Workers’ Comp Claims: What You Need To Know

Know Your Rights: Uncovering the Basics of Workers’ Comp Claims

Almost everyone is familiar with the concept of workers’ compensation insurance, especially those in high-risk professions. However, if you’ve never filed a claim, you probably don’t know much about what workers’ comp is and how it works. Here’s an overview of everything you need to know about workers’ comp.

What is Workers’ Comp?

Workers’ compensation is a form of insurance for workers who are injured on the job. It covers medical expenses, lost wages, and other costs related to workplace injuries. Workers’ comp premiums are paid by employers, to cover the costs of employee injuries without lawsuits or legal disputes.

Workers’ comp insurance is mandatory for employers in every state except Texas, where it remains voluntary for privately-owned businesses.

What are the Benefits of Workers’ Comp?

Workers’ compensation is designed to cover all the expenses related to on-the-job accidents and injuries. Workers’ comp pays for:

• Medical expenses, including prescriptions or medical equipment needed during recovery
• Lost wages
• Rehabilitation expenses
• Death and/or dependent benefits

For employers, workers’ comp also covers the cost of investigating suspicious claims and some legal and liability expenses. Employees are covered for these costs from the date of the accident or injury. In some cases, a person may not be aware that they have been injured at the moment — for example, a worker who was exposed to a hazardous substance on the job, but did not know it or show symptoms until a later date — in which case they are covered from the day that they become aware of the injury.

In complex cases where a worker is unaware of their injury, but has already invested in medical treatment — for example, a worker whose injury was misdiagnosed or who didn’t realize their illness was work-related — it is best to consult with a workers’ compensation lawyer to find out what costs are recoverable.What are the Penalties for Not Having Workers’ Comp?

In Texas, private employers are not required by law to carry workers’ comp insurance. These employers are called “non-subscribers.” Because it is not a requirement, there are no penalties for not having workers’ comp. However, non-subscribing companies have additional risks and requirements. Employers who choose to not have workers’ compensation insurance have:

• Additional notification requirements. Non-subscribing employers are required to notify employees at hiring that they do not carry workers’ comp insurance, and are also required to annually post a Notice of No Coverage to Employees in a prominent place. Employers who fail to comply with notification requirements may be fined.
• Note: some employers who choose not to carry workers’ comp carry other types of insurance instead, such as death or disability insurance. While they may be helpful in the case of accident or injury, these insurances are not considered equivalent or a replacement for workers’ comp.
• Additional legal liability. Workers’ comp insurance provides some legal protection to employers. Employees who receive workers’ comp payments typically waive their right to sue their employer for negligence. For non-subscribers, when an employee is injured on the job, the employee must sue for compensation, and the employer is also potentially exposed to additional liability for negligence, as well as legal fees and other costs.
• Note: an employer who is protected from ordinary negligence claims is not protected from liability for gross negligence. In other words, workers’ comp protects employers in the case of unforeseeable accidents, but it does not protect employers who show reckless disregard for employee health and safety. If you have been injured, and feel that your employer exposed you to unusual and unnecessary risk, contact a workers’ compensation attorney to discuss your case.

Another drawback to not having workers’ compensation is the inconvenience, for employer and employee. Workers’ comp provides a single source for claims, information, and payments, with comprehensive coverage and standardized benefits. Without it, employees and employers must work with various different insurance policies, legal teams, and communication channels, making recovery from an injury even more difficult and time-consuming.

How Do I File a Workers’ Comp Claim?

If you have been injured at work, report the injury to your employer and to the Texas Department of Insurance as soon as possible. While the priority is always seeking the appropriate medical care for your injury, it is best to immediately notify your supervisor verbally or by phone, and then send a written email to your boss and/or HR department with a detailed description of the incident. Many companies will have a form you will be required to complete.

You have 30 days from your injury to notify your employer. Once you have notified your employer, they should initiate the workers’ compensation claim accordingly. However, it is always best to contact the Texas Department of Insurance yourself and notify them of your injury directly.

Claims not filed within 30 days may be more difficult to process. If you have a work-related illness or injury that came on gradually, you have 30 days from the day you became aware that your injury may be work-related.

Where to Get More Information About Workers’ Comp

To learn more about Texas workers’ comp rules and requirements, visit the Texas Department of Insurance website, which has a lot of valuable information for workers, as well as tools to help you report an injury.

If you need information about your specific case, it is best to discuss it with an expert workers’ comp lawyer. Texas workers’ compensation regulations are unusual and complex, and you may be entitled to benefits you aren’t aware of. The Law Office of Aaron Allison offers free consultations to help you understand your rights and get the compensation you deserve.