When you believe your workers’ comp case has been unfairly decided, or if your employer does not have workers’ comp coverage at all, speaking with Austin workers comp lawyer Aaron Allison can provide you the information you need to move forward toward maximizing your recovery.

Texas is famous for a lot of things, and one of those is the Texan work ethic. The Lone Star State is teeming with industries, and because of the dedication of its workforce and its abundant natural resources — wide open spaces included — Texas reached an astonishing milestone in 2021. Texas now has the ninth largest economy in the world, knocking the entire country of Brazil down a place.

Texas shows no sign of stopping its growth, either, especially with the addition of major employers like Amazon and Tesla joining the family. Texas takes care of its own, but what happens when an injury leaves you feeling like you have been left out in the cold?

WHAT IS WORKERS’ COMPENSATION?

Workers’ compensation is supposed to provide relief to employees who have been injured while on the job. Texas is the only state that allows private employers to choose if they will cover their employees under workers’ compensation insurance. All public employers in Texas must provide workers’ compensation, such as government agencies; city, county and state employers; and public universities. In addition, building and construction contractors for public employers must provide workers’ comp for their employees, as must transportation carriers who move throughout the state.

 

TEXAS EMPLOYERS HAVE TWO OPTIONS FOR WORKERS’ COMP COVERAGE:

• Private insurance company
• Self-insurance, if they qualify

4 TYPES OF WORKERS’ COMPENSATION BENEFITS

When you suffer a work injury, you will file a claim with workers’ comp, then you expect to be compensated for your medical bills, lost wages and other qualifying expenses. At least, that is the idea most employees have about the program. By law, workers may be eligible for compensation from four different kinds of benefits.

1. Income benefits: From temporary to lifetime benefits, these are designed to replace some of the wages lost because of your injury.
2. Medical benefits: These cover “reasonable and necessary medical care” for your injury.
3. Burial benefits: Fatal injuries qualify for compensation to help cover the costs of funeral expenses.
4. Death benefits: Families may qualify for death benefits when their loved one dies from a work-related injury.

As a state-regulated program, Texas’ workers’ compensation program is managed by the Division of Workers’ Compensation, which is supposed to ensure that injured employees

• Are treated with dignity and respect
• Have access to a fair resolution process
• Have access to timely, high-quality medical care
• Receive rehabilitation services needed to return to work

Workers’ comp is designed to protect the employer from huge lawsuits while providing the employee, or their family in the event of a fatal work injury, compensation for their injury. However, some groups are concerned that states are rolling back their workers’ comp protections in favor of private insurance companies or devaluing or denying claims more often.

WHO IS ELIGIBLE FOR A WORKERS’ COMPENSATION CLAIM?

Being injured at work does not automatically qualify you to file a workers’ comp claim. In order to be eligible for a claim, your injury or illness must directly result from the “course and scope” of employment. Some examples of this are

• Operating a forklift in the warehouse where you work
• Being attacked by a dog while laying fiber optic lines
• Developing carpal tunnel syndrome from typing

Even if you are considered at fault for your injury, it is still covered as long as

• You were not horseplaying
• You were not engaged in a criminal act
• You were not intoxicated
• You did not injure yourself
• You were not participating in an off-duty recreational activity
• You were not the victim of someone else’s personally motivated criminal act directed specifically at you
• You were not the victim of an act of God incident

A few other important things to know about workers’ comp claims in Texas are that

• Workers’ comp appeals must be filed within 30 days of the injury, and you must submit any first appeal within 90 days of the decision.
• You will likely need to seek your medical care from a list of state-approved doctors.
• Workers’ comp may disqualify you from other benefits, or vice versa.

Regardless of whether you believe you were seriously injured, any time you are injured at work, you should immediately take steps to protect yourself — even if you are unsure whether you have a workers’ comp claim.

For more about which workplace injuries Workers Comp covers.

WORKERS’ COMP CLAIM PROCESS?

To file for a workers’ comp claim without risking your benefits, you will want to make sure you follow the rules of the state’s labor laws.

1. Report your injury immediately. As soon as your work injury occurs, you need to report it to your employer, even if you think someone else already has. You can lose your rights to workers’ comp if you do not file within the 30-day deadline, so it’s extremely important to be prompt. You do not have to file paperwork to report your injury, but you should make sure to document the day you reported your injury and to whom.
2. Get medical care. Depending on the severity of your injury, and whether you were unconscious, this may happen before step 1, and that is okay. Even if you do not think you are seriously hurt, you will need to be seen by a professional for both your own safety and for the documentation in your case. Some injuries take time to appear, and it always looks better that you took steps immediately to care for your health. Even if you must see a state-approved doctor, see one of your choosing if you can.
3. Call a work injury lawyer. Again, even if you do not think you need an attorney, call one. An Austin workers comp lawyer can educate you about your options and how to protect your rights as you move forward with your claim.
4. File your claim. In Texas, you have one year from the time of your injury to file a workers’ comp claim. Make sure that you see your claim confirmed as received, and document the date you filed your claim.

Sometimes, workers’ comp claims are resolved quickly and to everyone’s benefit. Other times, the insurer will fall far short of what seems fair considering the extent of your injuries. The two most common types of disputes in workers’ comp cases are medical disputes and indemnity disputes.

1. Medical disputes: In these situations, the state-approved doctor may deny care you believe you need in order to improve, such as surgery, rehabilitation or other forms of medical treatments.
2. Claim disputes: Notice of denied or insufficient workers’ comp benefits can be a blow to your peace of mind. Your family may be relying on these benefits as you recover or learn to live with your permanent disability.

WORKERS COMP DENIALS

Many people filing a workers’ compensation claim experience denial of their claim and refusal of benefit payments. Estimates range from 7% of all workers’ compensation claims to 90% of workers’ comp claims for certain diagnoses that are initially denied. However, if your claim has been denied, do not get discouraged.

Studies show that 67% of denied workers’ compensation claims are approved upon appeal, and those claims pay an average of 55% more than the initial filing amount.

Appealing a denied workers’ compensation claim in Texas can be a long, slow process with many steps. Here is a general overview of how a denied claim is appealed:

• Benefit Review Conference. If your workers’ compensation claim is denied, contact the Texas Department of Insurance (TDI) and request a Benefit Review Conference. During this conference, a Benefits Review Officer will meet with you and your employer to review your claim and attempt to reach an agreement. Although this is an informal meeting, your employer will always have legal representation on their side, so it is best to have your own Austin workers’ comp lawyer at the table with you.
• Arbitration. If you cannot reach an agreement during the Benefits Review Conference, your appeal may be escalated to a more formal arbitration process. You and your employer will meet again with a TDI arbitrator, who will hear both sides and make a decision. This decision is final and cannot be appealed, so it is important to consult with a workers’ compensation attorney before entering the arbitration process.
• Contested Case Hearing. If you choose not to undergo arbitration, you and your employer will instead have a Contested Case Hearing. This hearing is a legal proceeding: it is slower and more expensive than arbitration, but the findings can be appealed still further.
• Division of Workers’ Compensation Appeals Panel. If your claim is denied at the Contested Case Hearing, you can appeal to the Worker’s Compensation Appeals Panel. If they deny your claim, you can appeal still further to the Texas State Civil Court system and file a lawsuit against your employer.

If your workers’ compensation claim is denied, you should always appeal the decision and request further review. Statistically, your appeal will be successful and get you more compensation.

Although the appeal process is clearly explained by the TDI, and they will guide you through each step, it is always best to consult with a Texas workers’ compensation attorney to find out how to manage the process and prove your claims. Your employer will have an attorney fighting hard on their side to deny your claim; you should have a lawyer on your side fighting just as hard to get the benefits you deserve.

NON-SUBSCRIBER WORK INJURIES

Texas is the only state in America that allows employers to opt out of workers’ compensation insurance, depriving both the employer and the employee of the special coverage that workers’ compensation provides. Employers who don’t carry workers’ compensation insurance are called “non-subscribers,” and they have specific legal risks and responsibilities.

Non-subscribing employers are still required to compensate workers for on-the-job injuries, including the costs of medical care and treatment and the cost of lost wages due to illness or injury, as well as funeral and burial expenses for fatal workplace injuries. In addition, a non-subscriber employer may be held liable for emotional damages like pain and suffering, which is not allowed under Texas workers’ compensation insurance.

Employers who choose not to carry workers’ compensation must manage their liability for employee injury by other means, including:

• Self-funding claims. Companies may choose to simply pay the costs of workers’ injuries from their own accounts rather than paying insurance premiums. These companies will have their own processes for filing and processing claims and their own way of distributing benefits.
• Alternative insurances. Some companies choose alternative types of insurance rather than workers’ compensation. They may carry a specific insurance for medical care, another for disability, a separate life insurance policy, etc.

If you are hired by a non-subscribing employer, they are required to notify you that you are not covered by workers’ compensation and to provide information on how to file a claim using their own compensation system. It is important to review these documents carefully to understand your employer’s processes and benefits. Share this information with family and loved ones in case they need to help pursue your claim while you are incapacitated due to injury or fatality.

If the benefits offered by your non-subscribing employer are insufficient for the costs related to your on-the-job injury, you have no choice but to file a lawsuit and take your employer to court. Employers who carry workers’ compensation are protected from these kinds of civil lawsuits, but non-subscribers are not. Filing a lawsuit against your employer is not a decision to be taken lightly, and it is best to consult with an Austin workers’ comp lawyer to understand your rights.

Just because an employer does not carry workers’ comp insurance does not mean that they aren’t responsible for creating a safe and healthy workplace and for compensating employees for work-related accidents, illnesses, and injuries. These types of cases can be time-consuming and difficult, but it is important to fight for your rights and protect yourself and your family.

WORKERS’ COMP FOR EXPOSURE TO VIRUSES AND TOXINS

The Law Offices of Aaron Allison is not intimidated by tough cases that require complex scientific knowledge. Clean room litigation has become a prominent part of our personal injury and workers’ compensation practice. Hazardous chemicals used in the production of these chips have resulted in a high number of birth defects of children of clean room workers. Our law firm resides in a major center for semiconductor computer chip manufacturing, and  Austin workers comp lawyer Aaron Allison has the experience in pursuing these complex claims.

Furthermore, in 2020 alone, data reported by the Texas Department of Insurance (TDI) shows that nearly half of all workers’ comp claims for the year involved workers with COVID-19.

• Over 32,000 COVID-19 claims
• 130 fatalities reported
• 49% of claims were denied
• Only 17 disputes filed as of December 6, 2020

Debilitating illness and injury can impact you, your family and even generations to come. If your employer denies your workers’ claim, you can challenge the denial through the DWC. If you cannot solve the dispute through negotiation with the DWC, you can request a workers’ comp court hearing.

HOW CAN TEXAS WORKERS COMPENSATION LAWYERS HELP ME?

As an experienced work injury lawyer in Austin, we have successfully handled cases against some of Texas’s biggest businesses, including H-E-B, Lowe’s, Home Depot and several major healthcare facilities. Since 1978, our law firm has provided honest and competent legal counsel to the injured workers of Austin, and our Austin workers’ compensation team has the experience and resources necessary to work to meet your needs. Contact us today for a free consultation.

TEXAS WORKERS’ COMPENSATION FAQS

• How Does Workers’ Compensation Work?
• What Does Workers Compensation Cover?
• How Long Can I Collect Workers Compensation in Texas?
• Which Employees Are Exempt From Workers’ Compensation in Texas?
• What Is the Process for Filing a Workers’ Compensation Claim?

HOW DOES WORKERS’ COMPENSATION WORK?

When you are injured at work or contract an occupational illness, you should immediately report this to your employer. After your work injury or illness is reported, you will visit an approved healthcare professional, start the workers’ compensation claim process, file your claim, receive your benefits and, hopefully, return to work. Having an experienced Austin workers’ compensation law firm by your side right from the beginning can often make a significant difference in the outcome of your claim.

WHAT DOES WORKERS COMPENSATION COVER?

If you are granted workers’ compensation benefits, then it should cover all of your medical and rehabilitation costs. You will also receive partial wages for any work that you miss. Some policies will provide death benefits if an employee is killed on the job.

However, certain circumstances may affect the amount of workers’ compensation benefits that you are entitled to receive. Consult with our Texas workers’ compensation attorneys before making any final decisions.

HOW LONG CAN I COLLECT WORKERS COMPENSATION IN TEXAS?

Temporary workers’ compensation benefits can be collected in Texas for 104 weeks, with a possible extension if you have or will have spinal surgery due to your work injury within 12 weeks prior to the deadline. If your impairment income benefits run out under Texas workers’ compensation, then you may be able to receive supplemental income benefits, providing you meet a number of qualifications.

Texas does allow lifetime income benefits under workers’ compensation. However, this applies to only a few severe types of impairment. Our Austin workers comp lawyer will help you figure out how long you can collect workers’ compensation benefits in Texas.

WHICH EMPLOYEES ARE EXEMPT FROM WORKERS’ COMPENSATION IN TEXAS?

Certain farm and ranch workers, casual laborers, domestic workers and any worker covered by a method of compensation established under federal law may be exempt from receiving workers’ compensation benefits in Texas. The Texas workers’ compensation attorneys at our firm can help you determine if you are an exempt employee.

WHAT IS THE PROCESS FOR FILING A WORKERS’ COMPENSATION CLAIM?

Texas does not require most employers to have workers’ compensation insurance. The state allows private employers to decide whether they want to participate in the workers’ compensation system. This means your first step will be to determine whether your employer carries workers’ compensation insurance. If your employer does carry workers’ comp, then you will report your injury to your employer.

OTHER LOCATIONS WE SERVE

San Antonio Workers Comp
Houston Workers Comp
Dallas Workers Comp

RELATED PAGES

• COMMON CAUSES OF WORKERS’ COMPENSATION INJURIES
• Types of Workers Compensation Injuries