Workers’ compensation is a state-regulated insurance program that can provide medical and income benefits to employees who suffer a work-related injury or illness. When an eligible employee is injured on the job, workers’ compensation may help cover necessary medical treatment and replace part of the employee’s lost income. A work injury lawyer Houston can help injured employees understand their rights and legal options.
Texas has an important difference from most states: most private employers are not required to carry workers’ compensation insurance. Employers that choose to provide coverage are generally referred to as subscribers, while employers that do not provide coverage are known as non-subscribers. Understanding your employer’s coverage status is an important first step after a workplace injury because your rights, available benefits, reporting requirements, and potential legal options can depend on the circumstances of your injury.
How Does Workers’ Compensation Work in Texas?
Workers’ compensation generally provides benefits when an employee suffers an injury or illness that is related to their job and the employer has workers’ compensation coverage. The Texas Department of Insurance’s Division of Workers’ Compensation (DWC) regulates the state’s workers’ compensation system.
Workers’ compensation can provide benefits without requiring an injured employee to prove that the employer was negligent. Instead, the system is designed to provide medical and income benefits for qualifying work-related injuries and illnesses. The benefits available can depend on the nature and severity of the injury, the employee’s wages, the amount of time missed from work, and other factors established by Texas workers’ compensation laws.
Is Workers’ Compensation Required in Texas?
Unlike most states, Texas generally allows private employers to choose whether to provide workers’ compensation coverage. A private employer that does not provide coverage is called a non-subscriber and must comply with specific notification and reporting requirements. If you are unsure about your rights after a workplace injury, a work injury lawyer near me can help you understand your legal options.
Certain employers and situations are subject to different requirements. For example, Texas governmental entities must have workers’ compensation coverage, and certain private employers working on government projects may also be required to provide coverage.
Because coverage is not universal, an injured Texas worker should determine whether their employer has workers’ compensation insurance or is certified to self-insure before assuming that the workers’ compensation system applies.
What Benefits Does Workers’ Compensation Provide?
Workers’ compensation can provide several types of benefits to eligible employees. The Texas Department of Insurance identifies four primary categories: income benefits, medical benefits, burial benefits, and death benefits.
Medical Benefits
Medical benefits can pay for reasonable and necessary medical care related to a covered workplace injury or illness. Depending on the circumstances, treatment may include doctor visits, diagnostic testing, medication, physical therapy, surgery, or other medically necessary services.
If your employer uses a workers’ compensation health care network, you may need to receive treatment from a doctor within that network. If you receive care outside the network without the required approval, you may be responsible for some of the costs.
Income Benefits
Workers’ compensation may replace part of the income an employee loses because of a qualifying work-related injury or illness. Texas provides different types of income benefits depending on the circumstances of the injury and the employee’s level of impairment or disability.
Temporary income benefits, impairment income benefits, supplemental income benefits, and lifetime income benefits are among the categories recognized under the Texas workers’ compensation system.
Burial Benefits
When a covered work-related injury or illness results in an employee’s death, workers’ compensation may provide certain burial benefits. These benefits are intended to help with eligible funeral or burial expenses.
Death Benefits
Eligible beneficiaries may receive death benefits when an employee dies because of a compensable work-related injury or illness. These benefits can help replace some of the income the deceased employee would have provided to the family.
What Injuries Are Covered by Workers’ Compensation?
Workers’ compensation generally applies to injuries and illnesses that arise from or are related to employment. The injury may occur suddenly, such as in a workplace accident, or develop over time because of job-related activities or conditions. If you are unsure whether your injury may support a claim, a personal injury lawyer near me can help you understand your potential legal options.
Examples of workplace injuries can include:
- Back and neck injuries
- Broken bones and fractures
- Slips, trips, and falls
- Repetitive-motion injuries
- Muscle and tendon injuries
- Burns
- Cuts and lacerations
- Injuries caused by workplace equipment
- Occupational illnesses
- Exposure-related conditions
- Injuries caused by workplace accidents
What Injuries May Not Be Covered?
Workers’ compensation does not cover every injury that happens to an employee. Texas Department of Insurance guidance identifies several circumstances in which workers’ compensation generally will not pay benefits, including intentionally self-inflicted injuries and injuries that occur outside of work.
Coverage can also be affected when an injury occurs while an employee is intoxicated, while playing around, or during certain voluntary off-duty activities. An injury caused by someone else for personal reasons unrelated to the job may also fall outside workers’ compensation coverage.
Whether an injury is covered depends on the circumstances. If an insurance carrier disputes whether your injury is work-related, you may have the right to challenge that decision through the Texas workers’ compensation dispute-resolution process.
What Should You Do After a Workplace Injury?
Taking action promptly after a workplace injury can help protect your ability to pursue available benefits. Even if the injury initially seems minor, symptoms can sometimes worsen later.
Report the Injury to Your Employer
Notify your employer about the injury as soon as possible. Texas workers’ compensation law has specific deadlines for reporting work-related injuries, so delaying notice can create complications.
Provide clear information about when, where, and how the injury occurred. Keep a record of when you reported the injury and who received the report.
Seek Medical Treatment
Get appropriate medical attention for your injury. A healthcare professional can document your symptoms, diagnose the condition, and recommend treatment.
If your employer’s workers’ compensation claim is handled through a health care network, you may need to follow the network’s rules when selecting a treating doctor.
Document the Accident
Keep records related to the accident and your treatment. Depending on the circumstances, useful documentation may include:
- Accident reports
- Medical records
- Medical bills
- Prescription records
- Photos of the accident scene
- Photos of visible injuries
- Names of witnesses
- Employer communications
- Pay records
- Work restrictions
- Correspondence from the insurance carrier
What Happens After You File a Workers’ Compensation Claim?
Once a workplace injury is reported, the claim may be reviewed by the workers’ compensation insurance carrier. The carrier may evaluate whether the injury is work-related, what treatment is medically necessary, and which benefits may apply.
The Texas Division of Workers’ Compensation regulates the system and helps resolve disputes involving injured employees, insurers, and employers. DWC itself does not pay workers’ compensation benefits; insurance carriers pay benefits on covered claims. If there is a disagreement about benefits, medical treatment, impairment, or other aspects of the claim, the Texas workers’ compensation system provides a dispute-resolution process.
What If Your Employer Does Not Have Workers’ Compensation?
If your employer is a Texas non-subscriber, the workers’ compensation system may not apply to your injury. Texas private employers that choose not to provide workers’ compensation coverage must notify their employees and comply with specific reporting and notice requirements.
Non-subscriber status can significantly change an injured employee’s legal options. According to the Texas Department of Insurance, an employer without workers’ compensation coverage does not have the same legal protection against lawsuits that a subscriber generally receives.
If you were injured while working for a non-subscriber employer, the circumstances of the accident and your employer’s actions can affect what legal remedies may be available. Speaking with an attorney can help you understand the options that may apply to your situation.
Can You Sue Your Employer for a Workplace Injury in Texas?
Whether you can bring a lawsuit against your employer depends in part on whether the employer carries workers’ compensation coverage.
When an employer has workers’ compensation coverage, the system generally limits the employer’s liability for lawsuits by injured employees, subject to exceptions under Texas law. One important statutory exception involves gross negligence resulting in a fatality.
A different set of rules can apply when an employer is a non-subscriber. Because non-subscriber cases can involve traditional personal injury claims and different defenses, an attorney can review the circumstances of the injury and explain what legal options may be available.
What Are Your Rights After a Workplace Injury?
An injured employee may have rights relating to medical treatment, income benefits, claim information, dispute resolution, and other aspects of the workers’ compensation process.
Important steps include:
- Reporting your workplace injury promptly
- Seeking appropriate medical treatment
- Following applicable workers’ compensation network requirements
- Keeping copies of medical and claim records
- Responding to communications from the insurance carrier
- Understanding your available benefits
- Challenging disputed claims when appropriate
- Seeking legal advice when the claim becomes complicated or disputed
When Should You Talk to a Workers’ Compensation Attorney?
You may want to speak with an attorney if your claim is denied, your benefits are delayed, your medical treatment is disputed, or you believe the insurance carrier is not properly handling your claim.
Legal guidance can also be useful when your employer does not carry workers’ compensation insurance. Non-subscriber cases can involve different legal claims and procedures than traditional workers’ compensation cases. An attorney can review your employment status, accident circumstances, medical records, insurance information, and communications related to your claim to help explain your potential legal options.
Injured at Work? Get Legal Help in Houston
A workplace injury can affect your health, ability to work, income, and future financial security. Understanding whether your employer carries workers’ compensation insurance and what benefits or legal claims may be available is an important step after an accident.
After more than a decade defending insurance companies, Attorneys Nadia Lakhani and Stephen McGrath founded Lakhani & McGrath to help individuals navigate personal injury and insurance claims. Their experience on both sides of insurance disputes provides insight into how insurers evaluate and handle injury claims. If you were injured at work, the firm handles workplace injuries and other personal injury matters in Houston. You can schedule a free consultation to discuss your circumstances and potential legal options. Call (713) 424-4529 to speak with Lakhani & McGrath, PLLC.
