Workers Comp Fundamentals

What happens to my workers compensation if I test positive for drugs or alcohol?

Often times, someone gets injured on the job and they’re forced to do a urinalysis or a blood test and it tests positive for some type of an illegal substance. When that happens, their claim is denied. So the question arises, what do I do now? Well, it’s important that you talk to a lawyer if you’ve tested positive for any kind of illegal substance, because just because you’ve tested positive, doesn’t mean that your claim is barred. But what that does is is it shifts the burden of proof on a worker’s comp case so, that the injured worker has to not only prove their claim, but the injured worker also has to prove that they had the normal use of their physical abilities and their mental abilities at the time the injury occurred. There can be some very important things with respect to your case, so it’s very important that you talk to a lawyer if your claim is denied for testing positive for any kind of illegal substance.

What is the difference between a workers’ compensation claim and a non-compensation claim?

Texas is one of the few states where you don’t have to carry workers’ compensation insurance. There are employers in Texas that don’t have workers’ compensation insurance. it gets confusing because the employer may carry insurance and they may tell their employees that it’s workers’ compensation insurance but it’s what we call an occupational benefit fund. It’s a form of the insurance but it doesn’t have the same protections that workers’ comp has and it’s not regulated by the state of Texas. In those situations, an employer can very well retaliate against an employee. The employer can do anything basically what they want to you. They just can’t fire you for certain federal and protected things such as race discrimination, sex discrimination, those kinds of things but they can go and retaliate against someone if it is a non-Texas workers’ compensation fund. If it’s one of these occupational benefit plan type of situations. That’s why it’s important to talk to a lawyer so the lawyer can look at things and see just what kind of a case is this.

Can I sue my company for causing my injury?

Unfortunately in Texas, if your employer carries workers compensation insurance, your only rights of recovery are through workers comp. That means that you can’t sue your employer for causing your workers’ compensation injury. There are certain times when maybe you can’t sue your employer for causing your workers’ compensation injury, but if someone else somehow did something wrong that caused your injury, you may have a claim against that third party. That’s why it’s important to talk to a lawyer and in particular, it’s good to talk to a workers compensation lawyer who knows both general personal injury law, as well as more specialized workers compensation law. Those cases are going to require someone that knows both of those things and knows how to navigate the law, both for general personal injury, as well as for the workers’ compensation so that you can get the maximum recovery possible. In our offices, I’ve handled both the general personal injury type claims as well as of course, the workers’ compensation claims.

Can the company I work for fire me for filing a workers’ compensation claim?

If you feel threatened by your company because you want to follow workers’ compensation claim, don’t feel threatened. In Texas, it is illegal for a company to retaliate both against an individual who gets hurt on the job, as well as to retaliate against any other person who assists someone who’s been hurt on the job. For instance, if you get hurt on the job and you want to report your claim, absolutely do that. Also, if you need your witness statements, if you need to talk to other people to have them support any aspect of your claim, they don’t need to worry about being fired as well because it is illegal in Texas for a company to retaliate against someone for anything related to a workers compensation claim. It’s very important whenever you get injured on the job, the first thing to do is report the claim. The second thing you need to do is contact a lawyer immediately to get advice on things.

Can I just get a settlement and be done with it?

I get asked all the time, “Can I just take a settlement and just be done with this workers’ comp insurance company?” In Texas, you can’t do that. In Texas, when your employer carries workers compensation insurance, that protects them such that your only rights are through the workers’ compensation system. The Texas Workers Compensation system does not allow for settlements. At the end of your case, you’re going to get an impairment rating. That impairment rating is going to pay you three weeks pay for every 1% of impairment. Now at the end, what you can do is you can say, “I want to accelerate all of my benefits. I want to get my benefits paid in a lump sum.” But I never ever, ever advise clients to do that. Because is you do that, another one of the things that you have to do, is you have to waive all entitlement to future benefits. Why would you waive a lifetime of medical care and also potential future income benefits all for a quick lump sum payment of just a few days or weeks worth of benefits?

I have been injured on the job, what do I do?

When you’re injured on the job, the most important thing for you to do is to report the claim. Now, most companies have a lot of peer pressure on their workers. Like they’ll have some type of a policy that says if there’s no lost time, people get bonuses and that sort of thing. And so there’s a lot of peer pressure on you to not report that claim. But you need to report the claim. Certain time deadlines start whenever you report the claim. But also, certain time deadlines can affect you so that your claim can be barred if you don’t report that claim timely. And so it’s very important, whenever you get injured on the job, the first thing you do is report the claim. The second thing you need to do is contact a lawyer immediately to get advice on things.

How long do I have to make a claim?

When you get injured on the job, you’ve only got 30 days to let your employer know that you got injured on the job. So it’s very, very important when you get injured you let somebody know immediately. Most kinds of personal injury cases in Texas, you’ve got two years in order to do something about your personal injury. On workers’ comp, you only get 30 days. After you let your employer know within the 30 days, you’re limited to only one year to let the insurance company know.

Thousands of people are killed every year on the job, and multitudes of others suffer serious injuries. On-the-job injuries account for huge losses of time and productivity, but if you’re hurt at work, these concerns are secondary to your own. These injuries can prevent you from working, result in lost wages and even land you in bankruptcy thanks to high medical bills. Fortunately, there are workers compensation protections, and this is how you can become eligible.

Continue Reading What to Do If You Are Injured on the Job

Few things are worse than when you’re injured on the job and unable to continue to support your family because you’re unable to return to work. There could be many reasons for not being able to return to work, such as your employer is unwilling to accommodate your work-duty restrictions imposed by your doctor or your employer has simply terminated your employment. 

 

Under the Texas Workers Compensation Act, workers compensation insurance companies are required to provide financial and medical support to employees injured on the job. Employees will have their reasonable and necessary medical bills covered and receive income benefits to offset their wages.

 

In cases of severe work-related injuries, an employee may be paid for ongoing disability after the most common types of benefits have been exhausted. This is called Supplemental Income Benefits (SIBs). SIBs are paid on a monthly basis. SIBs are based on a complicated formula that an attorney can assist an injured employee to calculate. 

 

 

An injured employee must apply and qualify for SIBs on a quarterly basis, about every 3 months. For the first quarter only, the Division of Workers’ Compensation (DWC) makes the SIBs eligibility determination. On all subsequent quarters, the employer’s workers compensation insurance carrier makes the determination. If the injured employee is denied by the insurance carrier or DWC, the injured employee has the right to pursue his or her entitlement to SIBs for that quarter through the dispute resolution system of the Texas DWC.


The important period for qualifying for SIBs is called the “Qualifying Quarter.” Whether an injured employee is eligible depends on the circumstances during the 13 weeks before the beginning date of the SIBs determination. If an injured employee qualifies during the qualifying quarter, then he or she becomes eligible to receive payment during the supplemental income benefits quarter.

 


In determining eligibility under SIBs, an injured employee must show that as a direct result of a work-related injured he or she:

1.      Received an impairment rating of 15% or more; and

2.      Is unable to return to work because of the impairment, or has returned to work but is earning less than 80% of his or her pre-injury average weekly wage because of the impairment; and

3.      Did not take a lump sum payment of impairment income benefits; and

4.      Met specific work-search requirements based on Texas Workforce Commission standards or is actively participating in a vocational rehabilitation program.

From the date of the injury, SIBs continue to be paid in each quarter that an employee applies and is approved until the employee demonstrates long-term employment by going 4 consecutive quarters without being entitled to SIBS or until a total of 401 weeks (approximately 7 1/2 years) of income benefits have been exhausted on the claim.

 

Often, an injured employee’s SIBs application will be denied because they missed a deadline or failed to meet some SIBs requirement. Many injured employees think that a denial means they will no longer receive benefits. But this denial only applies to that particular quarter of SIBs to which the employee applied. The injured employee can still meet the requirements for the subsequent quarters of SIBs. It’s important to note that an injured employee will permanently lose entitlement to SIBs if the injured employee does not apply or applies and is rejected for four consecutive quarters. 


For all workers compensation needs, especially ensuring proper compliance with the SIBs qualifying requirements, it is better to have an attorney that is board certified in Texas Workers Compensation Law for representation. With proper legal representation, you can improve your chances of a favorable outcome.

 

 

Each day, Texas residents drive to and from work, expecting to arrive safely. On many occasions, employers may provide either (1) company-owned transportation or (2) financial reimbursement for travel expenses using a private vehicle. Both situations would be in furtherance of the responsibilities of the job and are directly connected with the performance of the employment. 

But what happens when the commute goes wrong and there’s an accident? If you become injured, who will pay for your injuries and damages? Does your employer carry workers compensation insurance? If they do carry it, are you entitled to receive benefits from your employer’s workers compensation insurance carrier?

The answers to these questions are complex and fact intensive. Not all cases are the same and not all injuries are the same. An attorney who specializes in workers compensation law will be able to assist you at every step of your workers compensation case. 

The law in Texas under the Workers Compensation Act provides for employee compensation when injuries arise out of and in the course and scope of employment for which compensation is payable. For an injury to arise in the course and scope of employment it must: (1) relate to or originate in, and (2) occur in the furtherance of, the employer’s business. Travel to and from work generally does not meet this test, unless the employee’s travel was pursuant to express or implied conditions of his employment. The claimant has the burden to prove that he was injured in the course and scope of his employment. (TWCC APD No. 931006) Whether an injury occurred in the course and scope of employment is a fact question that must be determined by the hearing officer. (TWCC APD No. 971607)

A recent Texas case helped clarify these legal issues. In SeaBright Inc. Co. v. Lopez, an employee was assigned to work at a remote job site. The employer provided a company vehicle but did not pay for the employee’s travel time to and from the job site. One morning, the employee was killed while driving to work with two other employees. The decedent’s wife sought benefits from the employer’s workers compensation carrier, but the insurance carrier denied the claim for benefits because the insurance carrier believed the employee was not on the job (a.k.a., the course and scope of employment) at the time of the accident.

The court concluded that the employer’s business called for employing specialized, non-local work crews in constantly changing, remote locations on temporary assignments. It required employees to obtain temporary housing and travel from that temporary housing to that temporary, remote location. Based on these facts, the court held that the plaintiff had conclusively established that her husband was acting in the course and scope of his employment at the time of the accident and was entitled to benefits.

As mentioned above, not all cases are the same. But with the help from an attorney that is board certified in Texas workers compensation law, you will receive skilled and knowledgable representation.