How do I Qualify for Workers' Comp in Texas?

Workers' compensation laws provide benefits to workers who are injured or become ill because of their job, according to the Texas Department of Insurance. These benefits are paid by private workers' compensation insurance companies paid by employers, rather than by the state.

Requirements

In addition to the employee having a work-related injury or illness, the employer must have workers' compensation insurance for the employee to collect benefits. An employee can collect benefits regardless of who was at fault for his accident or illness, but he must not have been intoxicated, injured himself on purpose, been injured by another for personal reasons, been injured by an act of God or horseplay. Employees must notify employers within 30 days of injury or illness.

Form

The first step in qualifying for workers' compensation benefits in Texas is filing the required form, according to the Texas Department of Insurance. The form must then be mailed or faxed to the department. Employees have one year from injury or illness to mail the form.

Denial

It is not unusual for an insurer to deny benefits, according to WorkersCompensation. If it does, it must send the employee a Notice of Denial that gives its reasons for denying the claim. Sometimes a letter or phone call will get it to reverse its decision, but the employee might need to retain legal counsel at this point. Employees, as well as insurers and the state, have the right to have a designated doctor examine the employee and make a recommendation.

References

• Texas Department of Insurance, Division of Workers' Compensation: Workers' Compensation in Texas
• Texas Department of Insurance, Office of Injured Employee Counsel: Notice of Employee Rights and Responsibilities in the Texas Workers' Compensation System
• Texas Department of Insurance, Division of Workers' Compensation: TDI Insurance Complaint Form
• WorkersCompensation: Employee Information, Denial of Benefits
• Texas Department of Insurance: Designated Doctor

Resources

• WorkersCompensation: What is Workers' Compensation