Texas Workers Compensation

History of Workers Compensation in Texas

Workers Compensation law was Texas enacted for the first time in 1913 with the idea that workers should be compensated for work related injuries. The idea that governments should ensure compensation to workers hurt on the job spread from Europe to the United States around the turn of the 20th Century. Today, all 50 states have Workmans Comp.

The U.S. Supreme Court ruled in 1917 that the States could mandate that workmans compensation be offered by employers. While many States at that time did move to require workmans comp coverage by employers, Texas kept its voluntary employer participation in the workers compensation system. As a result, Texas is the only state that allows employers, with the exception of public employees, or employers with a government building contract, to choose whether to offer workers compensation.

Texas law provided the basic framework for the state’s workmans comp system until 1991, when a new Texas Workers’ Compensation law went into effect. This new law set up specific work comp reporting and billing requirements for doctors treating injured workers and started new benefit and dispute systems. The next significant change to the delivery of health care to injured Texas workers came in 2001.

What is Workers’ Compensation?

Workers’ compensation is a state-regulated insurance program that provides medical and income benefits to workers for work-related injury or illness, regardless of who is at fault. It includes occupational illnesses (for example, a chronic lung condition caused by breathing in hazardous chemicals at work); trauma injuries caused by repetitive tasks or awkward positions while working (for example, a back injury caused by lifting of heavy objects). If you are killed on the job, workers’ compensation pays death and burial benefits. Workers’ compensation only covers injuries sustained while working. Workplace injuries that are self-inflicted, injuries resulting from worker intoxication, or injuries caused by worker horseplay or unsafe practices are not covered. Workers are also expected to use safety equipment provided by the employer.

The Texas Workers’ Compensation Act states that recovery of Workers’ Compensation benefits is a covered employee’s exclusive remedy against the employer for a work-related injury sustained by the employee or the death of the employee.

The Texas Workers’ Compensation law lists four types of benefits: income, medical, death, and burial. Income benefits replace a portion of any wages a worker loses because of a work-related injury or illness and provide compensation for a permanent impairment to a worker’s body. The four types of income benefits are:

• Temporary income benefits
• Impairment income benefits
• Supplemental income benefits
• Lifetime income

Medical benefits pay for any medical care that is reasonable and necessary to treat a work-related injury or illness. The employer’s Workers’ Compensation insurance company pays medical benefits directly to the physician or health care provider who treated the injured worker. The common phrase “lifetime medical benefits” means that an injured worker cannot “settle” for a certain amount of money or number of years of medical benefits not that an insurance carrier is obligated to pay for services that are unreasonable or unnecessary. Medical benefits pay only for the treatment of work-related injuries and illnesses. The worker may choose a doctor, but the doctor must be on a list of doctors approved by the Commission. Except in an emergency, the injured worker’s treating doctor must approve all medical care for an injury or illness.

Death benefits replace a portion of lost family income for eligible family members of workers killed on the job. Burial benefits pay some of the deceased worker’s funeral expenses.

Filing a claim for Workers Compensation in Texas

If you’ve been injured at work AND your employer is covered by workers’ compensation insurance you must report your injury to your employer within 30 days from the date of the injury or the date you discovered your injury or illness was job-related. Otherwise you might lose your right to benefits.

Send a completed claim form, which is called the DWC Form 041, to the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) within one year of the date of injury or date you learned of an illness related to your occupation.

State of Texas Workers Compensation – Employee Responsibilities

• Tell employer about injury or occupational disease
• Complete & send Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease form to Division of Workers’ Compensation
• Tell Division of Workers’ Compensation and the City’s Third Party Administrator whenever income or employment changes
• Tell Division of Workers’ Compensation and the City’s Third Party Administrator whenever address changes