No matter where you work or what type of work you do, you may suffer an injury or illness from work-related duties. No one should suffer injuries or die when working. But, if it happens to you and your family, the consequences may hurt, scare, and devastate you. You need help, including medical care and financial assistance.
If you are an injured worker, obtaining the benefits you should receive may be difficult and complicated. However, you are not alone. Our San Antonio workers’ compensation attorneys at Sibley Dolman Gipe Accident Injury Lawyers, PA, can explain your legal options, protect your rights, and guide you through the process.
An Overview of San Antonio Workers’ Compensation Law
Work-related injuries and illnesses are shockingly common. Workers die approximately every 99 minutes from an occupational injury or illness. According to OSHA statistics, 5,333 workers died on the job in 2019. The fatality rate was 2 percent higher than in 2018 and represented the highest figure since 2007. According to statistics reported by Texas private industry employers in the Survey of Occupational Injuries and Illnesses (SOII), there were 187,600 non-fatal cases in 2019. The national incident rate was 2.8 cases per 100 equivalent full-time workers, and the rate in Texas was 2.1 cases per 100 equivalent full-time workers.
To protect those employees, the workers’ compensation program covers medical and disability-related costs associated with a work-related injury or illness, generally regulated by individual states. Employers pay for workers’ compensation insurance. Unlike other types of injury claims, workers have the right to receive workers’ compensation benefits no matter who was at fault for a workplace injury or illness. Employees sometimes hesitate to report injuries because they fear retaliation. However, as provided in Chapter 451 of the workers’ compensation law, employers may not discriminate or take retaliatory action against employees who have filed or are in the process of filing workers’ compensation claims.
Workers’ compensation typically pays medical bills and replaces lost wages if an employee suffers a work-related injury or illness.
It will pay for the medical treatment of an injury or illness if:
- The injury or illness is job-related; and
- The worker’s employer has workers’ compensation insurance or is certified to self-insure by the Texas Department of Insurance, Division of Workers’ Compensation.
Workers’ compensation will also replace some of the worker’s lost wages if the worker loses some or all of their income for more than seven days due to injury or illness.
Every state has its own workers’ compensation programs and laws, which serve to aid injured workers in the aftermath of work-related accidents. In Texas, workers’ compensation began in 1913, when the Texas Legislature passed a law establishing the Industrial Accident Board and the Texas Employers’ Insurance Association to compensate employees for injuries or fatalities caused by accidents on the job. Subsequently, a Workmen’s Compensation Law, passed in 1917, continued support for the compensation movement.
There are workers’ programs in every state, including Texas. However, Texas is unusual because it does not require workers’ compensation coverage. Except for certain public employers, under Texas Labor Code Chapter 406, workers’ compensation insurance is elective coverage. Texas employers may choose whether or not to carry workers’ compensation insurance.
Those employers who decide to carry workers’ compensation insurance may:
- Purchase insurance policies from private insurance companies; or
- Self-insure, provided they qualify under the Texas Workers’ Compensation Act and are certified by the Texas Department of Insurance, Workers’ Compensation Department. Self-insured employers must uphold the same responsibilities as those who purchase from private insurance companies.
Employers who choose not to maintain workers’ compensation insurance are commonly referred to as “non-subscribers.” An employer that does not obtain this type of insurance coverage must notify the Division of Workers’ Compensation in writing. In addition, these employers must notify employees of the status of workers’ compensation coverage when they are hired, and they must post notices around the workplace to inform employees whether or not the employer carries workers’ compensation insurance.
An employer who is a non-subscriber is open to lawsuits from employees injured on the job, which may lead to an expensive damages award. Also, some of the defenses that may apply in other lawsuits may apply to a non-subscriber in a lawsuit based on a job injury.
Lawsuits Arising From San Antonio Work-Related Injuries
An employee injured on the job in Texas is generally limited to seeking recovery by filing a workers’ compensation claim unless the employer is a non-subscriber. If the employer carries workers’ compensation insurance, the injured employee cannot generally pursue a claim in civil court for the injury. However, there are some exceptions to this rule. These include situations involving a fatal injury that resulted from gross negligence. The second exception involves intentional injuries.
Typically, a worker who may receive benefits through workers’ compensation cannot sue for damages such as pain and suffering. However, the worker may still have the right to file a claim against a third party (someone not working for the employer) for causing a job-related injury or illness. Filing a third-party claim might affect workers’ compensation benefits, so if you are considering this option, consult a workers’ compensation attorney.
Third parties whom you may hold liable include:
- Contractors who are not the employer. There may be more than one contractor working for the same employer. A contractor, or sub-contractor, who causes an injury may be liable.
- Engineers and architects. Architects and engineers may contribute to a project. However, any errors, such as a faulty design or structural flaw, may be critical and cause a worker’s injury.
- Property owners. If the property owner knew about the hazard or should have known, they may be responsible unless they take steps to warn others or correct the condition.
- Car accidents in a company vehicle. If a motor vehicle accident occurs while someone is on the road performing work-related tasks, the person who caused the car accident may be a liable third party.
- Equipment manufacturers. Those who manufacture and sell all kinds of tools, equipment, and machines that workers use during their employment may be liable. For example, if the brakes on a forklift are defective or malfunction, the employee may file a product liability claim.
- Materials suppliers. Certain products pose unreasonable health and safety hazards, such as toxic substances or unstable scaffolding materials.
- Co-worker negligence. An employee might have a third-party claim for their injuries if a co-worker caused the injury willfully or through gross negligence.
Contact us at Sibley Dolman Gipe Accident Injury Lawyers, PA, to discuss your legal options.
Workers Who Commonly Suffer Injuries and Illnesses
In Texas, the oil and gas industry is particularly prone to workers’ compensation claims.
According to the Bureau of Labor Statistics, ten occupations accounted for 33.2 percent of all private industry cases involving days away from work in both 2018 and 2019.
- Nursing assistants
- Truck drivers—heavy and tractor-trailer
- Laborers and freight, stock and material movers
- Light truck drivers
- Construction laborers
- Maintenance and repair workers
- Stockers and order fillers
- Janitors and cleaners, except maids and housekeepers
- Registered nurses
- Retail salespersons
Laborers and freight, stock, and material movers had the highest number of cases resulting in days away from work, followed by heavy and tractor-trailer truck drivers.
In Texas, as with all states, the coronavirus has had a devastating impact on individuals, employers, and the workers’ compensation system. The circumstances constantly change, but in Texas, pending legislation may decide whether coronavirus cases are occupational injuries.
The U.S. Bureau of Labor Statistics’ 2019 data shows five categories of common causes of non-fatal workplace injuries.
- Extreme exertion
- Slips, trips, and falls
- Contact with equipment and other objects
- Attacks and violence involving other persons or animals
- Transportation accidents
Some workplace injuries are more common than others, but they may affect each victim’s life and ability to earn a living differently. Workers may also suffer catastrophic physical, cognitive, or spinal injuries, as well as progressive and incurable diseases. These types of serious health conditions may require life-long care.
Common injuries include:
- Strains or sprains
- Pain or lingering soreness or pain
- Cuts, lacerations, and punctures (approximately nine incidents per 10,000 full-time workers)
- Bumps and bruises
- Broken bones
From most to least, the injuries that cause employees and independent contractors to miss the most time from work are:
- Multiple injuries with fractures
- Carpal tunnel syndrome
- Strains, sprains, and tears
- Multiple traumatic injuries
- Soreness or pain
- Multiple sprains and soft tissue injuries
- Bumps and bruises
- Cuts, lacerations, and punctures
- Chemical burns
The number of fatal workplace accidents has increased. According to the Bureau of Labor Statistics, common causes of fatal workplace accidents are:
- Transportation accidents (2,080 fatalities in a recent year).
- Violence and other injuries caused by persons or animals (828 fatalities in a recent year).
- Falls, slips, and trips (792 fatalities in a recent year).
- Contact with objects and equipment (786 fatalities in a recent year).
- Exposure to harmful substances or environments (621 fatalities in a recent year).
- Fires and explosions (115 fatalities in a recent year).
Depending on the nature and extent of an injury or illness, in general, benefits available to Texas workers may include:
- Workers’ compensation pays for all necessary medical treatment for a work injury, as long as it has been recommended or approved by your treating doctor. This may include medical care such as emergency care, doctor visits, tests, medicines, adaptive equipment, and reasonably necessary travel expenses.
- Temporary income benefits. If you have to miss work while recovering from your injury, or your injury keeps you from earning your usual wages, you may be eligible for temporary income benefits. A formula generally may determine the difference between your average weekly wages and the wages you earn after your injury.
- Supplemental income benefits. After your impairment income benefits have run out, you may receive supplemental income benefits if you meet all the qualifications.
- Texas also allows lifetime income benefits for a limited number of very severe types of impairments, such as spinal injuries, blindness, and traumatic brain injuries.
- Vocational rehabilitation. If you cannot return to your normal job, even after you have reached maximum medical improvement, you may go to a vocational rehabilitation program, where you can get training, skill enhancement, and assistance finding a new job.
- Death benefits. If your job illness or injury is fatal, your spouse, children, or other dependents may be eligible for benefits.
What to Do After a San Antonio Work-Related Injury or Illness
If you sustain injuries in a work-related accident:
- Obtain medical treatment. If your injury is serious or obvious, such as a broken bone or torn muscle, you should request medical treatment as soon as possible after the injury occurs. However, some injuries are not apparent or worsen over time, so it is essential to see a medical professional. Another thing to remember is to make sure the first medical provider you see documents how you injured yourself. This can help if an issue arises with the insurance carrier regarding how you injured yourself or when you injured yourself at work.
- Notify your employer. In Texas, you must notify your employer, supervisor, or someone in a supervisory role if you suffered a work-related injury or illness. You should do this in person and in writing. Always keep a copy of any notice or injury report. You have 30 days to report a work-related injury, but even if you think the injury is minor, it is best to do so as soon as possible. If there is a significant delay in reporting the injury, the insurance carrier may question how and when the injury took place.
- Contact a workers’ compensation attorney at Sibley Dolman Gipe right away. Delays or missing important deadlines may affect your claim.
San Antonio Workers’ Compensation FAQs
Workers’ compensation was established in the United States over a century ago. Its main purposes were to prevent injured workers and their families from living in poverty and reduce the conflicts between employers and employees when accidents occur. It is sometimes called the “grand bargain” because regardless of fault, the employee receives workers’ compensation benefits but may not file a lawsuit arising from the injury against the employer.
However, workers’ compensation laws do not always mean that an injured employee gets the compensation they deserve. If you suffered an illness or injury on the job, a San Antonio workers’ compensation attorney can help explain the applicable laws and fight for full and fair compensation on your behalf.
Who must have workers’ compensation insurance in San Antonio?
Individual state law generally governs workers’ compensation, but the federal government administers separate workers’ compensation programs for specific groups, including federal employees.
Texas is the only state that does not require an employer to purchase workers’ compensation insurance. If an employer buys workers’ compensation insurance, then the injured employee cannot sue the employer for the injury. However, if the employer does not buy workers’ compensation insurance (nonsubscribers), then the employee can sue the employer for job-related injuries or illness.
What is the difference between an employee and an independent contractor?
Generally, independent contractors are not employees of a company, so workers’ compensation insurance policies do not cover them. Therefore, designating a worker as an employee or an independent contractor can be a complicated legal issue.
Fundamentally, an employer exerts direction or control over an employee. They also have responsibility for wage and tax reporting. An independent contractor is self-employed. He or she is not under an employer’s direction and control. An independent contractor must pay their own taxes and expenses. Fundamentally, a worker is one or the other, although in some cases, employers wrongfully identify employees as independent contractors to avoid paying workers’ compensation benefits. As the gig economy has grown, Texas clarified that gig workers are independent contractors.
What does a work-related injury or illness mean?
Workers’ compensation benefits are for employees whose illness or injury is work-related. Work-related means any injury, illness, or condition you suffer during the course and scope of your employment—including physical injuries, occupational illnesses, and repetitive stress injuries. However, there are exceptions to work-related injury coverage.
For example, workers’ compensation does not apply if the employee intentionally caused their own injuries. It also does not cover injuries when an employee is intoxicated or using illegal drugs. If the injury happened outside of work or while voluntarily participating in off-duty sports or social events, or by someone else for personal reasons unrelated to their job, they are probably not covered.
Injuries caused by an “act of God” are generally not covered unless the job had a high risk of exposure to such events.
What benefits does San Antonio workers’ compensation provide?
There are basically four types of workers’ compensation benefits in Texas.
- Income benefits to replace some of your financial losses caused by your work-related injury or illness, including temporary income benefits, impairment benefits, supplemental benefits, and lifetime benefits.
- Medical benefits.
- Burial benefits.
- Death benefits. They go a deceased workers’ family (spouse and children) following a fatal accident.
Who gets to choose the treating doctor?
If you are suffering from an injury or illness, the first priority is obtaining medical attention. Receiving the best possible medical care from a doctor of your choice is an important issue. Your medical care plays an important role in your recovery and may affect your workers’ compensation benefits. An injured or ill employee has the right to decide who becomes the “treating doctor” in their case, so long as the doctor will take a workers’ compensation claim. This medical provider is in charge of treatment and may refer the injured worker to specialists as needed.
To treat injured or ill employees, a doctor must have a current medical license to practice in the jurisdiction, but they do not need prior training or approval from the Division of Workers’ Compensation (DWC).
Employers may try to control your choice of doctor. They may require you to see a doctor at an urgent care center, where they may have contacts. Often an injured employee is referred to the “Company Doctor” after an injury on the job. These medical providers may concern themselves with the best interest of the employer and the employer’s safety quotas. They may downplay your injuries, provide inadequate treatment, or they may return you to full duty or light duty too soon, which could affect your benefits. The “impairment rating” provided by the doctor affects your benefits.
Even if you initially see a doctor of your employer’s choosing, you can still follow up with another doctor. However, when an injured worker goes to the company doctor and continues to see that doctor for 10 days or more, then the company doctor becomes the treating doctor for the claim. So, for the sake of your health as well as your benefits, find a good doctor as soon as possible.
Can you get a settlement in a San Antonio workers’ compensation claim?
As a rule, there are no settlements under Texas workers’ compensation. The injured worker receives compensation in the form of benefits. The difference between workers’ compensation benefits and a settlement is that the injured worker receives workers’ compensation benefits on an as-needed basis, as the expense arises. Settlements are a set amount of money, generally paid in a lump sum at the end of a lawsuit.
Disputes will sometimes arise during a workers’ compensation claim. Sometimes the parties work these disputes out and reach an agreement. In other cases, mediation or a contested case hearing is necessary.
What are the deadlines for San Antonio workers’ compensation claims?
There are many critical deadlines throughout the process of making a workers’ compensation claim, including:
- 30 days to make a report of your injury to your employer. You should file a report within 30 days of the accident or a workplace illness or injury diagnosis. Delaying the report may make it difficult to establish that your injury was work-related.
- 90 days to dispute an Impairment Rating. This rating helps to determine your compensation benefits and eligibility for supplemental income benefits.
- 10 days to dispute a denial of a request to change your doctor. This is also the time by which you may dispute a denial to extend your Maximum Medical Improvement after undergoing spinal surgery.
- Seven days to submit a Supplemental Income Benefits application.
- 10 days to respond to a request by the insurance carrier to undergo a Required Medical Exam.
- 15 days to appeal a Contested Case hearing decision.
- 20 days to choose or decline arbitration after a benefits review conference.
- 30 days after an appeal decision to request that a district court judge review the case.
If you pursue a third-party claim, you must file within the statute of limitations. In most Texas personal injury cases, the statute of limitations is two years from the date the injury occurs. Different deadlines may apply depending on the case.
How do I apply for workers’ compensation benefits in San Antonio?
The quick way is to call us.
If you have a good claim, we can:
- Find out if your employer has workers’ compensation insurance. Workers’ compensation insurance is optional for most Texas employers. So if an employee has a work-related illness or injury, the first step is to establish whether your employer has this insurance coverage. The law requires employers to provide this information to employees, but you can also check your employer’s insurance status through the state’s online database.
- Report the incident to your employer. You must report the incident to your employer within 30 days, or you may lose your right to collect workers’ compensation benefits. However, it is best to do this as soon as possible because delays in reporting may raise a red flag for the insurance company and your employer. You should report the incident even if you think the injury is minor. Make sure that you report all symptoms and the parts of your body that hurt or may be injured.
- Determine where you can receive treatment. Your employer should inform you how to seek medical care. Depending on the circumstances, you may have to choose a doctor from an approved network of physicians. This does not include emergency treatment. Do not forget to tell the medical care provider who treats you that your injury or illness is job-related.
- File a workers’ compensation claim. You initiate a claim by filing an “Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease.” You can do this in person, by mail, or online. The form will ask questions about you, your work status, your injury, and your employer. This is your official workers’ compensation application. You must file the form within one year after your accident, or after you learned about your work-related occupational illness.
Then, the Division of Workers’ Compensation (DWC) will contact your employer and the insurance company so that they can review your claim and decide whether to accept or deny it. Common reasons for denied claims include missed deadlines, disputing that your injury was work-related, issues with the filing date, or disputing certain benefits. If the DWC denies your claim, you may contest the denial.
Keep your own records regarding your injury or illness because, in addition to your workers’ compensation claim, you may have a third-party liability case.
What are my employer’s responsibilities?
While employers have a duty under Texas law to take all actions reasonably necessary to ensure a safe workplace, such as providing appropriate equipment, not all accidents are solely the fault of the employer or the employee.
The employer also has certain duties regarding workers’ compensation, if applicable.
- Reporting workers’ compensation insurance coverage to employees. Employers must notify employees of the status of their workers’ compensation coverage. They must also post a written notice at conspicuous locations at the workplace, in English, Spanish, and any other language common to the employees. These notices must appear in a specifically prescribed wording and format.
- Reporting illnesses and injuries. Employers must report any work-related injury that results in the employee’s absence from the job for more than one day, any occupational disease that the employer is aware of, and any work-related fatality to its insurance carrier within 8 days. The employer must provide a copy of the completed form to the employee.
- Reporting wages and benefits. An employer must report an injured employee’s wages and fringe benefits to the insurance carrier.
What is the difference between San Antonio workers’ compensation and a lawsuit?
Many procedural differences distinguish these two claims.
If a Texas employer has workers’ compensation insurance, an injured employee can pursue a claim for benefits regardless of fault, but they cannot file a lawsuit against the employer for compensation. Although the injured employee does not have to prove fault to obtain workers’ compensation benefits, they may receive less money than they would if they prevail in a personal injury lawsuit. In addition to compensation for medical expenses, a lawsuit may provide compensation for all lost income and non-economic damages, such as pain and suffering and diminished quality of life.
Why do I need a San Antonio workers’ compensation lawyer?
Many complex issues arise in connection with a job-related illness or injury. Every employee has the right to legal support, and without legal advice, errors or delays may affect your claim. An attorney can protect an employee’s rights to obtain the best possible compensation and file legal claims against third parties who contributed to the injury or illness.
A dedicated San Antonio workers’ compensation lawyer can ensure that you receive all benefits and medical treatment available under the law.
When You Need a San Antonio Workers’ Comp Attorney, Call Sibley Dolman Gipe
If you suffer from a work-related injury or illness, you may be dealing with significant financial and personal losses. Workers’ compensation benefits can help you through this difficult time. In some cases, employers or insurance carriers try to restrict your benefits or deny your claim. For more information or a free case evaluation, you can reach Sibley Dolman Gipe Accident Injury Lawyers, PA, at (833) 552-7274, or you can contact us online. We can fight for your rights and your benefits.