How to File a Texas Workers’ Compensation Claim

Learn when and how to file a workers’ compensation claim in Texas.

Provided you were hurt or were sick at work, you may be eligible to workers’ compensation payments in Texas if your company has workers’ compensation insurance. However, in order to begin the process of claiming those benefits, you must first disclose your injuries and file a formal claim. This page covers the procedure and timeframes for doing this.

Check to see whether your employer has workers’ compensation insurance.

Unlike almost every other state, Texas does not require most firms to have workers’ compensation insurance. Instead, the state gives private firms the option of obtaining insurance and participating in the Texas workers’ compensation system. So, if you are injured or unwell at work, you should find out whether your company provides insurance coverage. Employers are obligated by law to provide this information to all of their workers. Whether you’re not sure, you may check the state’s online database to see if your company has insurance.

If your company provides coverage, you must usually go through the workers’ compensation system to get compensation for your injuries. However, under some circumstances, such as when your company lacks workers’ compensation insurance, you may be entitled to sue your employer. (Find out when you may sue your employer for a workplace accident.)

Please Report Your Injury

The first stage in the workers’ compensation procedure is to notify your employer of your injury. If you do not provide this notification within 30 days of the injury, you may lose your entitlement to claim benefits. However, you should contact your employer as soon as possible. If you delay more than a day or two to report an injury without good justification, the insurance company may be dubious of your claim. If you have a medical issue that has grown over time (such as a repetitive stress injury or occupational sickness), the 30-day period begins when you find that your condition is connected to your job.

Your employer should advise you how to receive medical treatment once you report your accident. If your business has a contract with a workers’ compensation health care network, you must normally choose a doctor within that network. Otherwise, you may visit any doctor on the Texas Division of Workers’ Compensation’s list of authorized doctors (DWC). Tell the doctor that you were hurt at work on your first appointment.

Fill out a Workers’ Compensation Claim Form

You must submit an Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC Form-041) with the DWC to begin your formal claim. You may submit the form in person, via mail, or online using the DWC’s filing system.

The claim form requests information about you, your injuries, your employment status, and your employer. More thorough instructions for answering each question may be found at the bottom of the form. If you want assistance, contact the Office of Injured Employee Counsel, a distinct state entity that assists employees with workers’ compensation claims.

You must submit the form within one year of the date of your accident or discovery of your work-related occupational sickness. If you miss the deadline, you may lose your claim to benefits, unless you qualify for one of the few exceptions.

The DWC will contact your employer and its insurance carrier once it receives your claim. Your claim will then be reviewed by the insurance carrier, who will determine whether to accept or refuse it. (Learn about the most typical causes for refused workers’ compensation applications.)

Disputes Over Workers’ Compensation

If the insurance company declines your claim, you may file a complaint with the DWC. Before you may go before a workers’ compensation judge, you must first attend a benefit review conference. (Learn more about appealing a decision in your Texas workers’ compensation case.) Because disputed case hearings are subject to complicated procedural requirements, most injured workers will need to retain the services of an experienced workers’ compensation attorney in order to prevail at the hearing. Fortunately, workers’ compensation regulations allow you to employ an attorney. See our post on how much workers’ compensation attorneys cost in Texas for more information.