Although most states have had workers’ compensation insurance and regulations for over 100 years, workers’ comp is still a source of uncertainty and confusion, especially in Texas.
The truth is, although we often think of workers’ comp as applying to high-risk professions like construction and manufacturing, workers’ comp protects every worker who is injured on the job. Understanding what it is and how it works is essential to protect yourself and your family. Here is an overview of what most workers need to know about workers’ comp, but remember that it’s best to contact a workers’ compensation lawyer for information about your specific case.
Workers’ Comp: What Is It and What Does It Cover?
Workers’ compensation is a form of insurance that protects workers who have been injured at work and their families. Workers’ comp covers all the costs related to the injury, including medical and prescription bills, lost wages, rehabilitation costs, and other injury-related expenses.
If a worker has been killed on the job, workers’ comp provides death benefits to the family, including funeral expenses and financial benefits for the lost earnings.
Workers’ Comp: What to Do If You’re Injured on the Job
If you are injured on the job, it is important to follow the correct procedures to protect your rights. If you are injured at work:
- Protect yourself and secure the situation. If possible, try to prevent further accidents or injuries. Pull a fire or emergency alarm, shut down machinery, seek shelter, etc. to try to reduce the risk in the immediate situation.
- Seek appropriate medical care. Care for any urgent or emergent medical needs. Use first aid, call 911, etc to take care of yourself.
- Notify your immediate supervisor immediately. As soon as it is safe to do so, notify your immediate supervisor of your accident or injury. This may just be a brief message or call to let them know, with a more thorough and detailed follow-up later.
- Write down what happened. Write down a step-by-step description of the accident, with as much detail as possible.
- In some cases, your employer will send you a form or other document to describe your accident. You can use this form for your description, or create a separate document. Take as much space as necessary to describe your accident, even if it takes multiple pages.
- Contact the Texas Department of Insurance. Whether you need to file your claim yourself or make sure that your claim has been filed correctly by your employer, it is always a good idea to contact the Division of Workers’ Compensation Insurance of the Texas Department of Insurance (TDI) yourself.
Workers’ Comp: How to File a Claim
Workers’ comp is a form of insurance that covers the employer from certain kinds of liability and damages, so the employer is the one who purchases workers’ comp and pays the premium.
This means that it is usually the employer who files a workers’ compensation claim when there has been an accident or injury. However, it is a good idea to know how to file a claim yourself, and follow up independently. There is a time limit to apply for workers’ comp claims, so making sure the claim has been filed or filing it yourself ensures that you stay within the statute of limitations.
To file your own workers’ comp claim, contact the TDI Workers’ Comp Division by phone or online.
Workers’ Comp: What to Do If You’re Denied a Claim
Workers’ comp claims can be denied for many reasons, and not all of those reasons are fair or correct. If your workers’ comp claim has been denied, you can contact the Texas Department of Insurance for help filing an appeal.
However, if your claim has been denied, it’s always a good idea to seek a consultation with a workers’ compensation lawyer. Without new information or a more compelling argument, your claim may be denied a second time. Furthermore, your bills and costs are adding up throughout the appeal process, which makes a difficult time even more stressful. A qualified workers’ comp attorney can give you personal advice about your case and help you understand your rights.
Workers’ Comp: How to Appeal a Denial
If your workers’ compensation claim is denied, contact the Texas Department of Insurance to request a Benefit Review Conference. During the Benefit Review Conference, a TDI Benefit Review Officer will meet with you and with a representative of your employer to discuss your claim and attempt to reach an agreement. Although this is an informal meeting, it is always a good idea to consult with a workers’ compensation lawyer beforehand. Your employer has lawyers on their side; you should have a lawyer on your side.
If you and your employer cannot reach an agreement during the Benefit Review Conference, you have two choices:
- The arbitration process is similar to the benefit review process. You and a representative of your employer will meet with a TDI arbitrator. The arbitrator will hear both sides and will render a decision. This decision is final and cannot be appealed.
- Contested Case Hearing. The contested case process is a full legal proceeding, and is slower and more expensive than arbitration. Both parties submit all their evidence and arguments to a TDI Hearing Officer. The Hearing Officer will issue a written decision.
If you disagree with the Hearing Officer in your Contested Case Hearing, you can appeal to the Division of Workers’ Compensation Appeals Panel. If you disagree with the ruling of the Appeals Panel, you can take the case to the Texas State court system and sue. This appeal process is complex, time-consuming, and involves a huge range of legal processes. It is essential to work with a Texas workers’ compensation attorney to advance through the workers’ comp appeal process.
How Can Aaron Allison Help?
Workers’ compensation insurance protects workers who have been injured on the job and their families. It provides compensation for all the costs associated with a work-related illness, injury, or fatality, and the process is often simple and straightforward. However, not all workers’ comp claims run smoothly, and appeals can become slow and complex. If you have questions about your workers’ comp claim, contact the law offices of Aaron Allison for a free consultation.