WORKERS' COMPENSATION - New Law

If you or someone you know or care about has been involved in an industrial accident, this information may assist you in understanding the TWCC policies and procedures and may help you answer any questions you may have. The telephone numbers and addresses for your local TWCC offices to assist you in the handling of your claim are:

TWCC-Houston 880-0206
TWCC-Galveston 744-5773
TWCC-Austin
TWCC Website: http://www.twcc.state.tx.us/

How do I pay my medical bills?

Medical benefits are paid by your company's workers' compensation insurance carrier. The insurance carrier will pay for reasonable and necessary medical treatment of a compensable injury if your employer has worker's compensation insurance. These bills include pharmacy charges and medical supplies ordered by your treating physician.

How am I going to pay my household bills while I am unable to work?

The TWCC Act requires and insurance carrier to pay weekly benefits to an employee who is injured on the job and is unable to work. These Benefits are called TIBS and are paid at 70-75% of an injured worker's average weekly wage up to the state maximum.

How long will it take to get my worker's compensation?

The insurance carrier must either pay on your claim or deny your claim within 300 days following their notice of injury. You should begin receiving weekly benefits following the first week of lost time from work. Weekly benefits for the first week of lost time will be paid after you have missed 28 days of work.

Is there a deadline for reporting my claim?

There are two deadlines for reporting your claim. Notice of your injury must be given to your employer within 3000 days from the date of injury. Notice must also be filed with the TWCC w/in one year from the date of your accident. The TWCC-41 is the proper form to be completed and sent to the local TWCC field office or the TWCC in Austin, preferably both.

How do I find out who the worker's compensation insurance carrier is?

Your local TWCC can provide you with the name, address, and phone number of the worker's compensation carrier for your employer.

How long does my workers' compensation continue?

Weekly TIBS continue until the injured employee reaches a point of maximum medical improvement for until 1004 weeks from the date of the accident. After 104 , MMI is assumed. Once an employee has reached MMI, he may be eligible for IIBS.

Am I entitled to any benefits if my doctor tells me that my injury has caused permanent disability?

IIBS are weekly checks paid to you if you have permanent damage from a compensable injury. These benefits equal 70% of your Average Weekly Wage and are paid 3 weeks for each percent of your total body impairment. They are paid after you have reached MMI. These benefits are paid to you if you are working.

What if the accident is my fault?

Worker's compensation insurance will pay benefits, even if the accident results for your negligence. Some exceptions include intoxication or horseplay on the job that result in injury.

Do I still receive worker's compensation benefits if my accident was caused by someone other than my employer?

Worker's compensation benefits should be paid regardless of whether your employer or another caused your injury. If you were injured as a result of another company's negligence or because of a defective product or piece of equipment, you may have another type of claim. BEB can help you to determine whether you have a third party claim and make every effort to obtain the best possible settlement for you.

What if my employer does not have worker's compensation insurance?

If your employer does not carry worker's compensation insurance, they may be liable for damages that you have sustained in you on the job injury. These damages include past and future lost wages, medical expenses, pain and suffering, and disfigurement and physical impairment. Non-covered employers are not bound to the TWCC Act. BEB can help to evaluate your case and insure that you are adequately compensated for your injuries.

What if the insurance company denies my claim?

The TWCC provides several means of resolving disputes. The DDO and the Ombudsman will assist you to work through the disputes with the insurance carrier. If they cannot be resolved, the TWCC can set a BRC to informally attempt to resolve the dispute. If no agreement is reached, the TWCC can set a CCH which allows sworn testimony. An appeal can be perfected if claims are not resolved following this hearing. Arbitration is also available. In limited cases, some claims may be litigated in Texas Courts after the claim has been brought on appeal.

Do I have to go to the doctor that my company/insurance carrier recommends?

Under the TWCC Act you are entitled to your own choice of physicians. It is important that you let your doctor know that you were injured on the job. You should also contact the worker's compensation insurance company to let them know which doctor you want to see. In some cases, the TWCC may order you to see the insurance company doctor for an evaluation.

Will the insurance pay if my doctor refers me to a specialist?

Your treating physician has the right to refer you to a specialist to treat your injuries. This does not necessarily constitute a change in your treating doctors. You are entitled to change treating doctors one time before having to request approval of the TWCC. The insurance company should pay for treatment recommended by the specialist.

What if the insurance carrier's doctor and my doctor disagree about my condition?

The TWCC DDO can appoint a third doctor to address areas of disagreement between the insurance carrier's physician and the claimant's treating doctor. This "designated doctor's" opinion holds the great weight of medical evidence. The TWCC will order designate a doctor to address whether a claimant has reached MMI and to assess a percentage of permanent impairment.

What can I do if I can never return to my occupation due to my physical limitations?

The State of Texas has an agency to assist workers with disabilities. The Texas Rehabilitation Commission can help you to restrain or assist you in enrolling in an educational program in your area to learn a new trade. The TWCC has information who to contact to apply for vocational rehabilitation.

Can my employer fire me for filing on worker's compensation insurance?

The TWCC Act prohibits any employer from terminating an employee because he files a worker's compensation claim. Additional legal remedies may be available to employees who were terminated for filing a claim. In these cases, an attorney may be necessary to protect your legal rights.

Can my employer fire me if I am unable to return to my regular job?

The Americans with Disabilities Act was recently enacted and requires employers to make "reasonable accommodations to place an employee back to work within his /her physical restrictions. If your employer terminates you due to your disability, you may have a claim for illegal discrimination. You must file a complaint with he Equal Employment Opportunity Commission within 180 days of the discrimination.

If I am terminated, how do I pay the bills relating to this injury? Can I still apply for workers' compensation?

Termination from employment does not prevent you from filing a workers' compensation claim or from receiving medical and weekly compensation benefits. The insurance carrier for the employer for whom you were working at the time of the injury is responsible for payment of these benefits.

What are my rights if a loved one is killed in an on the job accident?

Payment of death benefits are made to a legal beneficiary if the employer has workers' compensation insurance. You must file a claim within one year from the date of death. The TWCC form 42 is used to report fatal claims. Beneficiaries include spouse, minor children and other persons who meet the legal requirements for economic dependency. Benefits equal 75% of the deceased worker's average weekly wage and are paid until death or remarriage of spouse or until children reach age 18. For all other benefits continue for 364 weeks.

Do I need a lawyer? If so, how much will it cost me?

This is a difficult question. The TWCC has been revised as of 1/1/91 to severely limit attorney involvement in worker's compensation claims. In most undisputed cases, an attorney is not necessary. The TWCC has an ombudsman who is employed to assist unrepresented claimants in the handling of their claims. Attorney's fees are submitted for approval to the TWCC and the fees are deducted from the injured employee's weekly benefits in increments not to exceed 25% of any one check.