If you’ve been injured or have become ill at work, it is normal to have questions about how you’ll support yourself and your loved ones while you seek treatment. You might be asking yourself: How will I cover my medical expenses? When can I go back to work? How will I afford to pay my bills while I’m recovering? These questions can be especially worrisome if the injury you’re dealing with is disabling in nature.
Fortunately, many employees in Texas are covered by their employer’s workers’ compensation insurance policy. These policies exist to provide coverage for workers who are hurt on the job, regardless of who caused the accident. They help injured workers get the quality treatment they need, while also providing a percentage of the individual’s expected take-home pay.
While these benefits can be a lifesaver for many, getting the benefits you need is not always easy. KRW Lawyers, we help injured workers and their families demand the full compensation they are entitled to receive. Contact us now to schedule your free consultation.
Workers’ Compensation Laws in Texas
Workers’ compensation benefits provide a valuable “safety net” for employees who have been injured or have become ill on the job. According to the Texas Department of Insurance (TDI): “Workers’ compensation is an insurance program that pays your medical bills and replaces some of the money that you lost because of your work-related injury or illness.”
In Texas, private employers are not required by law to have workers’ compensation coverage. Although not offering workers’ comp insurance may seem like a smart way for employers to maximize profits, doing so may actually end up costing them more in the end.
This is because, according to Texas law, workers’ comp insurance serves to limit both the type and amount of compensation that employees who are hurt can get. For an employee, this means a few important things:
If an employer does not offer workers’ compensation benefits:
- Any employee who has sustained a work-related injury or illness can pursue a personal injury lawsuit.
- The damages that an employee can sue for cover much more than workers’ compensation benefits would.
- If an employer chooses to forego workers’ comp insurance, and an employee pursues a personal injury case, the employer forfeits the right to assert certain legal defenses in court. These forfeited legal defenses include the assumption of risk, contributory negligence, coworker negligence, and more.
If an employer does offer workers’ comp benefits:
- Employees have the right to either accept or waive those benefits. Employers must notify new employees that they have five days to either accept or waive workers’ comp benefits.
- If an employee elects workers’ comp benefits, then that employee is almost guaranteed to receive some type of coverage in the event of a work-related injury or illness. However, this coverage is limited by Texas law.
- If an employee elects to waive workers’ comp benefits, then that employee retains the right to pursue a personal injury lawsuit in the event of a work-related injury or illness.
Texas employers benefit from workers’ comp insurance for two significant reasons:
- Workers’ comp protects employers from costly personal injury lawsuits.
- Workers’ comp places a limit on the amount and type of compensation that an injured employee can receive.
If you have been hurt on the job and want to talk about your legal options, please contact our firm now. We can explain whether you have the right to pursue workers’ comp benefits or a personal injury claim, and our team will help you through the entire process.
When Should an Employee File a Workers’ Comp Claim?
If you are eligible for workers’ compensation benefits, and you have been injured on the job, you should notify your employer and file a workers’ compensation claim as soon as you are able. There are two steps you should immediately take to preserve your rights in the event of a work-related injury or illness:
- You must file an injury report within 30 days. You have a period of up to 30 days to file an injury report, starting from the day that the injury occurred, or from the day that you knew your injury or illness was job-related. You should file this report as soon as possible.
(In Texas, employers are required to give injured employees a claim form within 24 hours after being notified of an employee injury or illness. Additionally, employers must provide written text to inform employees of their rights under state workers’ compensation laws.)
- You must file a workers’ compensation claim form within one year. From the date of the work-related injury, you have up to a year to send a completed employee claim form (DWC Form-041) to the Division of Workers’ Compensation (TDI-DWC).
Remember that the sooner you file an injury report and submit your claim, the sooner you may be able to receive compensation.
What Does Workers’ Compensation Cover?
There are three main types of benefits provided through workers’ compensation:
- Medical benefits: This covers the costs of medical treatments that are deemed “reasonable and necessary” for recovery.
- Income benefits: This type of benefit is intended to replace some of the income that an employee may have lost while recovering from a work-related illness or injury. There are four different types of income benefits:
- Temporary income benefits
- Impairment income benefits
- Supplemental income benefits
- Lifetime income benefits
- Death benefits: This covers some of the expenses that an employee’s family will incur if the employee passes away because of a work-related illness or injury. In some cases, the spouses of first-responder personnel may be entitled to receive lifetime death benefits ─ even after they remarry.
If you have been hurt on the job and need help understanding what benefits you may be entitled to receive, please contact our experienced workers’ compensation lawyers now.
What Workers’ Comp Typically Won’t Cover
By Texas law, workers’ compensation will not cover sick or injured employees if:
- The employee intentionally caused his or her own sickness or injury.
- The injury was a result of the employee’s horseplay.
- The injury was sustained while the employee was under the influence of drugs or alcohol.
- The injury was sustained during an off-duty recreational activity, such as a sports or social event.
- Another employee intentionally injured the employee for non-work-related reasons.
What Happens If the Insurer Approves the Claim?
Once you have submitted your workers’ compensation claim, you must wait for the determination of an insurer to approve or deny your request. If the determining insurer approves your workers’ compensation claim, you will be contacted with details on what kind of compensation you will receive. If this is the case, you can do one of two things:
- Accept the payment that you are offered
- Negotiate for a higher sum
If you submitted a claim on your own and it was approved, you may still benefit from having a lawyer review your case. At KRW Lawyers, we can go over the details of your claim in a free, no obligation consultation.
What Happens If the Insurer Denies the Claim?
If your claim is denied, you can request that the insurance company review the determination. You may also submit an appeal for your claim. It is crucial that you have a skilled attorney on your side to fight a denied claim.
How Can an Attorney Help with My Claim?
Remember, Texas employers benefit from offering their employees workers’ compensation insurance for two primary reasons:
- Workers’ comp protects employers from costly personal injury lawsuits.
- Workers’ comp places a limit on the amount and type of compensation that an injured employee can receive.
Even if your boss has your best interests at heart, it’s important to remember that the primary objective of a company’s insurance provider is to keep their financial losses and costs as low as possible. In too many cases, injured employees are taken advantage of by insurance companies that may not grant the appropriate type or amount of financial compensation.
This is why it is crucial to seek assistance from an experienced workers’ compensation attorney. Whether you need help with your initial benefits application or appealing a denied claim, KRW Lawyers is here for you. We have a notable track record of success helping injured workers in San Antonio fight for the full benefits they deserve after on-the-job accidents.
Call us or fill out our online contact form to schedule your free case evaluation toda
