What Is Workers’ Compensation?
In Texas, workers’ compensation is a state regulated insurance program that injured workers can take advantage of if they are injured while on the job. Workers’ compensation can cover injuries that occur off of the workplace premises, but while the worker is on the clock. Workers’ compensation also covers the development of work-related illnesses. This insurance provides compensation for medical bills incurred by the injured worker, and can also provide the injured worker with temporary compensation for lost wages.
Private employers can choose whether or not to provide workers with workers’ compensation insurance coverage in Texas, and must notify workers whether they have coverage or not. Workers’ compensation insurance coverage is not mandatory.
Workers’ compensation benefits are granted regardless of fault for the work-related injury, so long as the worker is not responsible for causing them in a deliberate or reckless manner. For instance, work-related injuries that are not covered by workers’ compensation include:
- The injuries arise from the worker’s own horseplay. A worker who is acting recklessly in the workplace likely is endangering themselves. The resulting injuries would be the worker’s own fault, due to the worker’s own recklessness.
- The injuries are the result of the worker’s intoxicated state. A worker who is at work while under the influence of drugs or alcohol could become injured. However, the injuries may not have occurred if the worker were not in an intoxicated state while at work. The injures are likely the worker’s own fault, due to their negligence.
- The injuries result from the willful criminal actions of the worker. If the worker is injured as a result of their own willful criminal actions, the injuries are not work-related injuries and are ineligible for workers’ compensation benefits.
- The injuries arise from voluntary participation in off-duty recreational activities. While the activities may be on the workplace premises, if injuries result from voluntary participation in recreational activities, the injuries are not workers’ compensation eligible because the injuries were not the result of work activities, and participation in the recreational activities by the worker was voluntary.
- The injuries arise from the criminal actions of third parties. When a worker is injured during the commission of a crime by a third party, the injuries may not qualify for workers’ compensation benefits.
What Types of Workers Are Eligible For Workers’ Compensation?
Full-time, part-time and some seasonal employees are eligible for workers compensation if their employer provides workers’ compensation insurance coverage for the workers. It does not matter how long the worker has been employed by the employer before they can make a workers’ compensation claim. Someone who has been injured on the job after just a few hours on their first day can make a worker’s compensation claim, as can an injured worker who has been an employee for 30 years.
Even if the injured worker has a pre-existing injury or illness that they did not get from their place of employment, the worker can still seek workers’ compensation benefits for a new work-related injury or illness. If the worker’s pre-existing injury or illness is aggravated or exacerbated by a new work-related injury or illness, it may be possible for the injured worker to obtain workers’ compensation for the aggravated injury or illness as well.
What Types of Benefits Does Workers’ Compensation Provide?
Texas workers’ compensation provides a number of different benefits to injured workers and/or their surviving family members. These benefits include:
- Medical Benefits. An injured worker is entitled to medical benefits that allow the injured worker to pay for the medical expenses associated with obtaining treatment for their work-related injury or illness.
- Income Benefits. In Texas, injured workers are eligible for four different types of “income” benefits.
- Temporary Income Benefits. Temporary income benefits are paid when a worker’s work-related injury or illness causes the worker to miss seven or more days of work. Temporary income benefits are effectively wage replacement benefits.
- Impairment Income Benefits. An injured worker could receive impairment income benefits in Texas if the worker suffers a permanent impairment as a result of their work-related injury.
- Supplemental Income Benefits. An injured worker can obtain supplemental income benefits based on their impairment rating and by satisfying other qualification criteria.
- Lifetime Income Benefits. Some specific injuries are so serious that they could entitle an injured worker to lifetime income benefits.
- Death Benefits. If a worker dies as a result of a work-related injury or illness, the decedent’s family (i.e., a surviving spouse, minor children, dependent grandchildren, and other dependents) may be eligible for death benefits.
- Burial Benefits. Burial benefits may be available for an individual who pays the burial expenses of an injured worker who died as a result of their work-related injuries or illness.
Can I Choose My Own Doctor?
Injured workers can choose their own doctor, so long as the doctor is designated by the Texas Division of Workers’ Compensation as a workers’ compensation doctor. A list of designated doctors is usually provided by the injured worker’s employer. However, if the employer is unable to supply this list, an injured employee can locate any workers’ compensation designated doctor to provide them with medical treatment for their work-related injury or illness.
If I Need Help With My Workers’ Compensation Claim, Where Can I Turn?
Injured workers have three main options when they need help dealing with the Texas workers’ compensation system. Injured workers can consult with an experienced workers’ compensation lawyer, they may contact a Texas Department of Insurance Division of Workers’ Compensation staff member, or injured workers can seek help from the Office of Injured Employee Counsel if the injured worker does not already have a workers’ compensation attorney. In any case, each option will be able to provide injured workers with:
- A better understanding of the workers’ compensation system;
- Guidance on how to navigate and use the Texas workers’ compensation system;
- Answers to any questions injured workers might have about a what claims are, how to file a claim, what a claim dispute is, or how to resolve a claim dispute; and
- Guidance on how to handle when an injured worker’s claim is denied.
Is Workers’ Compensation Claim Information Kept Confidential?
An injured worker’s workers’ compensation claim information is kept confidential, with only those who are involved in handling the claim being allowed to access the information that the claim contains. An injured worker may designate an individual, such as a spouse, as authorized to speak with the Texas Division of Workers’ Compensation concerning the injured worker’s workers’ compensation claim.
However, prospective employers are able to look up whether a prospective hire has had any reported work-related injuries in the recent past. Employers can view whether a prospective hire has had two reported work-related injury or illness claims in the past five years.
Is Workers’ Compensation My Only Means of Recovery?
Injured workers can seek compensation from other sources in certain situations when they are injured or become ill as a result of their performing their job functions. For instance, if a third party is liable for causing a work-related injury or illness, an injured worker may have a personal injury claim against the liable third party. In a third person liability lawsuit, an injured worker can seek damages that go beyond compensation for medical expenses and lost wages (which the injured worker could obtain by filing a workers’ compensation claim), and can seek noneconomic damages for injuries that are tough to put a monetary value on, like mental anguish, pain and suffering, etc.
Is My Boss Allowed to Treat Me Differently, Discriminate Against Me, or Fire Me?
There are certain legal protections in place that prevent an employer from discriminating against an injured worker who files for workers’ compensation benefits, and as a general rule, an employer should not treat an employee any differently after the injured employee files for workers’ compensation. An employer cannot fire an injured worker in retaliation for filing for workers’ compensation, and if they do, it may be grounds for a wrongful termination lawsuit.
However, Texas is an at will employment state, and employers can terminate their employees for any reason, so long as the reason is not one that is protected against by law. The employer could fire an injured worker because business is slow, or because the worker is no longer able to perform their work duties due to the work-related injuries. Texas employers must legitimize the termination of an injured employee.