| The purpose of
this short Texas Workers’ Compensation Injury
brochure is to provide you with basic
information to help you resolve claims which
result from on–the–job injuries.
This brochure applies only to injuries which
occur on or after January 1, 1991, and is
subject to change if the new Texas Workers’
Compensation law is changed.
I’ve been hurt
at work, and I have some questions....
1. Do I get paid while I’m off work?
If you were injured at work while you were
doing something in the course and scope of your
job in Texas, you may be entitled to workers’
compensation benefits, including payments of
money.
2. How long do I have to be off work
before I get paid?
When your injury causes you to be off work at
least seven days, then beginning on the eighth
day, you have a right to receive Temporary
Income Benefits weekly while you are disabled.
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3. How much will I be paid each week?
That depends on how much you were earning
before you were hurt. As a rule, your weekly
Temporary Income Benefits will be 70% of your
weekly earnings before you were hurt. If you
were earning less than $8.50 per hour at the
time you were hurt, the weekly benefit will be
75% of what you were earning before you were
hurt. If you are still able to work but are not
earning as much as before you were hurt, your
benefit will be 70% or 75% of the difference.
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4. Is that 70% of my take–home pay?
No, by law, the benefits are based on all
your earnings, and that includes not only money,
but also things like meals, car expenses, travel
expenses, health and life insurance payments and
uniforms.
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5. How long will I be paid?
You should receive these payments as long as
you are off work because of your injury, until
the doctors treating you decide you have
medically recovered as much as can be expected,
or for 104 weeks from the date you began missing
work, whichever comes first.
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6. What about my medical bills?
The workers’ compensation insurance company
should pay all reasonable and necessary charges
for medical care relating to your injury.
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7. Do I have to see the doctor my boss or
the insurance company wants me to see?
No, the laws allow you the right to choose
your own doctor, and neither your boss nor the
insurance company can require you to see their
doctor unless the Texas Workers’ Compensation
Commission agrees.
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8. My boss says that I can’t get workers’
compensation because it was my fault that I got
hurt. Is he right?
No, it doesn’t make any difference whose
fault it was. In most cases, unless you were
intoxicated when you were hurt, hurt yourself on
purpose or while you were horsing around, or
were hurt by someone who was mad at you for
personal reasons, you are entitled to weekly
payments and medical benefits for your injury.
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9. They say I can’t get workers’
compensation because I’m an illegal alien.
Right?
They are wrong. In Texas, aliens are entitled
to the same benefits as anyone else, and it
doesn’t make any difference whether they are
illegal aliens or legal resident aliens.
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10. It was my employer’s fault I got
hurt. Can’t I sue him?
No, if your employer had a valid workers’
compensation insurance policy when you were
hurt, you can’t sue him. The only way to get
payment is to accept the benefits of the workers’
compensation insurance policy.
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11. I don’t think my employer has
workers’ compensation insurance. Does he still
have to pay me while I’m off work?
If your employer does not have Texas workers’
compensation insurance, the law doesn’t
require him to pay you anything. If you can show
it was your employer’s fault that you were
hurt though, you can file a lawsuit against him
to recover your lost wages, your medical
expenses, and money for the pain and suffering
caused by your injury.
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12. What if I’m not able to go back to
work when my doctor says I’ve recovered as
much as I’m going to recover? Will I still get
weekly checks?
That depends. If your doctor does not say
that you have some impairment due to your
injury, you can’t get any more weekly
payments. If he gives you a percentage of
impairment, you can get three weeks of payments
for each percentage of impairment. For example,
if the doctor says you have a 10% impairment,
you multiply this impairment by three and may be
entitled to receive thirty more weeks of
payments. These payments are called Impairment
Income Benefits.
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13. Can I get any payments after that?
You may, but only if your doctor says your
impairment is 15% or more. If it is less than
15%, you aren’t entitled to any more payments
even if you can’t go back to work or can’t
find work because of your injury. If your
impairment is more than 15%, after you have
received forty–five weeks of payments, if you
still can’t work or can’t find work it may
be possible for you to get additional payments
called Supplemental Income Benefits. To get
those, you have to send in reports to the Texas
Workers’ Compensation Commission. They will
help you with the reports. If you don’t send
in the reports, the insurance company may not
have to pay you, even if you are otherwise
entitled to payments.
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14. What if I can’t ever go back to
work? Will I be paid for the rest of my life?
No, it is only possible to receive payments
for 401 weeks from the date you were injured,
with very few exceptions.
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15. If my doctor gives me an impairment
rating, do I have to take the payments weekly,
or can they pay me all at once?
Yes, you can settle the Impairment Income
Benefits in a lump sum. Even though you can, you
should not take a lump sum settlement because if
you do you will give up your right to ever get
any future income benefits.
The insurance company may tell you that they
will "commute" your benefits. Do not
let the insurance company "commute"
any benefits. "Commute" means the same
thing as a lump sum settlement.
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16. What do I have to do to get my
compensation benefits?
First, unless your employer has actual
knowledge of your injury, you have to notify
your employer that you were hurt. You can do
this by notifying your employer or supervisor,
and it is recommended you do it in writing. You
have to give this notice within thirty days of
the time you were hurt. If you do not notify
your employer within thirty days of the date you
were hurt, you may not be able to receive any
benefits.
Second, you have to file a claim with the
Texas Workers’ Compensation Commission. There
is a special form that must be filled out and
filed, and the Commission will give you the
form. If you do not file your claim within one
year from the day you were hurt you may not be
able to receive any benefits. The address of the
Texas Workers’ Compensation Commission in
Dallas is 6300 Forest Park, Suite 900, Dallas,
Texas 75235. The telephone number is (214) 350–9299.
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17. What if I have some questions after I
file my claim?
The Texas Workers’ Compensation Commission
has a person called an Ombudsman at each of its
offices to answer questions and to help you with
your claim. You can visit or call the Commission
office nearest you and ask to talk with this
person.
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18. What if the insurance company is not
being fair with me?
Insurance companies are required by law to
deal with you fairly and in good faith. If they
do not, you can sue them directly, and that
claim is separate from your compensation claim.
Whether your treatment by the insurance company
is fair is something you should discuss with a
lawyer. If you think you are not being treated
fairly, please call our office and we will talk
about it with you.
YOU
MAY BE ENTITLED TO OTHER BENEFITS!
If you were hurt because another person was
careless or negligent and that person was not a
co–worker, it may be possible for you to
receive additional benefits from that person or
his/her employer. If your injury was caused by
machinery or some sort of product that was
dangerous because of the way it was made or
designed, it may be possible for you to receive
benefits from the company that made the
machinery or the product. We will be glad to
discuss this with you, and to investigate
further to see if additional benefits may be
available to you.
We have made every effort to provide correct
information in this brochure. It is impossible
for a short paper such as this to provide
complete information regarding a complex law
such as workers’ compensation. If you have
additional questions, you should contact your
attorney or the Texas Workers’ Compensation
Commission.
The statements here are general in nature.
The facts in a given case may alter their
application or involve other laws not referred
to here.
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