Texas Workers' Compensation Process

Michael Grossman Explains The Texas Workers Comp Process for Those Injured On The Job

Texans are busy, hardworking people, so it’s not surprising that on-the-job injuries happen all too frequently. Work-related accident injuries aren’t just incidents that happen in industrial plants or construction sites.

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On-the-job injuries can happen anywhere, including offices, restaurants, retail shops, and industrial floors. They can happen while working logistics, driving a tractor trailer, handling a crane, or just lifting something that’s too heavy. It could even happen mopping up a wet floor. If you’ve suffered injury due to any type of workplace accident, you’re likely entitled to some form of reimbursement for the financial losses you’ve incurred as a result of your work injury in Dallas, Fort Worth, or elsewhere in Texas. Such compensation can assist you with issues like medical bills, pain and suffering, and your lost wages.

You are not without your rights. You may want to focus exclusively on your recovery, and that’s important, but it’s seldom advisable to take short cuts that could hurt your claims or legal case further down the road. Work injury laws in Texas have grown more complex regarding workers’ compensation. Additionally, there are often parties who may appear to be on your side, but they likely won’t have your best interests at heart. They throw a lot of paperwork and good intentions your way, but they often have ulterior motives that will not work to benefit you in the long run.

Texas on the job injury attorney Michael Grossman has put together the following information. He’s been at this for 20 years and knows how to navigate the complex legal landscape of workers’ compensation and personal injury law. Whether you need an attorney to help you file your claim, or you just want to know what your legal options are, our attorneys are here for you. In this article, Dallas on-the-job injury accident attorney Michael Grossman discusses the options you will have if you’ve been injured while at work.

First Things First – Your Health

If you’ve been hurt while on the job, the first thing you need to do is seek medical attention. Being examined by a medical professional is important both for your life and your case. Don’t worry about the cost. Even if you’re uninsured, medical treatment and examination is available. If necessary, we can help you locate medical attention that can take your financial and personal situation into consideration. In addition, we may be able to help you see a doctor at no cost to you. We can also show you how the time you take off from work to get care may be compensable by the defendant. Once that’s covered, now we turn our eye to your employer.

Get medical help, and immediately notify your employer about your work injury in the Metroplex. If the employer has workers’ compensation coverage – and we’ll talk more about that shortly – then you need to notify your employer immediately after the incident takes place.

Technically, you have 30 days after sustaining a work injury in order to fill out a workers’ comp claim. However, many companies will try to deny benefits to an injured worker, regardless of what may appear to be a black-and-white case in regards to blame. By reporting a work injury as soon as possible, you are working to protect your interests. An injured worker of a subscribing employer must fill out form TWCC­41 and submit it to the Texas Workers' Compensation Commission within one year from the date of the accident or they will lose their benefits. You must follow the guidelines set forth by their doctor and they must answer all written requests and fill out all necessary paperwork or they may lose their benefits.

Because all workers' comp claims are administered by private insurance companies, there can often be considerable unfairness in a workers' comp claim. The insurance carrier often looks to find any technicality by which to deny the claim or reduce the amount of benefits that the employee is entitled to receive. It’s recommended that an injured worker keep documents of everything and follow all the rules and instructions from their physician.

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Workers’ Compensation in Texas: It’s More Complicated and Lop-Sided Than You Imagine

You need to know if your employer has workers’ compensation insurance. We can help you find that out. This is one of the first questions that any on the job injury attorney in Texas should ask. It makes a big difference in your case as to how we approach it if your employer has bought one of these insurance policies. It helps determine how your claim is filed and what compensation you may be entitled to receive.

Workers’ comp in Texas is optional for employers, which is fairly unique in comparison to most states in the country. It is a choice the employer gets to make. It also determines your legal options as regards your own claim. As we explained, an employer that has workers’ compensation insurance is called a subscriber, while if an employer does not have a policy is labeled a non-subscriber.

Subscriber Companies

If your company has workers’ comp insurance, they are called a subscriber company. In 1992 the Texas Legislature enacted the Workers’ Compensation Act and, according to that law, employers who choose to purchase workers’ compensation insurance get a special slate of incentives under the law. These incentives usually are not incentives that work in your favor. The chief protection employers who pay for workers’ comp insurance have is that they cannot be sued under any but the most unusual of circumstances. This means that your sole recourse for getting relief from a liable subscribing employer for your damages is through a workers’ comp claim.

The Workers’ Compensation Act also puts limits on how much money you may be able to recover through a worker’s compensation claim. For starters, up to 70% of wages you lost while you were absent from work while recovering from your work-related injury (capped at a maximum of $600 per week) may be paid to you. This formula and maximum weekly payout also holds true in the case that you’ve been permanently disabled and are unable to work for the rest of your life. These paltry benefits may then have to sustain you through the rest of your life.

You are also entitled to complete reimbursement for all of your medical costs, such as the costs of medical treatment, prescription and over the counter drugs, and other medical supplies you need to fully recover from your injury. Ongoing treatment and medical needs are also potentially reimbursable. If you incur travel expenses in seeking medical treatment, supplies and prescriptions, those may likewise be recovered.

Workers’ compensation does not include coverage or reimbursement for any pain, suffering, or even general damages, aside from the income and medical expenses specified above. In other words, while an injury you’ve sustained may have been quite severe and have resulted in costly medical bills, the pain and suffering you’ve experienced is counted as next to nothing in regards to a workers’ compensation claim in Texas.

Another Subscriber Issue: Contractors vs. Full-Time Employees – Which Are You?

The law in Texas says that employers are not under any obligation to keep the workplace safe for contractors, volunteers, or temporary employees. As a result, employers believe that if they hire only these types of workers, they can cut corners on insurance costs and safety since they likely won’t be sued. We have seen employers try to get away with this, and we’ve caught them red-handed on plenty of occasions. This law doesn’t mean that contractors and temp workers can’t sue an employer. We’ve handled many of these kind of claims and have won them despite what employers claim. If you work like a full-time employee and are treated like one, you are likely an employee, even if the company says you’re a contractor. If one of more of the following factors apply to you, you can likely sue a liable non-subscribing employer as if you were an employee:

• The person or entity you worked for provided the tools, training and/or materials necessary for the work
• Taxes and social security were withheld from your check
• There is a document or contract between you and the person/entity you work for that specified conditions of employment, which limited your legal rights
• Your work was supervised, directed, and inspected you as you worked
• There is a set your work schedule
• If you were hired for an indefinite period of time, rather than by the project or task
• Likewise, if you were paid by the hour instead of by the project or task

Despite what other attorneys may have said, and even though you were hired as a contractor or a temp worker, you may still be able to recover from your employer if you can show the existence of an employer-employee relationship in the sense that you work like, and are treated like, an employee. Call the Dallas work injury law firm of Grossman Law Offices so we can help you determine whether the law considers you an employee or a contractor. Proving such a difference can be instrumental toward ensuring that you’re able to stand to receive full compensation for your sustained work injury.

Non-Subscriber Companies and Your Case

Non-subscribing companies have an almost unlimited liability to be sued, while a subscriber employer is largely protected against lawsuits and the damages assessed against them are much more limited. It is not uncommon for a non-subscriber to act as if they are a subscriber. A non-subscriber may choose to act in this unethical manner in order to make an injured worker believe that they cannot pursue legal action against them, knowing that such legal action may result in quite the loss of money for the employer.

A non-subscribing company may even try to pay an injured employee out of pocket or off the books while saying that the money is actually coming from an insurer. This is certainly never in your best interests. They wouldn’t pay you out of pocket if it was less expensive to pay you the damages to which you are entitled. Always keep this in mind: if you are injured or hurt and your employer doesn’t have insurance, you’re probably entitled to more compensation than you would likely receive under an insurance policy. The hush money that your employer wants to offer is almost certainly a pittance compared to what the law would almost surely find in your favor.

As we mentioned, the law penalizes employers who choose not to purchase workers’ comp insurance coverage. These non-subscriber companies, unlike those who do have workers’ comp insurance, can be sued without limit by employees who have been injured on the job, and they can be sued in regular courts. With a non-subscriber as the defendant, there is no maze of red tape that you find with the entire bureaucracy of the workers’ compensation system.

However, just because there’s no workers’ comp court red tape doesn’t mean it’s any easier to ensure your right to compensation. It’s a legal action like any other, and as with any legal action you will need professional representation. The non-subscriber employers will almost always contest your claims. They will have teams of attorneys who will try to pick apart your claims. They will contest your statements. They will do everything they can to make any accident look like you were the sole proximate cause. They will try to undermine any evidence you bring to prove the elements of your claim, and you have to prove all the elements of your claim. This is even more complex than it sounds; you must show that your employer was at least partially responsible for the accident, that the employer’s negligence caused the injuries, and that you are entitled to a specific amount of damages as compensation for your injuries. It’s like a one strike and you’re out system most of the time: if you miss evidence on even one of these points, your claim will almost assuredly be dismissed.

Are There Other Challenges in Non-subscriber Cases?

There are often two special challenges that you need to anticipate in a lawsuit. First of all, you should realize that even though they don’t carry workers’ compensation insurance, very often non-subscribing employers carry some form of insurance that they will use in paying at least a portion of your claim. In other words, you won’t just be up against your employer, but also against an insurance company. They are notorious for not wanting to pay, and they have teams of lawyers and insurance adjusters whose job it is to attack every element of your case.

These adjusters are not on your side. They aren’t like the friendly guys who come out and take digital snaps of your car when you’ve been in a fender bender and try to steer you to a preferred body and paint shop. These are the elite adjusters who are defending their own employer. They have one interest in mind and it’s not you – it’s pleasing the company that pays their high dollar salary. They attack these injury cases with the goal of denying claims and saving their employers money.

These attorneys and adjusters have a playbook of proven tactics for reducing what their employer has to pay an injured person. They train and study for years using tactics refined in court rooms every day. What they want to do is paint you, the injured party, as the sole proximate cause of your injury. That would mean that you and you alone caused the accident that injured you. This is because the one defense a non-subscriber employee has against a lawsuit involving on the job injuries is to establish that the injured person caused their own injury. If they can show that you and you alone were responsible for your accident, then they can be released from any liability at all. And because non-subscriber employers know that this is their only defense, they tend to use this defense in every single case.

They will tear your case down as much as possible and look into every corner of your work history and working habits. Employers and insurance companies interview witnesses and past employers and try to get your coworkers to admit that you make careless mistakes at work. Their one goal is to paint you, the victim of the workplace injury, as someone who is so sloppy and negligent that no one is to blame for your injury but you. We’ve seen this kind of tactic hundreds of times, and we know just what to expect. As attorneys with so much experience in personal injury and on the job accident cases, we are prepared for it, and we can prepare your case to withstand these attacks.

Subscriber or Non-Subscriber? You Have to Find Out

The right answer about whether an employer is a subscriber or a non-subscriber to Texas workers’ comp law is not always forthcoming. It’s not like there’s a sign on the door of the typical Texas business that says a business is a subscriber or non-subscriber. In fact, very often employees of a company don’t even know. Sometimes employers give the wrong answer when asked about their workers’ compensation status.

Sometimes the answer to the question is not clear. Sometimes the company doesn’t have a clear cut policy for dealing with accidents on the job. In some companies, finding a person who knows enough about the company’s status as a subscriber or non-subscriber to be of help can take considerable time, and if you’re in pain you’re probably not in the mood for cutting through all the red tape. We also have sometimes encountered situations where companies have outright answered falsely when asked if they are a subscriber to Texas workers’ comp. Workers’ comp is an expensive program and some companies choose not to buy it, reasoning that they can save money as long as no one is injured, because the cost of workers’ comp for an employer is related to how risky the job is, but inevitably there will be accidents. If you’re the victim, you need someone to make sure you’re not taken advantage of by an employer that may simply be seeking to save money instead of providing proper care for their employees.

The Workers’ Comp Process Is Complex

It is almost never easy or quick when navigating the workers’ comp insurance process in dealing with your on job injury. An insurance company is in business to make money. Insurance companies are usually more interested in helping themselves than helping you because you are not the one paying their premiums. You are a liability in their financial ledger. The less that is paid to you, the more they still have. Companies will very often contest your claims, as will the insurer.

Workers’ Comp Court – The Burden of Proof is On You

There’s a special workers’ compensation court established to hear these cases, and you have to prove your case in order to receive any compensation. It’s a complex, bureaucratic process fraught with hazards, and if enough doubt is raised as to your case, your damages can be reduced by the court. The Dallas work accident attorneys at Grossman Law Offices have been winning workers’ compensation cases against insurance companies for the past twenty years, and that’s why we feel it’s critical for injured parties to have representation that’s experienced and working in your interest.

Are There Other Options in Dealing With a Subscriber Case?

Although the law is tilted in favor of employers when they have workers’ comp insurance in that an injured victim cannot sue their employer, there are exceptions. The major exception to the rule that a plaintiff may not sue a subscriber employer is that you can sue a subscriber employer if you are the family member of an employee who died in a fatal work accident, provided that the employer’s gross negligence was the cause of that accident. If your case meets these two criteria, you can file a Dallas wrongful death lawsuit in regular court.

Third Parties That May Be Liable For Your On The Job Injury

Another avenue of redressing your grievances may be that your employer was not solely responsible for your injury. You can still file a lawsuit against other parties who are responsible for your injury. Often in the case of work injury accidents, there can be more than one party, person, or entity to blame.

Multiple parties can be sued for the exact same injury. Even though the law states that you cannot sue your subscriber employer, you may be able to sue others who bear liability for the work accident. Let’s say that a piece of equipment has fallen and it breaks your legs. Even if the collapse was caused in part by negligence on the company’s part, the employer can’t be sued. However, it might be that a contractor installing the equipment – be it a filing cabinet, scaffolding, a cubicle, or a store display – contributed to the thing collapsing due to sloppy or incompetent installation. This contractor could likewise be liable for the on the job injury. Maybe the materials used to secure the equipment when it was installed were defective. If this is the case, the manufacturer of those materials may also be sued.

It’s important to investigate all of the elements that lead to an on the job accident because it’s not right that someone else’s negligence, mistakes, or sloppy work could lead to an injury that cannot be compensated. The attorneys at Grossman Law Offices are experienced and skilled in conducting thorough investigations into the cause of every accident. We can help bring claims against every responsible party once they’ve been properly identified.

As a side note, don’t count on OSHA or any regulatory agency to help you. The Occupational Safety and Health Administration isn’t going to help you once you’ve been injured. The federal OSHA agency creates and enforces regulations regarding workplace safety, but they don’t act as an advocate after an injury. Establishing liability for your accident on the employer isn’t OSHA’s mission.

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Talk to a Professional with Experience in On The Job Accident Injuries

Don’t settle for handling your own case, and don’t accept any settlement that the employer or their insurance company makes, especially in the period immediately following an accident. These types of unmediated settlement offers are seldom fair to an injured worker; however, they can be legally binding. Anything you say to an insurer can be used against you. Anything you sign from your employer, their insurer, or their defense attorney can be used against you. Without the presence of your own legal counsel in such situations, you could inadvertently hurt your case through no fault of your own.

Call Dallas work injury attorney Michael Grossman as soon as you can after your work accident. By contacting Grossman Law Offices quickly, we can work to start an investigation into the accident just as quickly so that relevant evidence does not disappear or become manipulated by those that would rather not be held accountable for their negligent behavior. Our team is standing by to take your call. Call us at 1-855-326-0000 (toll-free) for a free consultation today!

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