San Antonio Workers’ Compensation Attorney

San Antonio is one of the fastest-growing cities in America, with a thriving economy that includes everything from Fortune 500 companies to emerging bioscience startups and a low cost of living that makes it attractive for workers.

All this growth has created jobs in important industries like construction and manufacturing, which, unfortunately, increases the rates of work-related accidents and injuries. The Law Offices of Aaron Allison help people recover their damages when they have been in a workplace accident or suffered a personal injury.

How Does Workers Compensation Work in San Antonio?

Workers’ compensation is a form of insurance for companies and employers. If an employee gets injured, becomes sick, or is disabled due to a workplace accident or incident, workers’ compensation pays that employee for their medical costs, lost wages, and other expenses. Workers’ compensation insurance protects employers from personal injury lawsuits and other liability risks while providing fair compensation to employees.

In San Antonio, workers’ compensation is administered through the Texas Department of Insurance (TDI). When an employee is injured at work, the injury is reported to the TDI, who then opens a claim. If the claim is accepted, workers’ compensation benefits are paid directly to the employee or their surviving family members in the case of a fatality. If the claim is denied, the employee may appeal the decision through the TDI.

Who Is Eligible for Workers’ Compensation in San Antonio?

All workers have the right to a safe work environment and to receive compensation after a work-related accident or injury, even if the employee is not a US citizen. In Texas, some classifications of employees (like independent contractors) may not be eligible for workers’ comp and should carry their own insurance.

In most US states, employers are required by law to carry workers’ compensation insurance to cover the costs of lost wages, medical expenses, and other injury-related damages. In Texas, employers are not required to carry workers’ compensation insurance. This can make construction accidents and other types of work-related injury cases more difficult to pursue.

Even when an employer does not have workers’ compensation insurance, workers still have the right to recover their damages. A San Antonio workers’ compensation attorney can help injured workers determine whether workers’ compensation or a personal injury lawsuit is most appropriate in their case.

Because of the complexity of worker protection laws in Texas, only 40 attorneys out of 95,000 are still representing injured workers in workers’ compensation cases. Aaron Allison is proud to serve as a workers’ compensation lawyer in San Antonio, as his family’s firm has for decades.

What Type of Injuries Does Workers’ Compensation Cover?

Workers’ compensation covers all types of work-related injuries and illnesses. While we often think of workers’ comp insurance for dangerous industries like construction and common injuries like slips and falls or accidents with vehicles or machinery, there are many more types of injuries that are eligible for workers’ compensation. If an employee has a repetitive strain injury, illness due to exposure to hazardous work conditions, loss of hearing ability, or other types of work-related conditions, they can claim workers’ comp.

A worker may also be eligible for compensation if they have been injured as the result of the negligence of a third party, even if workers’ comp denies the claim. If you or a loved one have been injured at work, you should consult a San Antonio workers’ compensation attorney to learn more about your rights.

The Types of Benefits Available with Workers’ Compensation

A San Antonio workers’ compensation claim pays several different benefits to injured employees. The most common workers’ comp benefits are:

Benefits for the Cost of Medical Care

All medical costs and expenses related to the injury are paid for through workers’ comp benefits as long as they are approved by the doctor who is treating the condition. These costs might include medical visits, surgery, therapies, medications, and medical devices used at home.

Benefits for Missed Work

If the illness or injury caused you to miss time at work, workers’ compensation will pay some of the lost wages through the Temporary Income benefit. The amount of the temporary income benefit depends on your wages. For workers who earn less than $10/hour, the benefit pays 75% of your average weekly earnings. For workers who earn more than $10/hour, workers’ comp pays 70% of average weekly earnings. State law sets upper and lower limits to these weekly amounts, and injured workers can claim the temporary income benefit for up to 104 weeks.

Benefits for Loss of Earning Capacity

If you were severely injured at work and are unable to return to your previous earning capacity, you may also qualify for the Supplemental Income benefit. For workers who return to work at less than 80% of their previous wages, suffer permanent impairment, or meet other conditions, this benefit provides a supplement to your post-injury income. The supplemental income benefit is equal to 80% of the difference between the amount you earned before and the amount you are earning after the injury and can be claimed for up to 401 weeks.

Benefits for Permanent Disability

In the case of severe workplace injuries with lifetime impairment, including blindness, limb amputation, and other permanent disabilities, workers’ compensation pays a lifetime benefit. The lifetime total disability benefit is equal to 75% of your pre-injury earnings and goes up by 3% every year.

Benefits for Surviving Family Members

If a family member dies in a work-related accident, the survivors can claim workers’ compensation death benefits. Workers’ compensation will pay the survivors an amount equal to the temporary income benefit, compensate the family for the costs of any medical care received before death, and pay $10,000 for burial expenses.

All workers’ compensation benefits are subject to specific conditions and limitations, so it is best to discuss your specific case with a workers’ compensation attorney to ensure you are getting all the benefits you are entitled to.

Injured Employee Benefits for Non-Subscribing Employers

Texas is the only state that does not require private employers to carry workers’ compensation insurance. These employers are called “non-subscribers”, and they have additional risks and liabilities that subscribing employers do not have.

In the event of a workplace accident or injury, employers are still required to compensate employees, even if they do not carry workers’ compensation insurance. A non-subscribing employer may choose to compensate injured employees privately, so that the company itself reviews injury reports, receives medical records, and pays injured employees. Or the company may choose to carry various types of private insurance that offer different benefits and have their own claims processes for injured employees.

For example, a non-subscribing employer may choose to offer medical insurance, accident insurance, disability insurance, and life insurance. There are also private insurance companies that offer workers-comp-like policies without mandated benefits or government oversight.

Depending on the industry, a company may also offer special insurances or benefits for specific risks, like exposure to hazardous materials, certain types of cancer, and other specific conditions. Each of these policies may have different coverage levels, benefits, and claims procedures, and each of them may apply to an injured employee or their loved ones in the event of a workplace injury.

Non-subscribing employers are required by law to inform new hires in writing that they are not covered by workers’ compensation and explain their alternative compensation processes. They are also required to post this information prominently in the workplace, in shared areas like break rooms and hallways where all employees have access to this information. If you work for a non-subscribing employer, read your company’s policies and procedures carefully so you know what to do if you are injured at work. Make sure that this information is also available to family members or loved ones who may have to pursue a claim on your behalf if you are incapacitated.

Importantly, workers’ compensation insurance protects employers from liability in personal injury claims, and non-subscribing employers do not have this protection. If you work for a non-subscribing employer, and are injured at work, and do not receive adequate compensation for your injuries, you should speak with a San Antonio personal injury attorney. You or your family members may be able to sue for your medical costs, lost wages, pain and suffering, and more.

The Process of Filing a Workers’ Comp Claim in San Antonio

The most important part of filing a workers’ compensation claim in San Antonio is to report your injury, in writing, to your employer as soon as possible. Injuries that are not reported within 30 days will not be eligible for a workers’ comp claim. Generally speaking, the process of filing a workers’ comp claim in San Antonio is as follows:

  1. Seek appropriate medical care. If you have been injured in a workplace accident, apply first aid and seek the medical care you need. Caring for your health is the highest priority.
  2. Report the incident to your employer. As soon as possible, report the incident to your employer in writing. If possible, note the names and contact information of any witnesses and take pictures of the accident scene if they are relevant.
  3. Report the accident to workers’ comp. In some cases, your employer will report the incident to workers’ compensation themselves, but it is always a good idea to read up on Texas Workers’ Compensation regulations and report the injury yourself.
  4. Wait for your claim to be approved. A claim adjuster will contact you to let you know whether your claim has been approved or denied. You should know the status of your claim within 15 days.

Texas has a statute of limitations on workers’ compensation claims. It is important to report the injury within 30 days and file a workers’ comp claim within two years of the incident.

Reasons Why a Worker’s Compensation Claim May Be Denied

Workers’ compensation claims may be denied for several reasons. Here are the most common reasons claims are denied:

  • The accident may not have happened at work. If the workers’ comp claim administrator believes that the accident did not happen at work, they will deny the claim.
  • The injury was not work-related. If an injury was pre-existing or not work-related, they might deny a workers’ compensation claim.
  • The employee is at fault. If an employee was using drugs or alcohol or knowingly engaging in reckless or unsafe behavior, workers’ comp would typically deny the claim.
  • The injury was the fault of a third party. If, for example, you are deliberately injured by another person at work, that person (not workers’ comp) is liable for your damages.
  • The employee has left the job. Workers’ comp is more likely to deny a claim if the employee is no longer employed at the workplace where the injury occurred.
  • The claim is for a non-eligible condition. Colds, flu, and other ordinary health conditions are not eligible for workers’ compensation.
  • The claim is for an “act of God.” Certain events, like floods, hurricanes, and other natural disasters, can cause accidents and injuries that are not eligible for workers’ comp, even if they happen at the workplace.
  • The employee is not covered by workers’ compensation. Independent contractors and other classifications of employees may not be eligible for workers’ compensation.
  • The statute of limitations has expired. Employees who have been injured at work have one year to file a workers’ compensation claim. In the case of repetitive injuries and other illnesses without a defined start date, the employee has one year from the date that they learned they had a work-related injury. Claims that exceed the statute of limitations will be denied.

What To Do If Your Workers’ Compensation Claim is Denied

If your workers’ compensation claim is denied, it is critical to appeal the denial and continue to pursue your case. You have the right to have your denial reviewed and reconsidered and your case argued in court. It is very common for claims to be denied and then reconsidered on appeal. In fact, 67% of workers’ comp denial appeals are successful, resulting in revised claims that pay out within a year.

The workers’ compensation appeal process is extremely long, with many levels of appeal and reconsideration, and each step increases in formality. Here is an overview of the process:

  • Benefit Review Conference. The first stage of appeal is a benefit review conference. During this stage, a Texas Department of Insurance (TDI) Benefits Review Officer will meet with you and your employer to review the claim. This review is more like a meeting, where the Benefits Review Officer tries to get both parties to reach a voluntary agreement. Although it is an informal meeting, the employer almost always has legal representation on their side, so it is best to have your own San Antonio workers’ comp lawyer at the table with you.
  • Arbitration. If the Benefits Review Conference does not help both parties reach an agreement, a workers’ compensation claim may be escalated to an arbitration process. The claimant and their employer meet with a TDI arbitrator, who will hear both sides of the argument 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 proceed with arbitration, you and your employer will proceed to a Contested Case Hearing. This hearing is a legal procedure, involving Texas courts, so it is slower and more expensive than arbitration. However, unlike arbitration, Contested Case Hearing findings can be appealed if the case is not settled in your favor.
  • Division of Workers’ Compensation Appeals Panel. If your claim continues to be denied at the Contested Case Hearing, you can appeal to the Division of Workers’ Compensation Appeals Panel. The appeals panel is made up of a group of judges who review the Contested Case Hearing and your written appeal. They do not hold a new hearing.
  • Further Appeals. If the Worker’s Compensation Appeals Panel denies your claim, you can appeal still further to the Texas State Civil Court system and file a civil lawsuit against your employer.

Remember that your employer will have a team of expert attorneys fighting your appeal at every stage. If you have filed a workers’ comp claim and they have denied your case, consult with a San Antonio workers’ compensation law firm to find out how to proceed with your case.

Exceptional Workers’ Compensation Claims

The San Antonio workers’ compensation system is designed for the most common types of workplace accidents, incidents, and injuries. If you have an exceptional case, you may find that your claim is denied or handled incorrectly simply because the nature of the claim is unusual. Some types of workplace accidents and injuries that require special care include:

  • Traumatic brain injury. These injuries can be life-changing, with a huge range of different impacts on the worker and their family. They can also inhibit the ability of the injured person to advocate for themselves. Because these cases are so difficult, and their impacts can be so different and far-reaching, they require special care and handling.
  • Medical disputes. It sometimes happens that an injured worker disagrees with their doctor or medical care provider about the extent of the injury or the types of treatment needed. Because workers’ comp only pays for care approved by the treating physician, medical disputes can be difficult and require a different appeals process.
  • Delayed symptom onset. It often happens that an employee is not aware of the cause of their illness or doesn’t experience severe symptoms until long after the workplace incident. Certain repetitive knee and shoulder injuries, damage to the feet and neck, or certain cancers and other serious illnesses may not fully manifest themselves for years. In the case of workplace injuries that were not noted or reported at the time, an employee may need to appeal the statute of limitations in order to receive compensation.
  • Special injuries. Some injuries, like spinal injuries or burns with severe scarring, may require exceptions and extensions to temporary income and other workers’ compensation benefits.

If you or a loved one have a work-related injury and feel that the medical system or the workers’ compensation system are not handling your case correctly, it is best to speak with an attorney and learn more about your rights and options.

How Can Aaron Allison Help?

Injured workers in San Antonio deserve the best legal representation and an attorney who will fight for their rights. Aaron Allison is a second-generation lawyer who has been helping injured workers since 1978, and he is proud to be one of the few workers’ compensation attorneys practicing in Texas.

Aaron Allison offers free consultations, and we work on contingency, so you don’t pay anything unless we recover in your case. If you or a loved one have been injured at work or have had a claim denied, contact us today to learn more about your rights.

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