace injury and illness claims. First, your attorney can schedule a Benefits Review Conference to negotiate an agreement between you, your employer, and the insurer. If this effort fails, the next step would be to file for a Contested Case Hearing where an administrative law judge will hear the facts of your case and make a decision. Finally, should you still not get the claim approval you need, our workmans' comp attorneys can appeal this decision and fight for the compensation you deserve.
You Need a Qualified Texas Workmans' Comp Attorney
Despite the Texas Workers' Compensation Act providing numerous benefits to injured workers, the need for a capable attorney is obvious. The current system leaves room for benefit calculation errors, manipulative insurance tactics, and other costly mistakes that the average person won't recognize.
Morgan & Morgan can provide the experienced advocacy for your workers' comp case that can avoid these common pitfalls and employers and their insurers accountable for the harm they cause. Should your injury claim be disputed, we have the experience and successful track record to set up the necessary negotiations and court hearings to get your matter heard. In addition, we understand how the impairment rating system works and will ensure that you receive the maximum benefit available under the law.
You deserve to be treated with dignity and respect during this challenging time in your life. If you or a loved one have been unfairly treated by workman's comp adjusters or an employer who doesn't carry such a policy, trust us to find a satisfactory resolution.
Morgan & Morgan is dedicated to Texas workers who got hurt on the job and were later denied the compensation they need to heal. Trust our experienced lawyers to be your skill advocate. Since 1988, hurt employees throughout The Lone Star State have come to our firm for help. Please fill out our brief contact form to get started today.