If you have been injured at your workplace, it is highly recommended that you seek legal advice immediately. There are so many rules which you must follow to receive and recover benefits under the Texas Workers’ Compensation Act (the Act). All employees are subject to the Act. Some employers purchase workers’ compensation insurance, others are self-insured and some employers are not insured.

It is important to know whether your employer has workers’ compensation coverage or is self-insured. If your employer is not, then you may sue your employer to recover damages such as lost income, medical bills reimbursement, physical pain and mental anguish. The Act provides recovery from your employer if your employer caused your injury. Most work-related injuries are not injuries caused by your employer’s carelessness. When the employer is not insured or not self-insured, you may be unable to recover any benefits and you may have to pay your own medical bills. Some employers have established a program which allows its employees to get medical treatment paid by the employer and to recover lost income. In the event an employer has established such a program, you must ask your employer for a copy of the program’s rules and procedure immediately after you have been injured. You must follow every rule. If you fail to do so, your employer can not be forced to pay or provide benefits under the program. Some programs require an employee to give notice of the injury within as short a period as the end of that employee’s shift or within 24 hours. If you follow all the rules and your employer refuses to pay or provide the benefits promised, you will probably have to file a suit in federal court to enforce your rights.

If your employer does have workers’ compensation insurance or is self-insured, the Act provides a procedure which must be followed if you want to recover lost income benefits or have your medical bills paid. The first thing you need to do is tell your employer that you have been injured. If you fail to tell your employer about your injury within thirty days of the date you were injured, your employer or his insurance company may not have to pay or provide any benefits to you. Second, you must report your injury in writing to the Texas Department of Insurance, Division of Workers’ Compensation (DWC) within one year of the date of your injury. Failing to make such report will also prevent you from recovering benefits. When you are first injured, you have a choice of which doctor treats your injuries. The emergency room doctor does not count as your choice. Your employer has no power to enforce you to see any doctor of its choice. Some employees worry that, if they file a workers’ compensation claim, his or her job is in jeopardy. The Act specifically prohibits any employer from discriminating against or terminating an employee because he or she filed a claim or took the steps to file a claim.

If you have been injured and your injury is serious enough to prevent your prompt return to work, you should file a claim to begin receiving temporary income benefits based on a percentage of your average weekly wages prior to the injury. Filing the claim will also set up a mechanism to begin paying your medical bills. Your employer or its insurance company has a right to dispute or controvert your entitlement to benefits and either party has the power to make you see a doctor of their choice for a second opinion. If a dispute arises between you and your employer or its insurance company, the DWC has the power to resolve the dispute. If one party is not satisfied with the DWC’s decision, that party may file an appeal by filing suit in a state court.  

If your employer believes you are able to return to work, he will ask the DWC to make you see a doctor to determine whether you have reached maximum medical improvement and, if so, for an impairment rating. If the impairment rating is less than 15%, then you will probably want a second opinion. You must dispute the impairment rating within 90 days of the date it was given or that impairment rating is final. If the impairment rating is less than 15%, you will still receive lifetime medical benefits but your income benefits will be limited to no more than 42 weeks.

The Act is highly complex and it would be a great benefit and comfort for you to seek legal advice while you go through the period following an incapacitating injury. You don’t have to go through it alone. Rafuse Law Firm, P.C. may take you through all the necessary steps and help you in your attempt to recover the benefits to which you are entitled.