Workers’ Comp FAQs

For most people, dealing with the myriad workers’ compensation rules, laws, and regulations can be daunting. The confusion can be worsened for those who are suffering from an on-the-job injury and are worried about their recovery or how to pay for it.

With that in mind, here is a list of some of the most frequently-asked questions concerning workers’ compensation in Texas.

1. What is workers’ compensation?

It’s a type of insurance program that is administered by the state of Texas. The purpose of workers’ compensation is to allow employees to recover compensation for medical bills and lost wages, but this compensation is usually not substantial and can be difficult to recover. Just because your employer has workers’ comp does not mean that you are limited to workers’ comp benefits.

2. Am I automatically qualified for workers’ compensation?

No. Unlike other states, Texas companies are not required to offer workers’ compensation to its employees. But if your employer does opt-out of the state system, it still can be held responsible in civil court if you are injured on the job.

3. Are all injuries covered under workers’ compensation laws?

Many workplace injuries are covered, however benefits may be limited. Exceptions to coverage include getting hurt doing non-job related duties, during horseplay, while committing a crime, or while impaired by drugs or alcohol.

4. Do workers’ compensation benefits apply to long-term conditions?

Sometimes. Repetitive stress injuries like carpal tunnel syndrome or chronic back problems may be covered by workers’ compensation. This could also apply to heart conditions, stress-related digestive problems, and similar issues if they were exacerbated by general working conditions.

5. What does workers’ compensation cover?

Medical expenses incurred for diagnosing and treating your injury are covered under workers’ compensation. You can also receive various types of weekly income benefits designed to replace your unearned wages if you are unable to work.

6. How much money can you receive for workers’ compensation income benefits?

The maximum limits for weekly income wages are set by the state. As an example, the maximum temporary income benefits amount is $850 per week. Similar limits are set for impairment, supplemental, and lifetime income benefits. You may be able to receive much more compensation by retaining a personal injury attorney to seek damages not covered by a workers comp policy.

7. How soon after an injury must I file a workers’ compensation claim?

You have one year from the date of the incident to file a claim form with the Texas Division of Workers Compensation. This paperwork must be filed even if you have already begun receiving monetary benefits.

8. Which doctor should I see for my injuries?

You must visit a physician that is a part of your employers’ certified workers’ compensation health care network. Your company’s human resources department should have a list of qualifying physicians. If your primary care physician is on this list, you may be treated by him or her.

9. When might I need a workers’ compensation lawyer?

Workers’ comp benefits can be extremely difficult to obtain. Even then, benefits are usually inadequate or improperly computed. You may need a qualified workers’ compensation attorney to handle your dispute and work to recover compensation in excess of what a workers’ comp policy may pay. Contact our San Antonio work injury Law Firm for a free consultation.

Additional Workers’ Compensation Questions

Can I Choose My Own Doctor for a Workers’ Comp Claim?

In Texas, your employer’s workers’ compensation insurance carrier may have an approved network of doctors. You are generally required to choose a treating doctor from within that network. However, if you are unsatisfied with your medical care, you have the right to request a change of treating doctor by contacting the insurance carrier. If your request is denied, you can dispute that decision through the Texas Division of Workers’ Compensation.

What Happens If My Workers’ Comp Claim Is Denied?

If your workers’ compensation claim is denied, you have the right to dispute that decision. The first step is typically a Benefit Review Conference, which is an informal meeting where a benefit review officer helps you and the insurance carrier try to resolve the dispute. If the issue is not resolved at that stage, you can request a Contested Case Hearing before an administrative law judge. Having an experienced San Antonio workers’ comp attorney represent you during these proceedings can significantly improve your chances of a favorable outcome.

How Long Do Workers’ Compensation Benefits Last in Texas?

The duration of workers’ compensation benefits in Texas depends on the type and severity of your injury. Temporary income benefits can last up to 104 weeks from the date of injury. Impairment income benefits are paid after you reach maximum medical improvement and are based on your impairment rating. For catastrophic injuries resulting in permanent total disability, lifetime income benefits may be available. Medical benefits for your work-related injury do not have a time limit as long as the treatment remains reasonably necessary.

Do I Need a Lawyer for a Workers’ Comp Claim?

While you are not required to have an attorney for a workers’ compensation claim, having experienced legal representation can help protect your rights, especially if your claim is disputed or your injuries are severe. An attorney can ensure you receive appropriate medical treatment, help you understand the full value of your claim, and represent you in hearings if the insurance company denies or underpays your benefits.