Your Rights in the Texas Workers’ Compensation System:

1. You may have the right to receive benefits.

You may receive benefits regardless of who was at fault for your injury with certain exceptions, such as:

• You were intoxicated at the time of the injury;
• You injured yourself on purpose or while trying to injure someone else;
• You were injured by another person for personal reasons;
• You were injured by an act of God;
• Your injury occurred during horseplay; or
• Your injury occurred while voluntarily participating in an off-work activity.

2. You have the right to receive medical care to treat your workplace injury or illness. There is no time limit for this medical care.

 3.  You have the right to choose your treating doctor.  If you are in a workers’ compensation health care network, you can choose your doctor from the network’s treating doctor list.  If you are not in a network, you can choose a doctor from the Approved Doctor List. This list is kept by the Division of Workers’ Compensation.

 It is important to follow all the rules in the workers’ compensation system. If you don’t follow these rules, you may be held responsible for payment of medical bills.

 4.  You have the right to hire an attorney at any time to help you with your claim.

 5.  You have the right to receive information and assistance from the Office of Injured Employee Counsel at no cost. 

Staff is available to answer your questions and explain your rights and responsibilities by calling the toll free telephone number 1-866-EZE-OIEC (1-866-393-6432).

 6.  You have the right to receive ombudsman assistance if you do not have an attorney and a dispute resolution proceeding about your claim has been scheduled.   

An ombudsman is an employee of the Office of Injured Employee Counsel. Ombudsmen are trained in the field of workers’ compensation and provide free assistance to injured employees without attorneys. Ombudsmen cannot sign documents for you, make decisions for you or give legal advice. Proceedings about your claim may include benefit review conferences (BRCs) or contested case hearings (CCHs).  Proceedings are held at local field offices. At least one ombudsman is located in each local office.

 7.  You have the right for your claim information to be kept confidential.

In most cases, the contents of your claim file cannot be obtained by others. Some parties have a right to know what is in your claim file, such as your employer or your employer’s insurance carrier.  Also, an employer that is considering hiring you may get limited information about your claim from the Division of Workers’ Compensation. 

Your Responsibilities in the Texas Workers’ Compensation System

 1.   You have the responsibility to tell your employer if you have been injured at work or in the scope of your employment. 

You must tell your employer within 30 days of the date you were injured or first knew your injury or illness might be work related.

 2.   You have the responsibility to know if you are in a workers’ compensation health care network (network). 

If you do not know whether you are in a network, ask the employer you worked for at the time of your injury.  If you are in a network, you have the responsibility to follow the network rules.  Your employer must give you a copy of the Texas Department of Insurance network rules.  Read the rules carefully.  If there is something you do not understand, ask your employer or call the Office of Injured Employee Counsel.  If you would like to file a complaint about a network, call the Customer Help Line at 1-800-252-3439.  Or file a complaint online at http://www.tdi.state.tx.us/consumer/complfrm.html

 3.  You have the responsibility to tell your doctor how you were injured and whether the injury is work related.

 4.   You have the responsibility to send a completed claim form (DWC-41) to the Division of Workers’ Compensation.  You have one year to send the form after you were injured or first knew that your illness might be work related. 

Send the completed DWC-41 form even if you already are receiving benefits.  You may lose your right to benefits if you do not send the completed claim form to the Division of Workers’ Compensation.  Call 1-800-252-7031 or 1-866-393-6432 for a copy of the DWC-41 form.

 5.   You have the responsibility to provide your current address, telephone number, and employer information to the Division of Workers’ Compensation and the insurance carrier. 

  6.   You have the responsibility to tell the Division of Workers’ Compensation and the insurance carrier any time there is a change in your employment status or wages.  Examples include:

• You stop working because of your injury;
• You start working; or
• You are offered a job.

These righs and responsibilities can be found at http://www.tdi.state.tx.us/wc/employee/workerrights.html.