Texas Workers Compensation Injured Worker Rights Guide

This Guide should not be a substitute for representation by an attorney.  You should have an attorney explain to you how the laws apply to the specific facts of your case. 

You have the right to receive benefits for a compensable workers compensation injury.  Your claim must be considered compensable in order to receive benefits.  There are numerous decisions regarding compensability of an injury that are applied to determine if you will receive any benefits.

These benefits include medical care to treat your injury or illness.  There is generally no time limit to receive this medical care as long as it is medically necessary and related to your injury. There are rules regarding payment and reimbursement of medical treatment that may affect whether payment is made to your doctors or to you, if you have already paid for the treatment.  There are treatment guidelines that affect the amount of treatment you will receive for your injury.

How do you find a doctor to treat you for your workers compensation claim?  
  • There is a list of doctors who are approved to treat workers compensation cases.  Your doctor must be on the approved treating doctor list. If your employer or insurance company does not use a workers compensation health care network, you may choose any doctor who is willing to treat your workers compensation injury.
  • What is the network?  If your employer or insurance company uses a workers compensation health care network, you must choose your doctor from the network's treating doctor list. 
  • If your employer is a political subdivision, such as a city, county, or school district, you must follow its rules for choosing a treating doctor.  
  • If you do not follow the rules for choosing a treating doctor that is within the workers compensation system, you may be held responsible for payment of the medical bills.
You have the right to be examined by your doctor and to talk to your doctor by yourself, alone, without extra people in the room who are from your employer or from the insurance company.  This includes a "medical case manager" or "nurse case manager" who works for the insurance company or your employer.  You can simply tell these people to please leave the room.  They are required to leave the room.  You have a physician patient privilege that allows you to see your treating doctors on a one on one basis, just you and the physician.  Some employees think that the medical case manager or nurse case manager is with the state agency.  She is not with the state agency.  She works for the insurance company or for your employer.  

You have the right to receive a copy of your medical records from any doctors who treat you or examine you for your workers compensation claim.  The doctors are required to provide you with a copy of these medical records.

You have the right to choose to have an attorney represent you on your claim.  When you have hearings on the claim, the insurance company usually has an attorney to represent them at the hearings.  The hearings follow specific procedures that are set forth in the Administrative Procedure Act, the Labor Code, and Division of Workers Compensation Rules.  There are rulings from prior hearings that may be applied to your case by the hearing officer.  If you have the chance to have an attorney represent you, it is better for you to have an attorney to fight the insurance company's lawyer.  Attorneys also see things in files that you don't see and understand how those things will affect your case.  Attorneys understand how things that happen at hearings at the Division affect cases when they reach the courthouse.  The contested case hearing at which you testify will be recorded and the transcript will be available at the trial.  Even if you win the contested case hearing, the insurance company can appeal the hearing decision and take you and your case on appeal to the Appeals Panel in Austin and to District Court.

Often, you can not find an attorney who is able to represent you.  This is because there are not very many attorneys handling workers compensation in Texas.  A recent article in the American Bar Association Journal stated that there are about 30 attorneys throughout the whole state of Texas who handle workers compensation claims for injured workers.  In my experience, the few attorneys that are still in the workers compensation system are good people who are sincerely trying to help injured workers.  They do their best to help as many people as they can.

The fact that you can not find an attorney does not mean you have a bad claim or that you shouldn't pursue your rights.  You have the right to receive assistance from an ombudsman, who is an employee of the Office of Injured Employee Counsel.  The Office of Injured Employee Counsel is a state agency that provides assistance to injured employees who do not have attorneys.  There is at least one ombudsman in each local field office.  You have the right to have the ombudsman assist you at the benefit review conferences, contested case hearings and appeals on your claim.  The ombudsman is not an attorney, although it is remotely possible that you may encounter an exception.  The ombudsman can not sign documents for you.  The ombudsman can not make decisions for you.  The ombudsman can not give you legal advice.  The ombudsman can not represent you in court if you or the insurance company takes your case to court.

You have the right for your claim information to be confidential.  The employer and the insurance company for your claim have the right to access your claim file.  If you have filed for workers compensation in Texas prior to this injury, the insurance company may request copies of old claim files from the Division of Workers Compensation.  Insurance companies may also share information about your past claims, even if these were liability claims, such as from motor vehicle accidents.  An employer that is considering hiring you may obtain limited information about your past claims from the Division of Workers Compensation.

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