RBA Insurance of Texas

624 W Bedford-Euless Rd.
Building A
Hurst, TX 76053
866.268.8844
817.268.3143 metro
817.282.4315 fax

2716 N Beltline Rd
Irving, TX 75063
888.314.9328
972.252.9328 metro
972.659.0672 fax

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This website is not meant to be tax or legal advice and that everyone should seek tax or legal advise from their tax or legal advisors.

Worker's Compensation FAQ

What is worker's compensation?

1. Workers' compensation is a state-regulated insurance program that pays medical bills and replaces some lost wages for employees who are injured at work or who have work-related diseases or illnesses. Workers' compensation will pay for the medical treatment of an injury or illness if:

• The injury occurred at work or the disease or illness is job-related; and
• The worker's employer has workers' compensation insurance or is certified by the Texas Workers' Compensation Commission to self-insure.

2. Workers' compensation will also replace some of the worker's lost wages if:

• The injury or illness caused the worker to lose some or all income for more than seven days.

3. Texas employers may choose whether or not to maintain workers' compensation insurance. Employers who choose to have insurance may:

• Purchase insurance policies from private insurance companies; or
• Self-insure, if they meet the requirements of the Texas Workers' Compensation Act and are certified by the Texas Workers' Compensation Commission. Self-insured employers have the same rights and responsibilities as employers who buy policies from private insurance companies.

What are the Texas injured worker responsibilities?

1. An injured worker has the responsibility to tell his or her employer about a work-related injury or illness. An injured worker must tell his or her employer within 30 days of the date of the injury, or within 30 days of the date the worker first knew the illness might be work-related. The injured worker, or someone helping the worker, may either talk with or write the employer or any supervisor at the worker's place of employment. If an injured worker does not tell the employer within 30 days, the worker could lose the right to get benefits.

2. An injured worker has the responsibility to fill out a claim form and send it to the Commission. An injured worker must send a completed claim form, called a TWCC-41, to the Commission within one year of the date the worker was injured, or within one year of the date the worker first knew the illness might be work-related. The completed claim form must be sent to the Commission even if the worker is already getting benefits. If an injured worker does not send the form within one year, the worker could lose the right to get benefits. Copies of the claim form may be obtained by calling any field office, or by calling 1-800-252-7031.

3. An injured worker has the responsibility to tell the Commission and the insurance carrier any time the worker's income changes. An injured worker who is not getting benefits and who has changed employers since the injury must tell the Commission if the injury causes the worker to miss work or lose income. Call 1-800-252-7031. An injured worker who is getting benefits and who has changed employers since the injury must tell the Commission and the insurance carrier paying benefits if the worker's income changes. The injured worker must tell the Commission and the insurance carrier regardless of whether income went up or down. An injured worker who has stopped working since the injury must tell the Commission and the insurance carrier if the worker starts working again or has a job offer.

4. An injured worker has the responsibility to tell the doctors how the worker was injured and if the worker believes the injury may be work-related. If possible, an injured worker should tell the doctor before the doctor provides treatment.

5. An injured worker has the responsibility to tell the Commission and the insurance carrier how to contact him or her. An injured worker should contact the Commission and the insurance carrier if the worker's home address, work address, or phone number changes, so the Commission and the insurance carrier will be able to contact the worker when necessary.

What are the Texas injured worker rights?

1. An injured worker may have the right to receive benefits. An injured worker may receive benefits regardless of who caused or helped cause the injury. An injured worker may not receive benefits if:

• the injury occurred while the worker was intoxicated
• the worker injured himself or herself intentionally or while unlawfully attempting to injure someone else
• the worker was injured by another person for personal reasons
• the worker was injured while voluntarily participating in an off-work activity
• the worker was injured by an act of God or
• the injury occurred during horseplay.

2. An injured worker has the right to receive the medical care reasonable and necessary to treat a work-related injury or illness without any specific time limit.

3. An injured worker has the right to the initial choice of doctor. An injured worker may not change doctors except with the approval of the Commission. An injured worker does not need to get approval to go to a different doctor

• for emergency treatment
• if the worker or the doctor moves or
• if the doctor is unable to continue treating the worker.

4. An injured worker has the right to hire an attorney to help the worker get benefits or to help resolve disputes.

5. An injured worker has the right to receive assistance from appropriate, qualified Commission staff and, in the event of a dispute resolution proceeding, from a Commission ombudsman free of charge. Injured workers may request assistance by calling the field office handling their claims, or by calling 1-800-252-7031. An injured worker has the right to receive information and assistance regarding the worker's claim. Commission staff will explain the worker's rights and responsibilities under the Texas Workers' Compensation Act. Additionally, an injured worker has the right to be assisted by a Commission ombudsman in informal dispute resolution and in administrative proceedings if the worker is not represented. However, an ombudsman cannot serve as a legal representative or attorney.

6. An injured worker has the right to confidentiality. Only people who need to know such as the injured worker's doctor, employer, or employer's insurance carrier may see information in the Commission's files. A prospective employer may get limited information from the Commission about an injured worker's claims, however.

What are the Texas Employer Responsibilities?

Reporting injuries and other information
1. An employer must tell the insurance carrier about each:

• work-related injury that causes a worker to miss more than one day of work
• occupational illness that the employer knows about, even if the worker has not missed any work
• work-related fatality

2. An employer may report injuries by mail, fax, phone, or by electronic transmission. The employers should keep a record of the date the injury is reported to the carrier.

3. An employer must notify the carrier within eight days of the date, if:

• a worker misses more than one day of work because of a work-related injury
• the employer learns that a worker has a work-related disease or illness
• a worker dies because of a work-related injury or illness.

4. The employer must send a copy of the report of injury to the worker at the same time the injury is reported to the carrier. The copy sent to the worker must include a statement explaining the worker's rights and responsibilities. The statement must be in wording specified by the Commission. The insurance carrier may send a copy of the report of injury and the statement of rights and responsibilities to the injured worker for the employer. However, the employer has the ultimate responsibility to ensure that the worker receives the information. If an employer does not send a copy of the report and the statement to the worker, or if the employer does not ensure that the worker receives the information, the employer could be fined up to $500 per occurrence.

5. An employer must report an injured worker's wages and other compensation to the insurance carrier. The employer must send form TWCC-3, Employer's Wage Statement, to the carrier within 30 days of the date income benefits begin to accrue. The employer must also send a copy of the form to the worker. A copy of the wage statement should not be sent to the Commission unless the Commission asks for it.

6. An employer must report any changes in an injured worker's pay or employment to the carrier. The employer must send form TWCC-6, Supplemental Report of Injury, to the carrier within

• 10 days of the end of a pay period in which an injured worker's pay changes
• 10 days of the date an injured worker resigns or is terminated
• three days of the date an injured worker returns to work
• three days of the date an injury causes a worker to miss additional work after returning to work.

7. The employer must also send a copy of the form to the worker. If an employer does not send the required forms, or does not send them on time, the employer could be fined up to $500 per occurrence.

Record-keeping responsibilities

1. An employer must keep a record of work-related injuries, illnesses, and fatalities. An employer must keep the injury and fatality records for at least five years from the last day of the year in which the injury or fatality occurred, or for the period of time required by the Occupational Safety and Health Administration, whichever is longer. If an employer does not keep these records, the employer could be fined up to $500.

Notice responsibilities

An employer must post notices in the workplace telling workers that:

• the employer has workers' compensation insurance and telling workers the name of the workers' compensation insurance company
• the Commission has staff to explain their rights and responsibilities and to help resolve disputes about claims
• the Commission has a 24-hour, toll-free hotline to report suspected safety violations in the workplace.

Posted notices must be in the wording and format adopted by the Commission. If an employer does not post these notices, the employer could be fined up to $1,000.

1. An employer must give new workers a written notice that includes the information in the posted notices. The written notice must also tell new workers that they have the right to choose not to be covered by the employer's workers' compensation policy. Workers have five days from the date they begin employment to tell the employer if they do not want to be covered by the policy. The written notice to new workers must be in the wording adopted by the Commission. If an employer does not provide this notice to new workers, the employer could be fined up to $500 per occurrence.

2. An employer must give all workers written notice if the employer cancels a worker's compensation policy or if the carrier cancels the policy. The notice must be given to workers within 15 days of the date the employer cancels the policy or is notified that the carrier intends to cancel the policy. If an employer does not provide this notice to workers, the employer could be fined up to $500 per occurrence

Other responsibilities

1. If an employer has 15 or more employees, the employer must have a policy to eliminate drug abuse in the workplace. Employers must give a copy of the policy to each worker. A free copy of the Commission's Drug-Free Workplace Resource Guide, which includes information on developing a drug-free workplace policy, can be downloaded from our safety and health publications page. Employers can also obtain a free copy by contacting the Commission's Health and Safety Resource Center at 512-804-4620, or at MS-25, 4000 South IH-35, Austin, Texas, 78704-7491.

2. If an employer is identified by the Texas Mutual Insurance Company to participate in the START/Rejected Risk program, or, if the employer is a public employer identified by the Commission as a hazardous employer, the employer must adopt an accident prevention plan developed by an approved consultant. (See Rule 164.3 and 165.2) The consultant must be an Approved Professional Safety Source and may be obtained from the Commission, the employer's insurance carrier, or from the list of private consultants provided by the Commission. If an employer, who is required to adopt an accident prevention plan, fails or refuses to do so, the employer could be fined up to $5,000 per day of noncompliance.

What are The Texas Employer's rights?

1. An employer has the right to contest the compensability of a claim if the insurance carrier accepts liability. Contesting the compensability of a claim means the employer can argue in dispute resolution proceedings and in court that the worker's injury did not occur or that the injury or illness was not job related.

2. An employer has the right, if the employer has asked the insurance carrier in writing, to have the carrier tell the employer of any dispute resolution or court proceeding related to an employee's claim or any proposal to settle the claim.

3. An employer has the right to attend any dispute resolution proceeding related to a claim filed by one of the employer's workers.

4. An employer has the right to present relevant evidence about disputed issues at dispute resolution proceedings.