Workers Compensation Insurance Laws

Medical benefits that pay the necessary medical care needed to treat an employee’s injury or illness caused by work.

Burial benefits for an employee’s funeral expenses if the employee dies from an illness or injury on the job.

Death benefits for families to replace some of the money lost when an employee dies because of a work-related injury or illness. Death benefits are 75% of the deceased employee’s average weekly wage.

Income benefits replace some of the money employees lose because of a work-related injury or illness, including:

- Temporary income benefits - Impairment income benefits - Supplemental income benefits - Lifetime income benefits

In Texas, you may get temporary income benefits if your work-related injury or illness causes you to lose some or all of your wages for more than seven days. Temporary income benefits are 70% of the difference between your average weekly wages. The money you are able to earn after your work-related injury.

In Texas, you can get impairment income benefits if you have a work-related injury or illness that affects your body as a whole. The amount of impairment income benefits you receive are based on an impairment rating given to you by your health care provider. This rating is based on the percent of permanent damage done to your body. You receive three weeks of impairment income benefits for each percentage of impairment.

Supplemental income benefits are paid monthly by the insurance company after your impairment income benefits have ended. Supplemental income benefits are 80% of what you get when you subtract the difference between 80% of your average weekly wages and any wages you earned after your work-related injury.

Depending on the severity of your injury, you could be eligible for lifetime income benefits. Lifetime income benefits are 75% of your average weekly wage with a 3% increase each year. You receive these benefits for the rest of your life.

Injuries Not Covered by Texas Workers Comp

In Texas, an injury or illness is covered, no matter who was at fault, if it was sustained in the course of one’s employment. This includes injuries that occur during work-related travel.

Still, the following injuries are not covered by Texas workers compensation insurance:

- Injuries that result from horseplay - Willful criminal acts or self-injury - Injuries that result from intoxication from drugs or alcohol

Filing a Workers Comp Claim

Injured employees must file injury reports within 30 days of the injury. And they must file the formal paperwork for the workers compensation claim within one year of the injury.

If an employee does not let an employer know about an injury or illness within 30 days, they may not get workers compensation benefits. That’s why it is vital to report a workers compensation. An injury claim as soon as possible.

Doctors for Workplace Injuries

Some employers choose to provide workers compensation coverage through a certified health care network. If your employer is in a certified health care network, you must choose a doctor from the network provider list for care (unless it’s an emergency or the employee has prior approval to go out of network). Be sure to ask your employer for this list.

The Texas department of insurance has a list of certified workers comp health care networks.

If your employer isn’t in a network, you can ask your current doctor if they treat workers compensation patients. If not, ask them to recommend a doctor that does. Family and friends are other good sources to tap. They may know doctors that take patients with workers compensation injuries or illnesses.