A workplace injury can quickly lead to questions about medical care, missed paychecks, insurance forms, and whether your employer is handling the claim correctly. Texas has its own workers’ compensation rules, and some of the advice that applies in other states does not apply here.
Grossman Law Offices is based in Dallas and helps injured people throughout Texas understand their legal options. This resource hub provides brief answers to common questions about the Texas workers’ compensation system and directs you to more detailed information when you need it. If you are searching for workers comp lawyers in Texas, our team is also available to review what happened and explain what steps may be appropriate.
Understanding Workers’ Compensation in Texas
What Is Texas Workers’ Compensation?
Texas workers’ compensation is an insurance system that may provide medical and income benefits after a covered employee suffers a work-related injury or illness. A worker generally does not have to prove that the employer was negligent, but the injury must meet the system’s coverage requirements. Benefits are controlled by the Texas Workers’ Compensation Act and administered by the Texas Department of Insurance, Division of Workers’ Compensation.
Read our overview of Texas workers’ compensation benefits.
Must Every Texas Employer Carry Workers’ Compensation Insurance?
No. Most private Texas employers may choose whether to carry workers’ compensation insurance, although government employers and certain contractors face different requirements. An employer with approved coverage is often called a subscriber. A private employer that opts out is called a non-subscriber, and a workplace injury involving that company follows a different legal path.
Learn how to determine whether your employer participates in workers’ compensation.
How Can I Verify My Employer’s Coverage?
Do not rely only on what a supervisor, benefits representative, or private plan document calls the coverage. Workers’ compensation status should be verified for the date of the injury because a company may start, change, or cancel coverage. The employer’s exact legal name and physical address can help identify the correct policy.
See how subscriber status affects a Texas work-injury claim.
How Is a Workers’ Compensation Claim Different from a Non-Subscriber Case?
A covered workers’ compensation claim focuses on eligibility for statutory benefits rather than proving employer negligence. In most cases, workers’ compensation also prevents the employee from suing a subscribing employer for ordinary negligence. When an employer is a non-subscriber, the worker generally must prove negligence but may pursue damages unavailable through workers’ compensation, including pain and suffering.
Compare Texas workers’ compensation and non-subscriber claims.
Can I Sue an Employer That Has Workers’ Compensation Coverage?
Workers’ compensation is usually the exclusive remedy against a subscribing employer for an employee’s work-related injury. Important exceptions may arise in fatal cases involving employer gross negligence or when an intentional act is involved, and separate claims may exist against negligent third parties. Coverage and the identities of all responsible parties should therefore be examined before assuming a lawsuit is barred.
Learn how workers’ compensation can prevent a negligence lawsuit against an employer.
Can I Sue a Third Party That Caused My Workplace Injury?
Possibly. Workers’ compensation may prevent a negligence suit against the subscribing employer, but it does not automatically protect an outside contractor, property owner, equipment manufacturer, commercial driver, or another third party whose conduct caused the accident. A third-party claim is separate from the benefits claim, and the workers’ compensation carrier may assert a reimbursement interest in a later recovery.
Read answers to common questions about third-party workplace claims.
Starting and Protecting a Texas Workers’ Compensation Claim
What Should I Do Immediately After Getting Hurt at Work?
Get appropriate medical attention, notify your employer promptly, and document when, where, and how the injury happened. Keep copies of the incident report, photographs, witness information, work restrictions, medical records, and every communication with the employer or insurer. These early records can become important if the carrier later disputes whether the injury occurred at work.
Follow our practical guide to what you should do after getting hurt at work.
How Do I File a Workers’ Compensation Claim in Texas?
Reporting the accident to a supervisor and filing a claim with the Division of Workers’ Compensation are related but distinct steps. An injured employee generally protects the claim by submitting DWC Form-041, Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease. Do not assume the employer or carrier completed every required filing on your behalf.
Learn how to file a Texas workers’ compensation claim.
How Long Do I Have to Report and File My Claim?
Texas workers generally must notify their employer within 30 days after the injury or after learning that an injury or illness may be work-related. They generally must file DWC Form-041 with the Division of Workers’ Compensation within one year. Exceptions may apply, but relying on one is risky, so both steps should be completed as soon as possible.
Read our complete guide to Texas workers’ compensation deadlines.
What Evidence Matters Most in a Workers’ Compensation Case?
The right evidence depends on what the carrier disputes. Medical records may connect the condition to the job, while incident reports, photographs, video, witness statements, schedules, and time records may establish where and when the injury occurred. Pay records and written work restrictions can support an income-benefits claim. Consistency across these materials is often critical.
See what evidence matters most in a Texas workers’ compensation case.
Should I Accept an Employer’s Offer to Pay Me Outside the System?
Be cautious if an employer offers to pay medical bills or wages privately in exchange for not reporting the injury. An informal payment may stop before treatment is complete, and it does not necessarily protect the filing deadlines for a workers’ compensation claim. Document the proposal and learn about your rights before agreeing to anything or signing a release.
Learn why an under-the-table payment can put a Texas claim at risk.
Medical Care and Income Benefits
What Benefits Can Texas Workers’ Compensation Provide?
Depending on the facts, the system may provide medical benefits and one or more types of income benefits. When a covered injury causes death, eligible beneficiaries may also qualify for death benefits, and the person who paid funeral expenses may seek burial benefits. Eligibility, duration, and payment amounts are governed by statutory formulas rather than the full damages available in a negligence lawsuit.
Review the benefits available through Texas workers’ compensation.
What Medical Treatment Does Workers’ Compensation Cover?
The carrier is responsible for reasonable and necessary health care related to a compensable work injury, subject to Texas utilization-review and network rules. Disputes can arise over whether treatment is related to the injury or medically necessary. Save referrals, denials, treatment requests, and medical records so you can identify who made a decision and when.
Learn how Texas workers’ compensation medical benefits work.
Can I Choose My Own Doctor?
Doctor choice depends on the claim. If the employer uses a certified workers’ compensation health care network and the employee lives in its service area, the worker generally must choose a treating doctor from the network, subject to limited exceptions. In a non-network claim, the worker generally has an initial choice of a doctor who accepts Texas workers’ compensation, while later changes may require approval.
Read more about selecting a doctor for a Texas workers’ compensation claim.
Can I Receive Benefits for Lost Income?
Texas provides several categories of income benefits rather than ordinary lost-wage damages. Eligibility depends on issues such as disability, pre-injury wages, post-injury earnings, maximum medical improvement, and impairment. These benefits replace only part of qualifying lost income and are subject to state maximums that change over time.
See how Texas workers’ compensation income benefits are calculated.
What Are Temporary Income Benefits?
Temporary income benefits may be available when a compensable injury causes disability, meaning the worker cannot earn the pre-injury average weekly wage. Texas has a seven-day waiting period, and payment for that first week generally becomes available only if disability lasts at least 14 days. Benefits can end for several reasons, including reaching maximum medical improvement or returning to pre-injury wages.
Learn more about temporary income benefits in Texas.
What Do Maximum Medical Improvement and an Impairment Rating Mean?
Maximum medical improvement does not always mean a complete recovery. It means the worker has reached a point defined by Texas law at which further material recovery is not reasonably expected, or the statutory date has arrived. A certifying doctor then assigns an impairment rating when appropriate, and disputes over either finding are subject to strict deadlines.
Learn how maximum medical improvement works.
What Are Impairment Income Benefits?
Impairment income benefits may begin after maximum medical improvement when the worker receives an impairment rating above zero. Texas generally pays three weeks of impairment benefits for each percentage point of impairment, using a statutory wage formula and maximum. Because the rating directly affects the duration of benefits, an inaccurate certification can have serious financial consequences.
Read our guide to impairment income benefits.
Are Supplemental or Lifetime Income Benefits Available?
Supplemental income benefits may be available after impairment benefits end if the worker meets requirements that include a qualifying impairment rating and reduced earnings tied to the injury. Lifetime income benefits are reserved for specific catastrophic injuries listed under Texas law. These programs have very different eligibility and filing rules.
Learn about supplemental income benefits and lifetime income benefits.
What Benefits May Be Available After a Fatal Workplace Injury?
Eligible family members may receive death benefits when a compensable work injury causes an employee’s death, while the person who paid qualifying funeral expenses may seek burial benefits. The identities of eligible beneficiaries, the duration of payments, and the applicable limits depend on Texas law. A separate gross-negligence or third-party claim may also require investigation.
Learn about Texas workers’ compensation death benefits.
Denials, Disputes, and Other Problems
Why Might an Insurance Carrier Deny My Claim?
A carrier may dispute whether the condition arose from employment, whether notice or filing was timely, whether the worker was in the course and scope of employment, or whether a statutory exclusion applies. A denial should identify the carrier’s grounds, but the wording may not reveal all the evidence behind its position. Obtain the written denial and preserve the documents needed to challenge it.
Review common defenses in Texas workers’ compensation claims.
Does a Positive Drug Test Automatically End My Claim?
No. Texas law can exclude an injury that occurred while an employee was intoxicated, and certain test results may create a rebuttable presumption of intoxication. However, a positive test does not always resolve what substance was present, whether the legal definition of intoxication was met, or whether contrary evidence exists. These disputes are highly fact-specific.
Learn how intoxication allegations affect Texas workers’ compensation benefits.
What Happens When I Disagree with the Carrier?
Many disputes begin with efforts to resolve the issue directly with the adjuster. If that fails, a party may request a Benefit Review Conference through the Division of Workers’ Compensation. Unresolved issues may proceed to arbitration or a contested case hearing, followed by Appeals Panel review and, in appropriate cases, judicial review. Deadlines apply at each stage.
Read Grossman Law Office’s overview of Texas workers’ compensation claim defenses.
Can My Employer Fire Me for Filing a Workers’ Compensation Claim?
Texas law prohibits an employer from discharging or discriminating against an employee because the employee filed a workers’ compensation claim in good faith, hired a lawyer for the claim, started a proceeding, or testified in one. That protection does not guarantee continued employment for every unrelated reason. Preserve messages, reviews, schedules, and termination records if retaliation is suspected.
Learn about retaliation after a Texas workers’ compensation claim.
Can I Settle a Texas Workers’ Compensation Claim?
Texas does not use full and final workers’ compensation settlements in the same way many other states do. Benefits are generally paid under statutory rules, although parties can enter agreements resolving specific disputed issues and some income benefits may be commuted when legal requirements are met. A workers’ compensation agreement is not the same as settling an ordinary personal-injury lawsuit.
Learn why Texas workers’ compensation benefits are different from a settlement.
Help With a Texas Workers’ Compensation Matter
When Should I Speak with a Workers’ Compensation Lawyer?
Consider seeking advice when coverage is unclear, the carrier denies the claim, medical treatment is delayed, wage benefits appear incorrect, an impairment rating is disputed, or a hearing deadline is approaching. A lawyer can review the records, explain the Texas process, communicate with the carrier, and help prepare evidence for a disputed proceeding.
Contact Grossman Law Offices to discuss your Texas work injury.
How Can Grossman Law Offices Help?
Michael Grossman founded our Dallas firm in 1990, and we have spent decades helping injured Texans and their families understand serious workplace cases. Our team can investigate the employer’s coverage, identify whether workers’ compensation, a non-subscriber case, or a third-party claim may apply, and explain what options remain when benefits are disputed. Every case is different, so the first step is a careful review of the facts.
Meet the attorneys and staff at Grossman Law Offices.
What Should I Bring to a Consultation?
Bring any incident report, DWC form, coverage notice, denial letter, claim number, medical record, work-status report, wage document, benefit check, impairment certification, and communication with the employer or adjuster. A timeline of the injury, treatment, missed work, and insurance decisions is also useful. The more complete the information, the easier it is to identify deadlines and disputed issues.
Request a consultation with Grossman Law Offices.
Get Clear Answers About Your Texas Work Injury
You do not have to sort through Texas workers’ compensation rules, medical decisions, wage calculations, and filing deadlines alone. The correct path depends first on whether your employer had approved workers’ compensation coverage and then on the specific facts the carrier is disputing.
Grossman Law Offices offers free consultations and is available 24/7. Call us or use our online form to explain what happened. Our team can review the available records, help identify the type of claim involved, and explain the next steps in plain language.
Contact Grossman Law Offices for a free case evaluation.
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