If you live and work in Texas, you should find out if your employer has workers’ compensation insurance. It is not compulsory in Texas as it is in most other states in the country. It has been left to individual employers to take out insurance if they wish to do so. This means that if there is no insurance available and you have a workplace accident or illness, you may have to make a personal injury claim against your own employer if you need compensation. Even if workers’ comp. is available, it is not always honored by the employer’s insurance company. However, you still have a right to appeal any denied claim. Talk to a workers’ comp. attorney about your legal options. Workers’ Comp. Law in Texas You can find out whether your employer has workers’ comp. insurance by checking the Texas Division of Workers’ Compensation website. The state is unusual because there is no state law that makes it compulsory for an employer to provide workers’ comp. insurance. If your employer does not have insurance and you are injured or suffer from a workplace illness, you must contact a personal injury attorney to discuss your legal options including a personal injury claim against your employer. You do have to prove liability, which could be difficult, whereas a workers' comp. claim does not need to establish liability. However, the financial compensation for a personal injury claim can be higher than a workers' comp. payment. If insurance is available you should make sure your employer is notified as soon as possible, even though the maximum time allowed is 30 days. You should then submit a claim with the Texas Division of Workers’ Compensation. They will advise the insurer and your employer that a claim has been submitted. The insurer will then make a decision whether to accept or deny the claim. You have a year from the incident at work in which you were injured, or from the time that a workplace illness was diagnosed, to make a claim. How a Workers’ Comp. Can be Denied A workers’ comp. claim may be denied by the insurer for a number of reasons. The most common reasons for a denial are simple ones. You may have forgotten to let your employer know in time (30 days) or there was an oversight at work which made a mistake about the date that the accident took place. Insurers can also deny a claim if it has been alleged that you did not use safety equipment provided or failed to follow established safety procedures or deliberately caused the injury in order to obtain compensation. Other reasons include: failing to submit sufficient documentation to establish the nature of the injury and medical costs; claiming for an injury or illness that didn’t happen at work; being intoxicated or affected by drugs when the accident took place. How the Workers’ Comp. Appeals Process Works in Texas As in other states where workers’ compensation laws are in place Texas does have a series of appeal stages which can be used to make an appeal against an unfair claim denial. The first step will be to attend a Benefit Review Conference. This is much like a mediation session as occurs elsewhere. A Benefit Review Officer, you and a representative from your employer will meet in an informal process to help resolve the dispute amicably without the expense and effort f having to take it further. If this is unsuccessful, you can choose to take it to arbitration or request a formal hearing. The arbitration hearing option is a more formal version of the Benefit Review Conference, but the decision is binding. If you do not agree with the arbitrator’s decision you cannot take the appeal any further. The other option is a formal hearing which will be heard by a judge who will examine the evidence provided by both sides of the dispute. A further appeal can still be made to the Appeals Board and failing that, the case can be brought before a state court. The Reasons for Hiring a Workers' Comp. Attorney An appeal against a workers’ comp. claim denial can be long and complex. You are strongly advised to contact a workers’ comp. attorney to discuss your legal options and provide advice about the appeals process based on the evidence you have available and the reason for the denial provided by the insurer. If your employer does not have insurance you may decide to file a personal injury claim against your employer, but you must have proof that the employer was negligent and this negligence resulted in an injury or illness. You will need help from a personal injury attorney. Many workers’ comp. attorneys are also general personal injury attorneys who work on employee claims.
