In this article, Dallas workmans comp attorney Michael Graham discusses the basics of a work injury claim and the various types of compensation that an injured worker may be eligible to receive.

The purpose of and significant elements in a Texas workers’ comp case

What exactly is Texas Workers Compensation?

If you have been injured on the job in Texas, chances are that your employer is covered by a workers’ comp insurance policy. Workers’ compensation coverage is more than a simple insurance policy that covers an injured worker. In fact, it is the culmination of tort reform efforts whereby the legislature amended the conventional work injury laws and put in place a system to resolve on-the-job injuries with fewer burdens on the employers. Workers’ comp is very pro-business and an injured worker’s rights are somewhat limited. It is for this reason that an experienced Texas workers compensation attorney can be a valuable asset in the event that you are injured on the job. Such a lawyer can help you navigate through the various loopholes and nuances of the law in order to receive maximum compensation in spite of the fact that the laws are fairly skewed in your employer.

Workers’ compensation in Texas has generally been overseen by the Texas Workers’ Compensation commission, which is now a subsidiary of the Texas Department of Insurance. In a practical sense, an employer will choose to opt in to Texas workers’ comp coverage and they will pay a monthly premium to an insurance company that has been approved to provide such coverage in Texas. When an employee is injured, the employer will turn the claim over to their insurance company who will review the claim and make decisions with regard to whether or not the injured worker is covered and what type of benefits they are eligible to receive. Frankly, the insurance carrier often has too much latitude with regard to how the claim is handled and it’s quite common for them to shortchange the injured worker and unfairly deny them the benefits that they should receive. Naturally, having your own legal counsel is the best way to ensure that the insurance company does not unfairly deny your benefits.

When does workers comp coverage apply and what compensation does the employee receive?

Perhaps the biggest benefit of workers comp coverage is that it is essentially no-fault coverage. This means that so long as the employee was performing their normal work duties and they were not under the influence of drugs or alcohol that the injury should be covered regardless of how the injury happened, in theory. Generally speaking, the mere fact that it happened on the job is typically enough to ensure that the claim will at least be processed. In theory, an injured worker who is covered by an official Texas workers comp policy should receive compensation for some portion of their lost wages, payment of medical expenses incurred to treat the injury, compensation for long term impairment or disability, and reimbursement for some incidental expenses. The problem is that the insurance company will often unfairly deny coverage of one or more of these types of compensation. For instance, if a worker injures his back while on the job and the insurance company discovers that he had a prior back injury (even if it is unrelated), they will often take advantage of that technicality and deny the claim.

How workers comp claims work

Unlike most other forms of personal injury cases, workers’ comp cases typically do not involve a judge, jury, or court house. Instead these claims are handled through an administrative process by a special board that is operated by the Texas Department of Insurance. This is a paperwork-intensive process whereby the claimant must carefully navigate his way through or the claim can be unfairly denied as a matter of protocol. It is vital to partner with an experienced lawyer that can help you make the most of your workers’ comp claim. In the event that the benefits are disputed, your attorney will assist you with an appeal. In some instances, multiple appeals will need to be made.