What is Worker’s Compensation?
In the state of Texas, worker’s comp is defined as a state regulated insurance program that provides benefits to injured workers if they are injured on the job. Worker’s comp can also cover injuries that occur out of the workplace, but only if the worker is on the clock. Worker’s compensation also covers any situation in which an employee may develop a work-related illness.
This insurance provides compensation for hospital bills that may have incurred by the injured worker, and can also provide the injured worker with some type of temporary compensation for lost wages. Private employers have the option to provide workers with worker’s compensation insurance coverage in Texas, and they must let workers know whether or not they have coverage. It is not required for employers to have Worker’s Compensation Insurance coverage. As long as the employee didn’t cause the injury through reckless or deliberate manner, worker’s compensation benefits will be granted. These examples include reasons why worker’s compensation will not cover the injury:
- If the injury arises from the employee’s own horseplay. An employee who is acting reckless, is endangering themselves. All resulting injuries are at the workers fault because of the worker’s own recklessness.
- The injuries are a result from the worker’s intoxicated state. Chances of an injury are high if an employee are under the influence of drugs or alcohol. If the employee was not under the influence of drugs or intoxicated, the injuries that occurred probably wouldn’t have happened. The work-related injury becomes the worker’s own fault due to negligence.
- Injuries have been the result of an employee committing willful criminal actions. When a worker has committed willful criminal actions, their injuries are no longer work-related and they may not receive worker’s compensation benefits.
- The worker decided to participate voluntarily in off-duty recreational activities. Even if the activities are in the workplace, if the injuries are a result from a recreational activity, the injuries are not eligible for worker’s compensation, because these activities were not related to work.
- Injuries have been the result of a third party committing criminal actions. In the event that a worker has been injured due to the commission of a crime by a third party, the injuries may not be qualified for worker’s compensation benefits.
What types of Workers Are Eligible For Worker’s Compensation?
Texas worker’s comp offers many different kinds of benefits to aid injured workers and their family. The benefits include:
- Medical Benefits – The injured worker is given medical benefits to help pay hospital bills and treatment for the work-related injury.
- Income Benefits – Throughout Texas, an injured worker is qualified for four different kinds of “income” benefits.
- Temporary Income Benefits – These are paid when an employee’s work-related injury has caused the worker to have to miss seven or more days of work. In other words, temporary income benefits are wage replacement benefits.So they are used to help replace an injured employee’s wage. Temporary income benefits are also known as wage replacement benefits.
- Impairment Income Benefits – An injured employee in Texas could obtain impairment income benefits in the event that he has suffered a permanent impairment as a result to their work-related injury.
- Supplemental Income Benefits – An injured employee may receive supplemental income benefits depending on their impairment rating and by other satisfying qualifying criteria.
- Lifetime Income Benefits – Some specific injuries happen to be so serious that the injured employee could be entitled to lifetime income benefits.
- Death Benefits – In the case that a worker has died due to a work-related injury or illness, the remaining family members could be eligible for death benefits.
- Burial Benefits – The person that pays for the worker’s burial can obtain burial expenses.
Can I Choose My Own Doctor?
As long as the doctor is chosen through the Texas Division of Worker’s Compensation as a licensed worker’s comp medical professional, the injured worker can choose their own doctor. There is a list of designated doctors typically provided by the injured employee’s boss. However, if the boss is unable to provide this list, an injured worker can search for a worker’s compensation designated medical professional to give them medical treatment for their work-related injury or illness.
If I Need Help With My Worker’s Compensation Claim, Where Can I Turn?
An injured worker has three main choices when they need help with the Texas worker’s compensation system. Injured employees can contact an experienced worker’s compensation attorney, they may consult the Texas Department of Insurance Division of Worker’s Compensation staff member, or they can seek assistance from the Office of Injured Employee Counsel if the injured employee doesn’t already have a worker’s compensation lawyer. The injured worker is able to get help from either option with:
- A comprehensible understanding of the workers’ compensation system
- Assistance on the usage and navigation through the Texas worker’s compensation system
- Answers to quires regarding what a claim is, how to file said claim, what a claim dispute is, or how to handle a claim dispute; and
- Guidance on what to do after an injured worker’s claim is denied.
Is Worker’s Compensation Claim Information Kept Confidential?
An injured employee’s claim info is kept 100% confidential, with only those who are directly involved with the case being able to access this information. In regards to the injured worker’s worker’s compensation claim, the injured worker is given the option to designate someone to be authorized to consult with the Texas Division of Worker’s Compensation. However, potential employers are able to see in a background check whether a prospective hire has had an worker’s compensation claims in the past. Employers are able to see if a prospective hire has reported two or more work-related injuries in the past five years.
Is Worker’s Compensation My Only Means of Recovery?
In some cases, injured workers may seek compensation from other sources if they have been injured or ill as a result of their jobs. For example, if a third party is responsible for causing a work-related injury or ailment, an injured employee might have to claim a personal injury claim against the liable third party. A third person liability lawsuit is where an injured employee can recover lost wages for an injury or ailment, if the damages are beyond compensation, in situations like mental anguish, pain and suffering, etc.
Is My Boss Allowed to Treat Me Differently, Discriminate Against Me, or Fire Me?
There are certain legal provisions put in place to protect individuals who have filed worker’s compensation, to be discriminated against, however, as a general rule, an employer should not treat their employee any differently after they have filed worker’s compensation. A boss may not terminated an injured worker in reaction to the worker filing worker’s compensation, if they do fire the individual, it may be grounds for a wrongful termination lawsuit. In Texas, employers may terminate their employees for any reason, so long as the reason isn’t protected by the law, because Texas is an at will employment state. Thus, the employer may fire the injured employee, if he cannot perform his job activities anymore due to the injury, or if business is slow. Before terminating an injured employee, Texas employers must be able to give a legitimate reason.