Workers' Compensation: Are you Covered?

            Workers’ compensation is a state-regulated insurance program that pays medical expenses and lost wages of employees who are injured at work or suffer from work-related illnesses. Workers’ compensation cases are treated on a case-by-case basis, which means that employees are treated differently based on the nature and severity of their injuries.

              In Texas, the agency responsible for regulating the state’s workers’ compensation system is the Texas Department of Insurance (TDI). Within the TDI exists a smaller division, which carries the sole responsibility of processing and monitoring workers’ compensation claims, called the Division of Workers’ Compensation (DWC).

            The DWC will not compensate all employees suffering from work-related injuries. To receive benefits, employees must meet two requirements: (1) fall under their employers’ workers’ compensation coverage and (2) suffer from certain work-related injuries.

 

                                Requirement #1: Workers' Comp Insurance

              First, employees must fall under their employers’ workers’ compensation coverage. In Texas, workers’ compensation insurance is optional, so not all employees automatically receive coverage. Employers have an incentive to provide coverage because insured employers receive important legal protections, including immunity from most lawsuits brought by employees. This means that employees, generally, cannot sue their employers for work-related injuries.  Instead, employees must go through the Texas Department of Insurance and/or bring a third-party lawsuit. The purpose of employer immunity is to establish a trade-off between employers and injured employees. Injured employees give up their right to sue employers, in exchange for the right to receive workers' compensation benefits, regardless of who was at fault for their injuries.

 

                          Requirement #2: Injured in the Course of Employment

             Second, employees must suffer from certain types work-related injuries. The Texas Labor Code requires employees seeking workers’ compensation benefits suffer from injuries “out of and in the course and scope of employment.” This means that employees must sustain their injuries while working in furtherance of their employers. Determining when employees work in furtherance of their employers and when they do not is a complicated issue, which is why injured employees should contact an attorney who specializes in workers’ compensation or personal injury cases.

               Injured employees who do not contact an attorney must, at the bare minimum, report their injury to their employer within thirty days from the date of the injury, or from the date they discovered that their injury related to their employment. Failing to notify employers within thirty days can eliminate an employee’s right to obtain benefits.

 

                                   Takeaway Points for Injured Employees 

  • In Texas, the DWC, within the TDI, handles all workers’ compensation cases
  • Texas employers have the option of providing workers’ compensation insurance, so not all employees receive coverage
  • Employees seeking benefits must fall under their employers’ coverage
  • Employees must sustain their injuries while working in furtherance of their employer’s business
  • Workers’ compensation will not pay for injuries caused by self-infliction, horseplay, voluntary drug or alcohol intoxication, or injuries sustained off-duty or during social events or sporting events
  • Generally, employees have thirty days to report their injuries  
    
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