When you are injured on the job in the state of Texas, and the company has Texas Workers’ compensation, you are entitled to certain injury related rights and benefits. In exchange, you have certain responsibilities to uphold.
The official government entity that oversees workers’ compensation issues for the state of Texas is the Office of Injured Employee Counsel, or OIEC for short.
The OIEC maintains local offices all across the state of Texas. Each local office provides comprehensive assistance with workers compensation, including services that fall under the umbrella of the Texas Department of Insurance, or TDI for short.
TDI regulates and administers services that fall under the Division of Workers Compensation (DWC) for the state of Texas.
Communicating with the OIEC and DWC
Both the OIEC and the DWC are reachable by phone or via the internet.
OIEC Contact Information.
DWC Contact Information.
Texas Workers Compensation Rights
These are your rights under Texas Workers Compensation law.
1. You have the right to independent legal counsel to assist with your workers compensation claims.
The State Bar of Texas (T-BAR) has an attorney referral system.
Contact T-BAR by phone at 1-877-983-9227 or visit their website at www.texasbar.com/.
The OIEC also maintains a lawyer referral information page at www.oiec.texas.gov.
2. If you do not have independent legal counsel and wish to receive legal guidance, the OIEC is legally obligated to provide this for you.
To get your questions answered, receive assistance in submitting your claim under Texas workers’ compensation law, file a workers’ compensation dispute, understand your benefits under Texas workers’ compensation law and for other issues, you can either visit a local OIEC office or contact the OIEC by phone or online.
Many workers find it easiest to visit a local OIEC office, since Texas law requires you to sign and submit a written form of authorization before OIEC representatives are permitted to access information related to your workers compensation claim.
If you need to schedule a benefit review conference (BRC) or contested case hearing (CCH) or another type of appeal, the OIEC can also assist you with these matters.
3. Under Texas workers’ compensation law, you have the right to income replacement and medical aid benefits. This right remains intact no matter who is deemed at fault for your injury while on the job.
Your beneficiaries may also be entitled to receive benefits, including death benefits.
However, there are certain exceptions to this right.
4. Texas workers’ compensation law stipulates that you have the legal right to medical care and treatment for any injury or illness sustained while on the job.
To receive these benefits, the illness or injury must be deemed medically necessary and related to your function on the job.
If you must travel for medical treatment, you are also entitled to reimbursement of your expenses to do so, as long as the trip adheres to specific requirements.
5. Texas workers’ compensation law states you have the right to lost income compensation benefits after sustaining a workplace injury.
The specific types of income replacement benefits vary, as does eligibility for each.
6. Texas workers’ compensation law states you have the legal right to medical dispute resolution services to resolve income and medical benefits disputes.
If you are not satisfied with how the insurance carrier has handled your medical or income benefits, you may request dispute resolution through the OIEC. However, be aware your dispute proceedings must take place within a 75-mile radius from your place of residence.
7. Texas workers’ compensation law stipulates you have the right to choose your physician.
However, if you are in the Workers’ Compensation Health Care Network (network), the physician you select must also be in this network.
If you are dissatisfied with your initial choice of physician, you have one opportunity to change to a new doctor without first obtaining approval from the network.
If you are not in the network, you may choose any physician willing to treat you as long as the following conditions are met:
– Making a change to your non-network physician will always require pre-approval by the DWC.
– If your workplace injury relates to employment by a political entity (such as a city, county or school district), their rules regarding choice of treating physician must be followed.
– Failure to follow governing rules for choosing a treating physician as well as all other Texas workers compensation rules and regulations may result in denial of benefits.
8. You have the legal right to full confidentiality in the details of your workers compensation claim.
However, there are exceptions in the case of your employer and your employer’s insurance provider, who may need to know details to process your workers’ compensation claim.
If you apply for a new job while your workers’ compensation claim is outstanding, the new prospective employer may also be entitled to access to limited information regarding your claim.
OIEC staff may have access to your confidential workers’ compensation claim information if you specifically give authorization by signing and submitting a written authorization form.
Texas Workers’ Compensation Responsibilities
These are your responsibilities under Texas Workers Compensation law.
1. You are responsible for alerting your employer within 30 days of sustaining a work-related injury or illness. This 30-day period begins the first day you sustained the injury or realized your illness or injury was work related.
2. You are responsible for finding out if you belong to a Workers’ Compensation Health Care Network (network).
This may include asking your employer if you belong to a network.
If you belong to a network, you must follow all network rules regarding workers compensation physician selection, changes and treatment as well as all other rules and regulations.
You must ask for clarification from your employer or the OIEC.
You can file a complaint about your network with the Texas Department of Insurance (TD).
TDI phone: 1-800-252-3439
Online TDI complaint form: www.tdi.texas.gov/consumer/complfrm.html#wc.
3. If you work for a political entity (city, county, school district, et al) it is your responsibility to ask your employer how to obtain medical treatment.
4. You are responsible for informing your treatment physician about the cause and nature of your injury or illness.
5. You are responsible for submitting either an Employee’s Claim for Compensation for a Work-Related Injury or an Occupational Claim Form (DWC041) to DWC within one year of the date of onset or suspicion of work-related injury or illness. You can obtain a copy of the required form by contacting the OIEC or DWC.
This responsibility persists whether you are receiving benefits or not. Failure to comply may result in loss of benefits.
6. You are responsible for providing current contact and employer information to the DWC and the insurance provider. Contact the DWC at 1-800-252-7031.
7. You are responsible for informing DWC and the insurance provider when there has been a change in your employment status or income.
8. Beneficiaries must submit a Beneficiary Claim for Death Benefits (DWC-042) within one year of the date of employee fatality to seek death and burial benefits.
9. No frivolous or fraudulent claims or demands will be tolerated.
Sandoval Law Firm, PLLC helps injured workers and their families. Call (346) 347-7777 for a free and informative consultation!