An explanation of the Texas Workers' Compensation Act
Workers' compensation laws in the State of Texas are defined by the
Texas Workers' Compensation Act. The statute was
created to protect both the employer and the employee. The rules
outlined in this act take effect when an
employee is injured while in the course and scope of his job, AND
his employer has workers' compensation insurance. Ultimately, an
employer chooses whether or not to participate, or subscribe, to the
protection offered by the Act. The employee is more or less subjected to
one of two sets of rules depending upon that decision made by the
employer. This double set of rules determining the rights of the worker have led to what is known in the legal world as Workers' Comp Law and Non Subscriber Law. (To learn about Non Subscriber cases, click here)
The Act is a benefit to the employer because the injured employee
cannot sue his or her employer in the event he or she is injured on the
job for any reason. The injured employee may receive a life altering
injury including paralysis and still not have the ability to sue his or
her employer, because the employer is a subscriber to the Act.
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The benefit to the employee is that there is at least some type of
insurance coverage that, in theory, should cover reasonable and
necessary
medical bills, so long as the employee can prove that the injury was
incurred on the job. If the employer subscribes to workers' comp
insurance, it lessens the chance that the employee gets nothing, as is
often the case when the employer simply has no money to pay to an
injured worker. The employee is also entitled to receive a
percentage of his lost wages for a certain number of weeks. The amount
of weeks the employee is entitled to is determined by the extent of the
injury and the impairment rating that the doctor determines. Generally
speaking, an employee does not receive any lost wages compensation for
the first 7 days that they are out of work. So, if an employee misses
15 says of work, they only start getting compensated on day 8. However,
if the employee misses 30 consecutive days of work, or more, then they
are retroactively compensated for the first 7 days.
To recap, if the employer has workers' comp insurance, the
laws of the Workers' Compensation Act apply to any injured employee
that works for that company. The employer is protected because they
cannot be sued by the employee for their involvement in the injury. The
benefit to the employee is that there is at least some money for the
employee to tap into if they are injured. The workers' comp insurance
policy will pay for their medical expenses and pay some percentage of
their income while they are unable to work, even if they can never work
again.
However, the above is how it is "supposed" to work. In
reality, many employers try to bend the rules in order to avoid paying
an increased premium for their workers' comp insurance. They often
resort to unscrupulous tactics that are neither fair or legal. Also,
many workers' comp insurance carriers require that the employee sees a
doctor of their choosing who may or may not have the best interests of
the employee in mind. Once an employee faces this type of opposition,
they will need the help of a Houston workers' compensation attorney as the case will ultimately go before the Texas Workers' Compensation Commission which will ultimately resolve all disputes.
Complications with Workers' Compensation Law
There are many issues that arise in Texas workers' comp cases. Most
attorneys do not accept these types of cases since the passage of the
new workers' comp laws in 1992. Before 1992, a lump sum payment could be
made by the employer or their insurance carrier for past monies owed to the employee. After the passage of
the new laws in 1992, a lump sum payment arrangement is no longer
possible. Furthermore, the fees that an attorney can charge are defined by the
Act. The fee schedule effectively discourages lawyers’ involvement in
these types of cases. As a result, many employees who need legal
representation are not able to obtain it. Thus, when an employee goes
in front of the Commission without an attorney and the workers comp
insurance co shows up with an attorney, it is not a fair fight.
Exceptions to the Workers' Comp Rules
There is one major exception to the rules regarding an employee's inability to file a lawsuit because the employer is protected by workers' compensation insurance. Three criteria must be met:
- The employee has to have died as a result of their injuries
- The employee must have financial dependents
- The employer must be shown to have committed gross negligence
The other major exception is when the employer does not subscribe to workers' compensation insurance at all. This part confuses most non-attorneys, but there are ultimately two sets of laws related to work injuries: worker's compensation laws which apply when the employer chooses to participate, and non subscriber laws which apply when the employer does not wish to participate in worker's comp insurance. (Click here to learn about non subscriber laws.)
The benefit of hiring the Grossman Law Office workers compensation lawyers in these types of cases is
that you will not go in front of the Commission without legal counsel.
We can make this a “fair fight”. These workers comp insurance companies
like Zurich need to know that you will not be taken advantage of
because you do not have an attorney.
Many times the workers' comp carrier will make arguments that you were
not hurt on the job, but instead you were hurt getting out of the
shower, picking up your kids, or mowing the lawn. Houston Grossman Law Offices partners with qualified medical professionals who can evaluate your injuries and provide a solid medical opinion to verify the proximate cause
of your injuries.