Morrow & Sheppard LLP are privileged to represent injured workers and their families. Oftentimes they are entitled to receive workers’ compensation benefits.
Depending on the situation, injured workers may also be entitled to separate compensation from other responsible parties, so speaking with an accomplished Houston workers’ compensation lawyer is vital to securing fair and full compensation.
What Is Workers’ Compensation?
Workers’ compensation is a state-regulated insurance program that entitles injured workers to income and medical benefits in the event of an on-the-job injury.
In Houston and throughout Texas, companies choose whether or not to purchase workers’ compensation insurance for their employees. The reason companies buy this insurance is that, in certain circumstances, injured workers covered by workers’ compensation insurance are prohibited from suing their employers for additional compensation.
In most cases, employers are required to notify workers about whether or not they provide coverage.
What Injuries Are Covered by Workers’ Compensation?
In general, any injury sustained while at work is covered by workers’ compensation. The injury must be significant enough to warrant medical treatment beyond what may be remedied by a first aid kit. Common injuries at work include slips and falls, accidents involving tools or machinery, burn injuries, electrocution, and exposure to toxic chemicals.
Injuries may happen outside of the workplace, but still be work-related. If you are traveling between job sites and are in a car accident, that would be covered by workers’ compensation. If you take a client out to lunch for work and are injured at the restaurant, that is work-related and is covered by workers’ compensation. If you are injured at a required company event that takes place away from work, your injury would be covered as well.
In addition to injuries you may sustain at work, illnesses that develop over time due to work environments are covered by workers’ compensation. Repetitive stress injuries such as carpal tunnel syndrome, if they develop due to your regular job duties are covered by workers’ comp.
Continual exposure to loud noises at work that result in hearing loss or exposure to toxic chemicals on a regular basis may over time cause illnesses which would then be covered by workers’ compensation.
The medical field now recognizes the role of stress in causing many illnesses. If your line of work is particularly stressful, illnesses that result from the increased stress would be covered.
Additionally, some mental conditions may arise from the workplace environment that would be covered by workers’ comp. If events at work lead to a psychological problem, such as post-traumatic stress disorder, you would be eligible for benefits through workers’ comp. If you have any questions about whether or not your injury is covered, reach out to a Houston workers’ compensation lawyer.
Workers’ Compensation Does Not Bar All Claims Against Employers
Although corporations and insurance companies would have you believe otherwise, in many situations, injured workers and affected family members are entitled to bring lawsuits even though there is workers’ compensation insurance coverage.
For example, when an injured worker dies, surviving family members are entitled to bring claims against the employer for punitive damages arising from gross negligence or intentional acts.
Workers’ Compensation Does Not Bar Claims Against Other Responsible Parties
Even in situations covered by workers’ compensation insurance, injured workers and affected family members are often entitled to bring claims against other persons and companies (besides the employer) whose conduct may have caused or contributed to the injuries. They may also be entitled to bring claims against the manufacturer of defective products involved in the accident.
Workers’ Compensation Does Not Bar Claims Against Employers That Do Not Purchase Insurance
More and more, employers are making the conscious decision not to purchase workers’ compensation insurance, commonly referred to as going “bare.” In fact, 44 percent of Texas employers are “non-subscribers.”
Employers that choose not to purchase workers’ compensation insurance are betting that their employees will be too fearful to file a claim, or that they can pressure injured workers to accept nominal settlements in the event of an injury. Do not settle before you speak with an experienced lawyer experienced in workers’ compensation claims.
List of Texas Companies That Are Non-Subscribers to Workers’ Compensation
Texas companies that either were or currently are non-subscribers to workers’ compensation insurance include:
- Best Buy
- Girling Healthcare
- HEB Grocery Company
- Hobby Lobby
- Home Depot
- J.B. Hunt
- JC Penney
- Kentucky Fried Chicken (KFC)
- Neiman Marcus
- Pizza Hut
- Sysco Corporation
- Wells Fargo
- Whole Foods
These are just a few examples. There are much more. If you or a loved one has been injured on the job, consult a knowledgeable Houston workers’ compensation lawyer to discuss your employer’s status and whether or not you may be entitled to bring a claim.
Texas Workers’ Compensation Benefits
Texas law prescribes several benefits that you can expect to receive if you have been injured on the job.
Any medical expenses related to your injury will be paid for as part of your workers’ comp benefits. Any medical treatment must be authorized beforehand, but you have the right to receive the appropriate medical treatment for your injury and have those expenses covered by your employer or their workers’ comp insurance.
Temporary Income Benefits
If you miss seven days of work or fewer, you may not receive temporary income benefits. After eight missed days of work, you will begin to receive your temporary income benefits, and if you miss more than 14 days, the first seven days of missed work will be paid to you retroactively.
Temporary income benefits are calculated at 70% of your average weekly wages. If you earn less than $10 per hour, you will receive 75% of your average weekly wage. The maximum you can receive in benefits is $913 per week as of October 1st, 2017.
You may collect temporary income benefits until you reach your maximum medical improvement, you return to work, or for a maximum of 104 weeks.
Impairment and Lifetime Income Benefits
If your doctor evaluates you and determines that you have reached the maximum medical improvement and are permanently disabled, you may be eligible for impairment income or lifetime income benefits.
Any mileage traveled for medical treatment more than 30 miles one way is covered by workers’ comp benefits.
If you are unable to return to your previous job due to your injury, you may receive vocational training and assistance in finding a new job.
If a person is killed in an accident at work, the family may receive benefits for funeral and burial expenses.
How to File a Workers’ Compensation Claim in Texas
Because of Texas’ unusual laws regarding the employer’s requirement to buy workers’ compensation insurance, there are two different ways to begin filing your claim. Depending on whether or not your employer has chosen to purchase workers’ compensation insurance, you may need to work through their insurance company or seek compensation directly from your employer.
In either case, your first step in filing a claim is to notify your employer of the accident that caused your injury. This begins the process of getting the appropriate treatment for your injury.
If your employer carries workers’ compensation insurance, they may have a network of healthcare providers. If that is the case, you must seek treatment from a doctor that is in that network.
If they do not have a healthcare network, you may seek treatment from any doctor you choose. It is important that whichever doctor you see, you immediately inform them that your treatment is for an injury suffered at work.
To file your workers’ comp claim, you will need to file a form, the Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease, with the Texas Division of Workers’ Compensation (DWC). If your employer does not provide you with that form, you may find it online at the DWC website. The form provides information on how to answer the questions. However, if you still are unsure of how to fill out the form, the Office of Injured Employee Counsel can assist you with any questions you may have.
The DWC will review your claim and inform your employer and their insurance company, if there is one, of your claim. At that point, the employer’s insurance company or your employer may decide to accept or reject your claim.
Time Limit to File a Workers’ Compensation Claim in Texas
There are two deadlines that must be met in order for your claim to be considered. Failure to meet the required deadlines can mean denial of your claim and no compensation made for your expenses, even if your claim otherwise merits approval.
The first time limit is the time you have to notify your employer of your injury. From the time of your injury or the time you discover an injury, you have 30 days to notify your employer. Failure to notify your employer in the time allowed will almost certainly forfeit your right to collect benefits.
While you have 30 days to notify your employer legally, it is best to notify them as soon as possible after your accident. Unless there is a very good reason to delay notifying your employer, the insurance company or your employer will be more skeptical of claims made after a significant delay and may be more likely to dispute your claim the longer you delay in notifying them of your injury.
The other significant time limit regards filing your workers’ comp claim. Filing the form that must be returned to the DWC actually starts your worker’s comp claim. You have one year from the date of the injury to file that form or one year from the date that you knew that your injury or illness was work-related. A failure to file the form within one year will almost certainly result in a denial of any benefits.
As in the case of notifying your employer, in most cases, it is best to file the claim as soon as possible after your injury. You cannot begin receiving any benefits until the claim is filed, and filing the claim sooner helps ensure that you receive the compensation you are entitled to.