Worker's Compensation Benefits
Authored By: Legal Aid of Northwest Texas - Waxahachie
Worker's Compensation Act; Texas Labor Code §§ 401.001 et seq.
This is an insurance program to protect you from loss of income or medical costs resulting from an injury that happens while you are working. Employers have three options regarding Worker's Compensation. They can purchase insurance from an authorized insurance company. They can be self insured by creating a benefit plan that pays similar medical and wage benefits. They can choose not to provide benefits for injuries that happen on the job. If your employer decides not to provide medical and wage benefits for work related injuries, you are not covered by this insurance program and your employer will be denied certain defenses in a law suit to recover the damages you realize because of an injury on the job.
Most, but not all, doctors are approved by the Worker's Compensation Commission to provide medical treatment to injured workers. If you are injured on the job, you are entitled to select a Commission approved doctor of your choice to provide medical treatment. Your employer can have a "Company" doctor to provide consulting advice. You do not have to allow this "Company" doctor to be the treating doctor, but you may be required to visit this "Company" doctor so they can advise your employer about your medical condition. You will be entitled to receive medical treatment for your work related injuries paid for by the employer until you reach "Maximum Medical Improvement." "MMI" means you have fully recovered or further medical treatment will not help you and you will have a permanent partial or total disability rating.
While you are unable to work because of the job related injury, you are entitled to weekly pay equal to an amount calculated by your usual rate of pay and the state average weekly wage. This money is not subject to garnishment or attachment by creditors but can be taken for child support obligations.
If you require the assistance of a lawyer to obtain your benefits, the attorney fee can not exceed twenty-five percent (25%) of your award.
If you realize an injury or disease related to your work, you should notify your employer immediately. If you wait more than 30 days to notify your employer, you may lose your right to claim benefits. Any job related injury or disease that makes you lose at least one day of work must be reported by your employer to the Commission and the insurance company. In order to receive medical or wage benefits, you must then file a claim with the Commission. Your claim must generally be filed within one year of the date you realized the work related injury. The insurance company or benefit plan administrator will have 60 days to investigate the claim. However, unless they decide to deny the claim within 7 days of receiving the claim, they must begin making payments until they have completed their investigation.
The Commission is required to maintain a person to help you with your claim. This person is called an OMBUDSMAN. This is the person you should contact first if you are having problems with your claim. You should be able to contact the Ombudsman for your area by calling 1-800-252-7031.
If your claim becomes disputed on any point at any time, either you or your employer can request a Benefit Review Conference. This is essentially a mediation process designed to help the parties reach a mutual agreement. If agreement can not be reached, the parties can agree to submit the dispute to binding arbitration by filing a request for arbitration within 20 days of the conference. Arbitration is a procedure where the dispute is submitted to a specially trained person who makes a decision similar to the way a judge makes a decision. If arbitration is not agreed to, either party can request a contested hearing before a Commission hearing officer. The hearing officer decision can be appealed by either party within 15 days to a three member panel. Unless judicial review is requested, the decision of the three member panel will be final and enforceable in state court. If judicial review is desired, it must be requested within 40 days of the panel decision. .