Workers’ Compensation: How the Claim Process Works

Your Employee Rights and Benefits Under Workers’ Compensation

They also provide lost income compensation (based on a percentage of your normal wages) for any work missed as a result of the injury.

Texas Workers’ Compensation

Every state has its own rules regarding workers’ compensation. Regulations differ between states on which employers are obligated to have coverage as well as which employees are qualified to file for benefits. In Texas, these rules are as follows:

• Employer coverage. All public employers are required to carry some sort of workers’ compensation coverage for their employees if they employ more than five workers. Private employers are allowed to choose if they want coverage. However, if a private employer decides not to purchase WC insurance, he must still report all incidents (injuries, diseases, health risks), no matter the severity, to the Division of Workers’ Compensation (DWC). The DWC will investigate the incident and advise both the employer and employee(s) on their legal options. Since the employer doesn’t have insurance, he may wind up paying the expenses for the injury out of his own pocket.
• Employee benefits. Workers’ compensation insurance is typically required by the state for every employee and can be claimed regardless of whether the work accident was your fault or not. However, state law does provide certain exemptions for farm hands, owners/officers, smaller companies with five or fewer employees, independent contractors, and domestic workers.

Claim Process

After your on-the-job injury or illness occurs, it is the employee’s responsibility to complete a claim form and submit it to either the employer or the state workers’ compensation board. Your employer should provide an incident report immediately after you report the injury, but if he fails to do so, it is your obligation to request the forms.

Once the injury has been reported, the employer is always given an opportunity to respond to the claim. If he does not contest the claim, the insurance company will make payment of medical bills and wages.

If the employer contests the claim, a hearing can be scheduled to determine the validity of the claim as well as how much the claim should award in benefits.

Double-Dipping

In some circumstances an employee may be able to file for workers’ compensation as well as additional personal injury claims. If you’re already receiving workers’ comp, additional lawsuit success is far from guaranteed. However, depending on the circumstances of your accident, additional claims may be warranted. For example:

• If you believe your employer’s negligence was intentional. Did he know the risks but deliberately ignored them? Did he purposefully put you in harm’s way?
• If your employer has been previously warned of the dangers but continued to turn a blind eye. Have similar accidents happened before? Has your employer made any attempts to rectify the situation?
• If you believe your employer consciously ignored warning you and your fellow workers about the potential danger to prevent a personal financial loss. Did your employer gain as a result of ignoring hazards? Did he deliberately put you at risk to make more money, or avoid having to lose money?

Building Your Claim

If you or a loved one has been injured in a work accident, it’s a good idea to speak with an attorney about your compensation options. An experienced lawyer can help guide you through the complicated application and appeals process, giving you the best possible chance of receiving the benefits you deserve.

Call the office of Attorney Steve Lee today at 800-232-3711 to schedule a FREE consultation at a time that is convenient for you.

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