Injured Employee FAQ from the Texas Department of Insurance

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Employee Frequently-Asked Questions

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Frequently Asked Questions

1. I've been injured on the job, what should I do?

You must report your injury to your employer within 30 days from the date of the injury, or from the date you knew your injury or illness was related to your job. If you do not notify your employer within these 30 days, your right to obtain benefits could be lost.
You must send a completed Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC-041) to the Texas Department of Insurance, Division of Workers' Compensation (Division) within one (1) year of the date of injury to protect your rights.
For more information please see the Injured Worker Rights and Responsibilities page or call Customer Assistance at 1-800-252-7031

Related Questions

What are Injured Worker Rights and Responsibilities?
How do I file a claim?
How do I find a doctor to treat me for my work-related injury?
My employer has a Return to Work Program. How will this affect me?
I am having trouble working with my adjuster, what can I do?
My employer is treating me differently since my work-related injury, what can I do?
What is fraud?
What information do I need to provide the Division/the carrier/the doctor/my employer?

What are Injured Worker Rights and Responsibilities?

They are your rights and responsibilities as an injured worker under the Texas Workers' Compensation Act.

How do I file a claim?

You may file a claim by filling out the paper form DWC-041 Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease.

You also may send the completed DWC-041 paper form to the following address:

Texas Department of Insurance, Division of Workers' Compensation
7551 Metro Center Drive, Suite 100 MS-93
Austin, TX, 78744-1645

Online forms can be completed at local field offices. You may find your field office information by clicking on the following link and locating your county name: DWC Office by County.

How do I find a doctor to treat me for my work-related injury?

TXCOMP is a Division online system that can help you find a doctor. To find a treating doctor in your area, click on TXCOMP on the blue navigation bar. Then place your cursor over the words "Main Menu" until a drop down menu appears. From that menu click on "Locate Doctor". Enter the required information (city, county, state or zip code) under "Location" and then click on "Search". A list of doctors in your area will appear.

Please note that doctors previously removed or denied admission to the Division's former Approved Doctor List (ADL) are excluded from providing any service within the Texas Workers' Compensation system (except in an emergency situation). A list of excluded doctors can be found on the TDI website.

If you experience problems with your doctor search, please contact Customer Assistance at 1-800-252-7031

My employer has a Return to Work Program. How will this affect me?

Please click on the following link for information regarding return to work, Return to Work page, or read Question 7.

Additional Resources:
Department of Assistive & Rehabilitative Services (DARS)
Texas Workforce Commission (TWC)

I am having trouble working with my adjuster, what can I do?

It is very important to communicate with your insurance carrier adjuster. Providing information to your adjuster that is related to your claim will help build a solid working relationship with your adjuster.

If you have problems with your adjuster and have attempted to work out your differences without reaching a resolution, ask to speak with the adjuster's supervisor. If you continue to experience problems, contact Customer Assistance at 1-800-252-7031.

My employer is treating me differently since my work-related injury, what can I do?

If you believe you are being treated unfairly by your employer because of your injury, please contact Customer Assistance at 1-800-252-7031. It is against the law for an employer to discriminate against you for filing a workers' compensation claim.

What is fraud?

Fraud occurs when a person knowingly or intentionally conceals, misrepresents, or makes a false statement to either deny or obtain worker's compensation benefits or insurance coverage, or otherwise profit from the deceit.

What information do I need to provide the Division/the carrier/the doctor/my employer?

The Division:

Completed DWC-041, within one year
Any change of address and/or phone number as soon as possible

The insurance carrier:

Date of injury
Copy of Form DWC-041 filed with the Division
Any information regarding your work-related injury or illness
Any medical information, regarding your work-related injury or illness, past or present
Change of address and/or phone number, as soon as possible

Your doctor:

Information regarding how, where and when the injury occurred
Medical information, regarding your work-related injury or illness, past or present

Your employer:

Information regarding how, where and when the injury occurred
Any pertinent information regarding work status

2. There has been a work-related death in my family - does workers' compensation cover this?

Workers' compensation benefits are paid to the beneficiaries of a person who dies as a result of a work-related injury. The staff of the Texas Department of Insurance, Division of Workers' Compensation (Division) is available to answer questions regarding a deceased worker's benefits to his or her beneficiaries. For more information about eligibility, please see Death Benefits, or contact Customer Assistance at 1-800-252-7031.

Related Question

How do I file a claim for death benefits?
Beneficiaries of the deceased will need to file a DWC-042, Notice of Fatal Injury or Occupational Disease and Claim for Compensation for Death Benefits with the Division and the insurance carrier within one (1) year of the death of the deceased worker.

You may send the completed DWC-042 to the following address:

Texas Department of Insurance, Division of Workers' Compensation
7551 Metro Center Drive, Suite 100 MS-93
Austin, TX, 78744-1645

or you may send your completed DWC-042 to your local field office. You can find your local field office information by clicking on DWC Offices by County and locating your county name.

3. I have questions regarding my claim, who can help me?

The Texas Department of Insurance, Division of Workers' Compensation staff is available to answer questions regarding your claim. For more information, please call Customer Assistance at 1-800-252-7031 or you may find your local field office information by clicking on DWC Offices by County and locating your county name.

DWC Field Offices by County

Read more about your right to receive information and assistance with your claim.

4. What are medical benefits and how do I get them?

Medical benefits pay for the medical care necessary to treat a work-related injury or illness. If you were injured on-the-job, you may be eligible to receive medical benefits. For more information please click on Medical Benefits or call Customer Assistance at 1-800-252-7031.

Related Question

What if my injury poses a life threatening risk to me?
If you are injured on the job, use your best judgment in seeking medical care. If your injury or illness poses a risk to your life and your treating doctor is unavailable to treat you, you may seek the help of another doctor other than your own treating doctor. For more information please see the Benefits page or call Customer Assistance at 1-800-252-7031.

5. How can I find a doctor who will treat me for my injury?

You have an initial choice of treating doctor. TXCOMP is an online system available on the Division website that can help you find a doctor. Before you pick a doctor, you should call the doctor's office to make sure they are taking new patients and are able to treat you for your type of injury. For more information, please contact Customer Assistance at 1-800-252-7031.

See also information on medical benefits.

Related Questions

What is TXCOMP and how do I use it to find a treating doctor?

Once I choose a treating doctor, can I change to another one?

It depends. To do so, you will need to fill out and submit a Change of Treating Doctor form (DWC-053) to your local field office. The Division must approve your change prior to seeing the new doctor. For more information, please call Customer Assistance at 1-800-252-7031. Your treating doctor can refer you to another doctor without you having to change doctors.

What should I do if my doctor refuses to treat me?

If your doctor refuses to treat you, you should find out exactly why to see if the situation can be resolved. If not, you may need to ask for a referral or change doctors. With each request to change doctors, you will need to complete a DWC-053 and submit it to the Division for approval prior to seeing your doctor.

My doctor's bills are not being paid and now the doctor won't treat me, what should I do?

Doctors have the right to refuse treatment at any time, which means that you, as the injured worker, may have to change doctors. Call Customer Assistance at 1-800-252-7031 for help in finding another doctor, or go to our TXCOMP system to find a doctor online. Your doctor will have to contact the Division's Medical Dispute Resolution (MDR) Section at 1-512-804-4812 to have his bill issue resolved.

My doctor is billing me for treatment due to my work-related injury. Do I have to pay this bill?

A doctor may not bill you for a work-related injury or illness. For more information please see the Benefits page, FAQ #2 for Health Care Providers or call Customer Assistance at 1-800-252-7031.

6. My doctor has taken me off work due to my injury. Will I be compensated for my time off? What benefits am I entitled to? How will I get paid?

It depends. Qualifying for wage replacement benefits (Temporary Income Benefits, or TIBs) is determined on a case-by-case basis. TIBs replace a portion of wages a worker loses because of a work-related injury or illness. If you are eligible to receive these benefits, you will be paid by your employer's workers' compensation insurance company. Please note that your eligibility is dependent on your ability or inability to return to your job.

Related Questions

What benefits may be available to me?

There are four different types of benefits:

*Medical Benefits are discussed in further detail on the Benefits page and in FAQ #4.

** Death and Burial Benefits are discussed in further detail on the Benefits page and in FAQ #2. For more information please call Customer Assistance at 1-800-252-7031.

What are income benefits and how do I get them?

There are four different types of "income" benefits, each with their own qualification criteria. To learn more about these benefits, please click on the corresponding links.

See also information about average weekly wage.

7. I haven't been released to return to work yet, but I think I am ready. What should I do?

You don't have to be completely recovered to go back to work - in fact, you might be able to return to work while you are still healing. To do this, you should:

Talk to your doctor. Tell him about your regular job and other jobs in the company. This will help him to determine what type of work you can do safely.
Talk to your employer. Let them know you want to come back to work. When your doctor says it is safe to return to work, let your employer know so that they can try to find work within your restrictions, if any.

Related Questions

My employer says they have a Return to Work Program. What is that?
Where can I find out more about Return to Work?

My employer says they have a Return to Work Program. What is that?

Return to Work is a program set up by an employer to help injured workers go back to work more quickly and safely while they heal - either with changes to their regular job or in a temporary, alternate work assignment.

Where can I find out more about Return to Work?

The Division has developed Return to Work information for injured workers or you can call Customer Assistance at 1-800-252-7031.

Additional Resources:

See also information on temporary income benefits.

8. The insurance carrier is denying my claim, what should I do?

Call your adjuster to discuss your claim. Very often, speaking with the adjuster can clear up your concerns quickly and easily.

However, if that does not resolve the problem, you should contact Customer Assistance at 1-800-252-7031 to see if you should request a Benefit Review Conference. At that point, Division staff can help you try to resolve your dispute. If they are unable to resolve it you may need to attend a Benefit Review Conference (and possibly additional dispute resolution proceedings.)

Related Question

What is Dispute Resolution?
Dispute Resolution is a series of proceedings to resolve disputes brought before the Division and include the following:
For more information, please call Customer Assistance at 1-800-252-7031 or see the Resolving Workers' Compensation Claim Disputes page.

9. Do I need an attorney to assist me with my workers' compensation claim?

You are not required to have assistance from an attorney, however you do have the right to obtain the services of one at any time. The attorney may attend dispute resolution proceedings with you and may present your evidence and your side of the dispute.

Read more about the right to hire an attorney.

Related Question

How can I find an attorney?
How much can an attorney charge?
How can I find an attorney?

Division employees cannot recommend an attorney to you. For a listing of attorneys in Texas, please see the State Bar of Texas website.

How much can attorney charge?

An attorney may charge a maximum of $150 per hour, plus expenses, for work performed on your workers' compensation claim. A maximum of 25% of your benefits may be withheld to recover the attorney's fees. For additional information please see Attorneys' Fees in the Division Rules.

10. What is an Ombudsman? How do I obtain the assistance of an Ombudsman?

An Ombudsman is a specially trained employee of the Office of Injured Employee Counsel (OIEC) who can assist you if you have a dispute with your employer's insurance carrier free of charge. For more information on Ombudsman assistance see http://www.oiec.state.tx.us/topics/ombudsman.html.

General information questions (not related to a proceeding) should be directed to Customer Assistance at 1-800-252-7031 or see the Resolving Workers' Compensation Claim Disputes page.

11. I have just received a letter that says I am scheduled for a designated doctor examination. Do I have to go and what will the designated doctor do?

You are required to attend a designated doctor examination. A designated doctor is a doctor selected by TDI-DWC to make an recommendation about your medical condition or to resolve a dispute about a work-related injury or illness.

The designated doctor will:

review medical information from your treating doctor and other doctors who have treated you for your work-related injury or illness;
examine, test, and evaluate the parts of your body affected by the work-related injury or illness;
determine if you have reached maximum medical improvement and, if so, when;
give you an impairment rating if you have reached maximum medical improvement. If you have not reached maximum medical improvement, the designated doctor cannot give you an impairment rating; and
submit a medical evaluation report, including a narrative report and documentation of your impairment rating, to TDI-DWC within seven (7) days of the date you were examined. The designated doctor also must send a copy of the report to you and the insurance carrier.

For more information please call Customer Assistance at 1-800-252-7031.

12. How does an employee report an unsafe work environment?

If you believe your work environment is unsafe, please contact the Safety Violations Hotline at 1-800-452-9595 or you may send your information via e-mail. Reports are taken in both English and Spanish and can be made anonymously.

For more information regarding the Safety Violations Hotline or how to e-mail your report, click on the following link: Safety Violations Hotline

Also, read about notice requirements in your workplace.

13. Is my claim file information confidential?

Your claim file information is confidential and only those parties dealing with your claim have the right to obtain that information. For more information, please call Customer Assistance at 1-800-252-7031.

Read more about your right to confidentiality.

Related Question

How can I authorize my spouse to speak on my behalf?
To authorize another person to speak with the Division on your behalf, you will need to provide a written notice stating the name of the authorized person with your original signature and submit it to your local field office. For more information, please contact Customer Assistance at 1-800-252-7031.

14. I am having problems paying my bills, where can I get help?

There are agencies within your own community that may be able to provide you with assistance while your claim is being resolved. For instance, some agencies provide assistance with utility bills.. Each county or city has its own set of services. To learn more about services in your area, please call Customer Assistance at 1-800-252-7031.

For more information contact: WorkersCompCustomerServices@tdi.state.tx.us

Last updated: 07/15/2009