injured worker holding his arm after machinery accident

Workers’ Compensation Covers Employees

You need to be classified as an employee to be covered by your employer’s workers’ compensation insurance. If you work for a company, receive a regular paycheck with tax withholdings, and receive a W-2 at the end of the year, then you are most likely an employee.

As a rule, independent contractors are not entitled to workers’ comp benefits if they get hurt on the job. However, employers sometimes misclassify employees as independent contractors in an effort to avoid liability for taxes and minimize other costs.

The intentional misclassification of employees is illegal. You should speak to an attorney promptly if you believe you are being unfairly denied access to workers’ compensation coverage.

Workers’ Compensation Covers Job-Related Injuries

In Texas, workers’ compensation only covers job-related injuries and illnesses that are work-related. As the Texas Department of Insurance (TDI) explains, “[w]orkers’ compensation pays for benefits like medical care to treat employees who are injured or become ill because of their jobs.”

According to the TDI, workers’ compensation does not cover:

Employees who intentionally injure themselves
Employees who are injured while intoxicated or “playing around”
Employees who are injured outside of work
Employees who are injured in hurricanes or other acts of God, “unless the job had a high exposure to these types of events”

Workers’ Compensation Covers Medical Bills

If you have a workers’ compensation claim in Texas, you are entitled to coverage for all of the costs of diagnosing and treating your injury. This is referred to as the “medical benefits” portion of your claim.

In general, eligible employees can receive medical benefits until either (a) they are fully healed or (b) they reach their “maximum medical improvement.” Maximum medical improvement is the point at which an injury or illness is not expected to get any better with further medical treatment.

Workers’ Compensation Covers Lost Earnings (In Some Cases)

If you are unable to work for more than a week as a result of your job-related injury, workers’ compensation will also provide coverage for a portion of your lost income (70% to 75% for most employees). These temporary income benefits (TIBs) end when you are able to return to work, when you reach maximum medical improvement, or when you have received benefits for two years.

In addition to TIBs, some injured workers will qualify for additional wage replacement benefits as well. These may include:

Impairment income benefits – covers 70% of your average weekly wage “if you have a work-related injury or illness that affects your body as a whole”
Supplemental income benefits – covers 80% of your average weekly wage minus any wages you are able to earn; supplemental income benefits become available when your impairment income benefits end but impairment still affects your ability to work
Lifetime income benefits – covers 75% of your average weekly wage for life if you suffer certain qualifying injuries on the job

Workers’ Compensation Covers Death Benefits and Burial Expenses

For families who lose loved ones in job-related accidents, workers’ compensation covers death benefits and burial expenses. Death benefits provide partial coverage for the family’s loss of income, and families can obtain up to $10,000 in reimbursement for burial expenses incurred.

5 More Important Facts About Workers’ Compensation

In addition to understanding what workers’ compensation covers in Texas, there are some other important facts injured workers and their families need to know as well. For example:

1. Texas Law Doesn’t Require Most Employers to Provide Workers’ Compensation Coverage

Unlike other states, Texas does not require private employers to purchase workers’ compensation insurance. Companies have the option to purchase coverage, and many do because it limits their legal liability in the event of a workplace injury. However, not all employers in the state choose to carry workers’ comp insurance.

2. If You Can’t File for Workers’ Compensation, You May Be Able to Sue Your Employer

Workers are generally barred from suing their employers for on-the-job injuries if the employer has workers’ compensation insurance. But, if your employer doesn’t provide coverage, then you may be able to sue for your injury-related losses.

3. Even If You Can File for Workers’ Compensation, This Might Not Be Your Only Option

Even if you can file for workers’ compensation, you may still have other legal options available. For example, you may be able to bring a third party claim if:

You were injured due to the negligence of a property owner who failed to keep the premises safe
You were harmed by a defective product in the course of your work
You were in a work-related motor vehicle accident caused by a careless motorist

If a third party was responsible for your work injury, you are not limited to the benefits provided by workers’ comp. You can pursue compensation for all of your losses.

4. If You Have a Workers’ Compensation Claim, You May Need to See an Approved Doctor

Some employers that purchase workers’ compensation insurance opt to enroll in a workers’ compensation healthcare network. In the event of a work-related injury or illness, the employer must inform the worker that the claim is in a healthcare network.

If you receive notice that your claim is in a workers’ compensation healthcare network, you will need to see an approved doctor for medical expenses to be covered. If your claim is not covered by a healthcare network, you have the right to select your own doctor.

5. You Can Lose Your Rights If You Don’t Take Action Promptly

Regardless of which type of claim or claims you can file, you can lose your rights if you don’t take action as soon as possible after a workplace injury. If you or a loved one has been injured on the job in Houston, you should speak with a lawyer right away.

Contact a Houston Work Injury Lawyer Today

Workers in Texas are in a tough spot if they are injured on the job or become sick as a result of their work. Patrick Daniel Law can help you identify all of your options for pursuing compensation, including workers’ comp, third party claims, and more.

Please call (713) 999-6666 today for a FREE consultation. Houston work injury lawyer Patrick Daniel serves clients throughout Texas.

What Does Workers’ Compensation Cover in Texas?