Workers’ Comp Basics | Your Guide to Workers’ Comp

Workers’ Comp Basics | Your Guide to Workers’ Comp


Hi, my name is Kelly and I’m with the Texas Department of Insurance, Division of Workers’ Compensation. Workers’ compensation is an insurance program that pays your medical bills and replaces some of the money you lost because of your work-related injury or illness. The Division of Workers’ Compensation is
here to help resolve disputes and make sure the laws and rules are followed. In Texas, employers do not have to have workers’ compensation insurance unless they are certain private employers or part of a government
or educational system. With workers’ compensation insurance, an employer buys an insurance policy from an insurance company. That insurance company pays any income or medical benefits to you or your beneficiaries if you are hurt on the job. In the Texas Workers’ Compensation system, injured employees have certain rights and responsibilities. When you are hurt on the job, you have the right to receive income benefits after you meet certain requirements. You have the right to receive reasonable and necessary medical care to treat your work-related injury. You have the right to keep your claim private and choose the doctor who will treat you. Your employer must tell you if your claim
is in a health care network, so that you can use a doctor in that network if you are hurt. If you get treatment from a doctor who is
not in the network without getting approval from the network, you could have to pay for the cost of the treatment. Some doctors do not treat workers’ compensation patients. For a list of doctors who may treat workers comp patients go to tdi.texas.gov/wc/employee. At this link there is also a list of doctors
who are not allowed to treat workers’ compensation patients in Texas. You have the right to legal review of any
disputes on your claim. Injured employees and their beneficiaries
have a right to hire an attorney at any time. They also have a right to ask for help from an agency called OIEC, the Office of the Injured Employee Counsel. OIEC can help you if you have a dispute with your claim. Along with rights you also have certain responsibilities. You must tell your employer within 30 days if you have a work-related injury or illness. Deadlines like this are really important because if you miss them, you might not get your benefits. You must also report your injury to the Division of Workers’ Compensation within one year. To do this, send DWC form 041 to the Division of Workers’ Compensation. The form is called the Employee’s Claim
for Compensation for a Work-Related Injury or Occupational Disease. This form can be found under the employee forms link at tdi.texas.gov/wc/employee. You have to let your doctor know how you were hurt and if it was work-related. You also have to let the Division and the
insurance carrier know about any changes in your pay or in the work you do. You must let the Division and the insurance company know if there are any changes in your mailing address and phone number so that we can make sure you get important letters, reports, and benefit payments. To learn more about your rights and responsibilities in the Texas Workers’ Compensation system, go to tdi.texas.gov/wc/employee, or call our customer service number for more information at 800-252-7031, option 1.

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