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Would you know how to file a claim for a Texas workplace accident?

Here’s your comprehensive guide to the types and amounts of workers’ compensation insurance to which you could be entitled if you’re injured on the job in Texas.

You might feel like your workplace is your home away from home. And that makes sense because employees in Texas spend an average of more than 34 hours a week at work. While your home may be your sanctuary, sometimes the workplace comes with an element of risk.

Everyone should be safe at work. But whether you work in a profession included among the most dangerous jobs or you have a low-risk desk job, accidents happen. Some people suffer injuries at work from accidents like tripping over a phone cord in their office, slipping in a puddle in the restroom, or other mishaps that occur in our daily lives—even, sometimes, for employees who have accidents while working from home.

Of course, there are some types of jobs that are inherently more dangerous. If you are in one of those professions, you might have a higher likelihood of being injured at work. If you do, it’s important to know what type of workers’ compensation benefits you can count on.

What is workers’ compensation?

Workers’ compensation is a federal program, but each state regulates the amount and method of administering its benefits.

There are a few concepts within the workers’ compensation system that are universal:

1. Workers’ compensation is no-fault insurance.

The injured person does not need to prove that their injury was caused by someone’s negligence. You can be eligible to receive benefits in two ways:

You were physically present at your place of work when the injury happened.
You were not at work but were carrying out duties related to or required by your job when you were injured.

2. Workers’ compensation is an exclusive remedy.

You cannot file a personal injury lawsuit against your employer, even if you were injured because of their negligence, if you are eligible for workers’ compensation benefits. This benefits both the employer and the employee. The employee is guaranteed their benefits, regardless of how the injury happened. The employer is spared a lengthy and costly lawsuit.

The exception is if the injury was caused by the negligence of someone other than your employer. If that happens, you could file a third-party claim against that person or entity.

Texas workers’ compensation insurance

Who is eligible/required to have Texas workers’ compensation insurance?

Some states require all private employers to carry workers’ compensation insurance. Texas does not. A private employer that contracts with a government entity is required to provide workers’ comp for those employees who are working on the government project. There are other contractors who require their subcontractors and independent contractors to have workers’ comp insurance.

However, many private employers choose to provide workers’ compensation insurance because it protects them from lawsuits by their employees. If they don’t provide workers’ comp insurance, then they do not have protection against lawsuits. In that instance, an injured employee could file a lawsuit against the employer for negligence.

The employer also must do the following if they choose not to provide workers’ compensation:

File an annual notice with the Texas Division of Workers’ Compensation;
Post notices in the workplace; and
Advise new employees in writing that they are not covered by workers’ compensation.

There are specific instances when a covered employee would not be able to claim workers’ comp. These are if the employee:

Intentionally caused their own injury;
Was playing around or was intoxicated;
Was injured outside of work or while voluntarily participating in an off-duty sports or social event;
Was injured by another person for reasons unrelated to their job; or
Was injured by an "act of God" like a hurricane, tornado, etc. unless the job had a high likelihood of exposure to these types of events.

Source: Texas Department of Insurance

What benefits can you receive from a Texas workers’ compensation claim?

Replacement of lost income

Temporary income benefits, or 70% of the difference between your average weekly wage and the amount you could earn following the injury. There are maximum and minimum amounts, but your TIB could be 75% of the difference between your average weekly wage and the wages you could earn after your work injury if your injury was before Sept. 1, 2015 and you earned less than $8.50 an hour OR if you were hurt on or after Sept. 1, 2015 and you earned less than $10 an hour.
Impairment income benefits based on an impairment rating from a health care provider after you’ve reached maximum medical improvement (MMI). This is a determination that you’ve improved as much as can be expected after treatment. You can receive 70% of your average weekly wage. It lasts for a period of time related to your impairment rating, which is three weeks for each point of impairment. For instance, if your impairment rating is 10%, you would receive three weeks of benefits for each percentage of impairment, or 10% x 3 weeks, totaling 30 weeks.
Supplemental income benefits that are paid monthly after your impairment income benefits end. You must have an impairment rating of 15% or higher and have not returned to work. If you did return to work, you must be earning less than 80% of your average weekly wage from before your injury. You must indicate that you are actively looking for work and may not accept a lump sum payment for your injury.

The supplemental income benefit is 80% of what you receive when subtracting the difference between 80% of your average weekly wage and any additional wages you received after your injury.
Lifetime income benefits are provided for the remainder of the injured person’s life under certain circumstances. As of September 2023, the criteria for eligibility includes:

total and permanent loss of sight in both eyes;
loss of both feet at or above the ankle;
an injury to the spine that causes permanent and complete paralysis of both arms, both legs, or one arm and one leg;
a physically traumatic injury to the brain resulting in a major permanent neurocognitive disorder that requires supervision in activities of routine self-care, and causes the person to be permanently unemployable;

loss of both hands at or above the wrist;
loss of one foot at or above the ankle, and loss of one hand, at or above the wrist;
third degree burns that cover at least 40% of the body and require grafting; or third degree burns covering the majority of both hands, one hand and one foot; or one hand, one foot and the face; or
a serious bodily injury to a first responder.

Lifetime income benefits are 75% of your average weekly wage with a 3% increase each year.

Medical benefits

These include costs for any medical treatments, including hospital stays, doctor visits, diagnostics, prescription medication, etc.

Burial and death benefits

If the person dies from a work-related injury or illness, the person paying for the burial may receive compensation for burial costs. If the injury was prior to September 1, 1999, the expenses paid are up to $2,500. If the injury was between that date and before September 1, 2015, they may receive up to $6,000. If the injury or illness was after September, 2015, they may receive expenses paid up to $10,000.

Death benefits are intended to replace some of the surviving dependents’ losses. The recipients could include:

a surviving spouse,
minor children,
children less than 25 years old who are enrolled in an accredited college or university,

dependent grandchildren,
other dependent family members, or
non-dependent parents (but only when there are no surviving eligible dependent family members).

Death benefits are 75% of the deceased employee’s average weekly wage. The surviving spouse could receive death benefits for the remainder of their lifetime unless they remarry. If there are children, the spouse receives half the benefits and the children split the remaining half. If the spouse remarries, they receive a lump sum payment equal to two years of benefits. Or, if there are dependent children, they would receive the entire benefit, divided equally among them.

If the deceased person was a first responder, the spouse may receive death benefits for the rest of their life even if they remarry.

A child receives benefits up to age 18 or up to age 25 if they are enrolled as a full-time student. When one child ages out of receiving benefits, the remaining benefits are divided among the younger children. An adult child who was financially dependent on the deceased worker may receive death benefits for 364 weeks after the person’s death. A child who has a physical or mental disability may receive benefits for their lifetime or until they no longer have the disability.

Grandchildren may receive benefits if they were at least 20% dependent unless the child’s parent is receiving benefits. Other dependent relatives could get benefits if there is no surviving spouse, child or grandchild.

How to receive Texas workers’ compensation benefits

1. Call the Texas Department of Insurance Division of Workers’ Compensation

Inform the Division that you were injured and need to file a claim. The Division will send you a packet of forms and information.

2. Complete the DWC Form 041

The Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease, or DWC Form 041, must be completed and mailed to the Division.

This fulfills the employee’s obligations to file a Texas workers’ compensation claim.

3. What to do if your Texas workers’ compensation claim is denied

You will have the opportunity to attend a benefit review conference, which is an informal meeting where you can speak with an insurance representative and an officer from the DWC. If your claim is not resolved to your satisfaction, you can then request a contested case hearing. This allows you to appear before a DWC administration law judge, who reviews your claim.

You may appeal the judge’s decision through an appeals panel, or you may go to arbitration. If you choose to submit to arbitration, testimony is offered under oath and neither side may appeal the decision. Likewise, if you leave the decision to an appeals panel, you have 45 days to appeal. If you still believe that your claim was wrongly denied, you could request judicial appeal.

Do you need a Texas workers’ comp lawyer?

It depends.

If your claim is straightforward, your medical treatment has concluded and you’re back at work, you might not need additional legal guidance. But if your claim involves long-term treatment, if there’s a possibility of additional treatments in the future, or if you believe you aren’t receiving the full cost to cover your medical expenses, you might wish to consult a Texas workers’ compensation lawyer.

Once you accept a settlement, you can’t go back for more if your medical status or situation changes. So if there is any question about your future needs, you want an expert to determine what your costs will be. That’s what your lawyer is trained to do.

Your lawyer can help you through the process, negotiate on your behalf, and help you receive the Texas workers’ compensation benefits you deserve for your injury.

Still not finding what you need?

Check out our other articles on workplace injuries and workers’ compensation in Texas.

Did you know that workers' compensation law varies by state?

Alabama

Arizona

California

Colorado

Florida

Georgia

Indiana

Montana

North Carolina

South Carolina

Tennessee

Texas

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