Texas Workers' Compensation

First steps after a work injury

• Get emergency care right away if you need it
• Report the injury to your employer as soon as possible. Texas law generally requires notice within 30 days
• Ask whether your employer carries workers' compensation insurance and whether the insurer uses a health care network
• Choose a treating doctor and schedule an evaluation

Your treating doctor

Your treating doctor directs your care, completes work status reports and communicates with the insurance carrier. If your employer's carrier uses a certified network, you generally choose a treating doctor from that network. If it does not, you may generally choose any doctor who accepts workers' compensation patients.

Maximum medical improvement and impairment ratings

At some point your doctor will decide you have reached maximum medical improvement (MMI), meaning your injury is not expected to improve much further. An impairment rating is then assigned using the AMA Guides. If there is a dispute, the DWC can appoint a Designated Doctor to examine you. Dr. Stowe has experience with these examinations.

Nonsubscribing employers

Texas is the only state where most private employers can choose not to carry workers' compensation. If your employer is a nonsubscriber, your care may be paid another way. Call us and we will talk through your options.

What are the Texas workers' comp deadlines you cannot afford to miss?

Texas generally gives you 30 days to report a work injury to your employer, counted from the day you were hurt or the day you knew the condition was work related. Separately, you generally must send DWC Form-041 to the Division of Workers' Compensation within one year to protect your rights.

These are two different steps with two different audiences. Telling your supervisor is not the same as filing with the state, and your employer's report to its carrier does not replace your own claim form. Many workers assume the employer handles everything and learn otherwise months later.

There are exceptions in the law for some situations, but relying on an exception is risky. If a deadline has already passed or is close, call the Office of Injured Employee Counsel at (866) 393-6432 or talk to an attorney right away.

• Within 30 days: notify your employer, ideally in writing
• Within one year: send DWC Form-041 to DWC
• Keep proof of both, such as an email or a mailing receipt

How does a certified health care network change your care?

If your employer's carrier uses a certified workers' compensation health care network and you live in its service area, you generally must get care from network providers. You choose a treating doctor from the network's list and need that doctor's referral before seeing a specialist. Emergencies are an exception.

Networks are certified by the Texas Department of Insurance and their service areas are usually set by county. If you do not live inside the service area, you generally are not required to use network providers, and the carrier still pays for your care.

Seeing a doctor outside the network without approval can leave you responsible for the bill. Before your first visit anywhere, ask the adjuster whether your claim is in a network and request the provider list. Call us with that information and we will check where you stand before you book.

How do you choose or change your treating doctor in Texas?

If your claim is not in a network, you generally have the right to choose your treating doctor, as long as that doctor is not on the state's list of doctors barred from workers' compensation care. Texas law counts a licensed doctor of chiropractic as a doctor, so a chiropractor can serve in that role.

Changing doctors works differently in and out of a network. Inside a network, you can pick a new doctor from the list and notify the network, and TDI says the network cannot deny that request. Outside a network, changing for most reasons requires approval from DWC using DWC Form-053, with an explanation of why.

Because a change can take time, it is worth choosing carefully at the start. Look for a doctor who communicates clearly, files reports on time and treats the kind of injury you have.

What is the DWC Form-073 work status report?

DWC Form-073 is the report your doctor files to tell the carrier and your employer whether you can work and with what restrictions, such as limits on lifting, standing or driving. It is filed after your first exam, when your status or restrictions change, and on a carrier schedule of no more than every two weeks.

The report is one of the most important papers in your claim. Your employer uses it to decide whether a modified duty job is available, and the carrier uses it when handling income benefits. A vague report can create confusion on both sides.

Our providers fill out the form based on what your exam shows and what your job requires. You receive a copy, and we encourage you to read it and ask questions if anything does not match what you can actually do.

• Released to full duty without restrictions
• Able to return with specific restrictions
• Prevented from working for a stated period

When do Texas workers' comp income benefits usually start?

Income benefits in Texas generally begin on the eighth day you are unable to work because of the injury. The first week is usually paid later only if the disability lasts two weeks or more. Your treating doctor's work status reports are part of how the carrier decides these payments.

The exact amount depends on your wages and the type of benefit, and the rules are detailed. The carrier or the Division of Workers' Compensation can explain how your benefit was calculated, and OIEC can help if you believe it is wrong.

From a treatment standpoint, our job is to keep your records current and accurate so there are no gaps. Missed appointments and outdated work status reports are common reasons patients run into trouble, so we schedule your follow ups with those dates in mind.

What if your Texas employer is a nonsubscriber?

Nonsubscribing employers must file DWC Form-005 with the state and post a notice telling employees they do not carry workers' compensation. If you are hurt working for one, you may have a negligence claim instead, and Texas law limits several defenses that employer can raise, so an attorney consultation is often worthwhile.

Under Texas Labor Code 406.033, a nonsubscriber generally cannot argue that you were contributorily negligent, that you assumed the risk, or that a coworker caused the injury. Some nonsubscribers offer their own injury benefit plans with separate rules and deadlines, so read any plan documents closely.

Your care still matters in the meantime. We can discuss health insurance, self pay or arrangements through your attorney before treatment starts.

Frequently asked questions

This page is general information, not legal advice. For questions about a claim, talk to an attorney or the agency that handles your claim.