What Is Workers’ Compensation?

Workers’ compensation is a form of insurance that provides benefits to qualified workers who suffer an injury or contract an illness on the job or because of exposure to something in the workplace. It has generally been described as the “grand bargain,” representing a compromise between management and labor that is intended to provide tangible benefits to both parties after a work-related injury.

An injured worker does not need to establish that the employer was negligent—workers’ comp requires only that the party seeking benefits show that they suffered an injury that was work-related. Additionally, if a workers’ compensation claim is approved, the injured worker will start to receive benefits within a few weeks, as opposed to the years it can take to recover a judgment in a civil lawsuit.

Workers’ comp law benefits employers by placing a cap on the maximum amount of benefits an employer must pay for any given injury. In addition, workers’ compensation in most states is considered to be the exclusive remedy for workplace injuries, meaning employers don’t have to face civil lawsuits with the potential for large damage awards from sympathetic juries.

Workers’ Compensation Law in Texas

Texas takes a somewhat different approach to workers’ compensation than any other state, as there is no requirement in the Lone Star State that an employee subscribe to or participate in the state’s workers’ compensation program. Statistics show, however, that about three of every four companies in Texas subscribe to the program, and more than 80% of all workers in Texas are employed by companies that subscribe.

An employer who chooses not to subscribe to the Texas workers’ compensation program must complete and file an Employer Notice of No Coverage or Termination of Coverage with the state of Texas. In addition, the employer must take certain steps to ensure that employees are notified of non-subscription. If a worker is injured and the employer does not participate in the Texas workers’ compensation program, the employee may file a civil lawsuit to recover damages.

Who Pays Your Workers’ Compensation Benefits?

If your employer subscribes to the Texas workers’ compensation program, your employer will cover the costs of any potential injuries by purchasing a policy of workers’ compensation insurance. When you have an approved claim, the benefits will be paid by the workers’ comp insurance provider. If your employer does not subscribe, any benefits covering the costs of injuries are paid directly by the employer.

Who Is Eligible for Workers’ Compensation?

As a general rule, there are only two requirements to qualify for workers’ compensation benefits: a person must have been injured and the injury must be job-related, i.e., it must have occurred in the performance of the injured worker’s duties. In Texas, because employers have the option not to subscribe, the following criteria must all be met:

The individual seeking benefits must be an employee—independent contractors are almost always excluded from eligibility.
The employer must subscribe to the Texas workers' compensation program.
The injury or illness must have been caused by the claimant's job.
The applicant must meet all requirements for timely reporting and filing a claim.

What Benefits Are Available Through a Workers’ Compensation Claim?

The Texas workers’ compensation laws provide a broad range of potential benefits to anyone suffering a job-related injury or illness:

Replacement of lost income—Workers’ compensation will not reimburse you for lost wages during the first seven days after you suffer an injury or illness. Once you become eligible for wage replacement, the amount of your benefits will be calculated based on your average weekly wage for the 13 weeks prior to your injury. Payments are typically 70% of your average weekly wage, or 75% if you were earning less than $10 per hour. These benefits are not subject to income tax.
Reasonable and necessary medical expenses arising out of your injury or illness—You will likely be required to submit to a medical examination by a doctor selected by your employer or the workers’ comp insurance company. Otherwise, you have the right to choose your own treating physician, unless the Texas Workers' Compensation Commission finds your chosen doctor to be unqualified.
Reasonable rehabilitation expenses—Your medical reimbursement can include physical therapy, occupational therapy, and other forms of rehab.
Certain costs associated with retraining—If your injury prevents you from ever returning to your former job, you may be able to pursue training or education for a new position and have the costs covered by workers' compensation benefits.
Compensation for permanent injuries—If your injuries prevent you from ever being gainfully employed again, you may be entitled to lifetime benefits equal to 75% of your average weekly wage, with an annual 3% cost-of-living adjustment. You may also qualify for lifetime benefits for certain types of injuries, even if you can still work in some capacity. The injuries that can make you eligible for lifetime benefits include:
- Paralysis in at least one limb
- A traumatic brain injury (TBI) that causes any level of mental impairment
- Third-degree burns over more than 40% of your body that require a skin graft
- Total loss of vision
- Amputation of or total loss of use of a hand, foot, arm, or leg
Death benefits after a workplace fatality—A spouse, dependent children or grandchildren, and dependent parents or grandparents may recover up to 104 weeks of benefits, calculated at 75% of the deceased worker’s average weekly wage. Death benefits are not subject to income tax, but they are capped based on the state average weekly wage.
Funeral and burial expenses—Under Texas workers’ compensation law, the workers’ comp insurance provider must pay either $6,000 or the actual costs of funeral and burial, whichever is less.

To learn more about all the benefits available when you’ve been hurt at work, contact the aggressive Dallas workers’ compensation lawyers at Bailey & Galyen.

How Long Does an Injured Worker Have to File a Workers’ Compensation Claim in Dallas?

The length of time you have to file any type of legal claim is governed by the statute of limitations. In Texas, the statute of limitations for a workers’ compensation claim is one year from the date of the accident or from when the worker reasonably should have discovered their injury or illness. You must, however, provide notice to your employer within 30 days of your discovery of an injury or illness. If you retain a workers’ compensation lawyer in Dallas immediately after your injury, they can ensure that your application for benefits is filed in a timely manner.

What Is the Process for Successfully Filing a Workers’ Compensation Claim?

In the days and weeks following a workplace injury, you can be at a loss as to how you can best protect your rights. Here are the steps you need to take:

Seek medical attention—When you’re hurt on the job, or if you contract an illness or disease that you believe is work-related, your first concern should be your health. Get treatment immediately, whether at the company dispensary, a hospital emergency room, an urgent care facility, or the office of your primary care physician. The longer you wait to seek medical care, the greater the likelihood that your employer or the workers’ compensation insurance company will argue that your injuries were not that serious.
Notify your employer—Once you receive any necessary medical treatment, let your employer know about your injury or illness as soon as possible, but no later than 30 days after the accident or discovery of the illness.
Gather evidence—To determine your eligibility for benefits, the workers’ compensation insurance company will consider eyewitness testimony, medical records, and other forms of documentary, physical, and testamentary evidence.
Hire an experienced Dallas workers’ compensation lawyer—Once you’ve received any necessary medical care, this should be your next move. Your attorney will immediately become your intermediary with your employer, the insurance company, and the Texas Department of Workers' Compensation.
Complete the claim form—You must submit a completed form DWC-041 to the Texas Department of Insurance, Department of Workers' Compensation (DWC), within one year. If you’ve already hired an attorney, they will handle that for you.

Once your claim form is submitted, the workers’ compensation insurance company will conduct an investigation. They may talk to coworkers, visit the scene of the accident, or even send out private investigators. If they determine that your case has merit, they will approve the claim, and you’ll start to receive benefits within two to four weeks.

Though the vast majority of claims are eventually approved, statistics indicate that about one of eight claims are initially denied. In Texas, the workers’ compensation insurer has 15 days from the date you file your claim to either start paying benefits or notify you that the claim has been denied. If the claim is denied, the insurer must provide a reason.

If your Dallas workers’ compensation claim is denied, you have certain rights to appeal. Here’s what that process looks like:

Step 1—The worker requests a benefit review conference, using DWC Form-045. An informal meeting will then be scheduled with the Department of Workers' Compensation, where a benefits review officer will try to get the parties to reach an agreement. If successful, you’ll sign a settlement agreement and start receiving benefits.
Step 2—If you cannot reach a voluntary agreement with the insurance company, you can elect to move forward in the appeals process, either through arbitration or a contested case hearing (CCH). In arbitration, which typically takes less time, you’ll be assigned an arbitrator by the DWC, who will take testimony, consider all evidence, and make a decision. If you choose arbitration, it will be binding. Neither party has the right to appeal the findings of an arbitrator. Alternatively, you can choose to resolve the matter through a CCH, held in front of a DWC hearing officer. The CCH looks very much like a civil trial, with opening and closing statements, witness testimony, and consideration of physical evidence. Once the CCH is complete, the hearings officer will make a ruling. Either party may appeal the ruling.
Step 3—To appeal the DWC hearing officer's decision, you must ask for review in writing within 15 days of your receipt of the ruling. Once you submit your request for review, the insurance company will have an additional 15 days to respond. The DWC Appeals Board will review all documents and testimony, but it will not hold any type of hearing.
Step 4–If the Appeals Board denies your claim, your only recourse is to bring a civil lawsuit.

How Much Does It Cost to File a Workers’ Compensation Claim in Dallas, Texas?

As with most personal injury claims, workers’ compensation cases are usually handled on a contingency basis. That means that the Dallas workers’ compensation lawyer who handles your case will take a percentage of whatever you recover in exchange for the legal services provided. If there are additional costs associated with your claim, such as filing fees or expert witness fees, those will come out of your pocket.

How Can an Experienced Dallas Workers' Compensation Lawyer Help with Your Case?

The workers’ compensation system can be complex and intimidating, even when a claim seems relatively straightforward. There are many ways that a workers’ compensation lawyer in Dallas can benefit you:

A proven Dallas workers’ compensation lawyer can conduct a thorough investigation into the causes of your injury or illness and effectively gather and preserve all evidence to support your claim.
A knowledgeable workers’ compensation lawyer in Dallas will anticipate challenges by your employer and/or the workers’ compensation insurance company and take appropriate measures to protect your rights.
An experienced attorney will ensure that all deadlines are met, that all required documents are accurately and timely filed, and that the evidence supporting your claim is as compelling as possible.
A skilled lawyer can be your voice in all meetings, hearings, and proceedings.
A dedicated workers’ compensation lawyer in Dallas can help ensure that you get the medical care you need, including treatment by specialists, if necessary.
Your attorney can work with your doctors, your employer, and the insurance company to make certain you don’t return to work prematurely and risk further injury.
A knowledgeable workers’ compensation lawyer in Dallas can determine whether you are eligible for any permanent workers’ compensation benefits.

What Types of Injuries Are Covered by Workers' Compensation Benefits?

Under Texas law, you can seek workers’ compensation benefits for any injury or illness that prevents you from working, including both physical injuries and mental health conditions. That includes:

Repetitive stress injuries—Your job may require that you perform that same task for hours at a time, which can lead to injuries from overuse. Joint injuries, as well as injuries to connective tissue, such as muscles, tendons, or ligaments, are common as a result of repetitive motion or stress. One of the most commonly covered repetitive stress injuries is carpal tunnel syndrome, a condition that affects the hands and wrists.
Head injury/traumatic brain injury (TBI)—This may involve impact to your head from a foreign or stationary object, but it can also include whiplash-like injuries, where your brain careens off the inside of your skull.
Soft-tissue injury—Bruises or contusions, cuts and lacerations, often affecting the back and neck
Bone fractures
Back injuries, including herniated, slipped or dislocated discs, spinal cord injury, compression fractures, and soft-tissue injury
Sprains and strains of any muscles, including knees, ankles, shoulder, wrist, back, and neck
Nerve injury or damage

A Summary of Your Rights in a Dallas Workers' Compensation Claim

In Dallas, when you have suffered any type of injury on the job or contracted a work-related illness, you have legal recourse. Unlike other states, Texas allows an employer to elect not to subscribe to the state workers’ compensation program. If your employer is a participant, you may be eligible for benefits if you’ve suffered any type of work-related injury or illness. If your employer does not subscribe, you must seek benefits directly from your employer, through a civil lawsuit, if necessary. The experienced Dallas workers’ compensation lawyers at Bailey & Galyen can help you get the benefits you need and deserve.

Bailey & Galyen
Dallas Workers’ Compensation Lawyers

Frequently Asked Questions About Workers' Compensation Claims in Texas

Workers’ compensation is a government-administered program that provides benefits to workers who are hurt or contract an illness on the job. Workers’ compensation allows injured employees to recover benefits more quickly and without having to prove negligence. In most states, it is the only remedy available to workers who are injured because of the carelessness of an employer or co-worker. In Texas, however, workers may have the right to file a direct claim against their employer, depending on whether or not the employer has elected to participate in the state’s workers’ compensation program.

The benefits paid to an injured worker are insurance benefits, typically paid by the workers’ compensation insurance provider. In Texas, employers who elect to not participate in the state’s workers’ compensation program will pay benefits directly to employees.

Under Texas law, you must notify your employer of a potential worker’s compensation claim within 30 days of the discovery of an injury or illness, and you must file a claim with the Department of Workers’ Compensation within one year of the date of the injury or discovery of the illness. Look to an experienced Dallas workers’ compensation lawyer to ensure your claim is filed on time.

After a work-related injury or illness, you must first seek any necessary medical attention. You must then notify your employer (within 30 days). You should hire an attorney as soon as possible, so that he or she can conduct an investigation and gather and preserve evidence. Your attorney can help you complete and submit the necessary claim form with the Texas Department of Workers’ Compensation.

An experienced workers’ compensation lawyer in Dallas can dramatically improve your chances of maximizing your workers’ compensation claim, investigating and gathering evidence, preparing and filing all necessary documents, and acting as your advocate in all hearings, meetings, and proceedings. Your attorney can help you get the medical treatment you need and can help ensure that you don’t return to work before you’ve fully healed.

If your Texas workers’ compensation claim is approved, you may be eligible for a wide range of benefits, including reimbursement of any wages lost, all reasonable and necessary medical expenses caused by your injury or illness, any rehabilitation you may need because of your injuries, and any job training that may be required to allow you to be gainfully employed. If your injuries prevent you from ever working again, you may be entitled to lifetime benefits. Surviving family members may recover workers’ compensation benefits to cover lost financial support, as well as funeral and burial expenses up to $6,000.

Under Texas law, you can seek workers’ compensation benefits after any physical or mental trauma that prevents you from performing the duties of your job. That includes repetitive stress or motion injuries, back and neck injuries, traumatic brain injury (TBI), spinal cord or nerve damage, broken bones or fractures, burns, amputation or loss of limb, sprains or strains, and any other soft-tissue injuries.

Once your claim is approved, you can expect to start receiving benefits within two to four weeks.

Dallas Workers’ Compensation Lawyers

The Rights of Injured Workers in Dallas, TX