WHAT IS THE STATE EMPLOYEES WORKERS’ COMPENSATION PROGRAM?

The State Employees Workers’ Compensation Program provides a financial safety net for state workers who are injured or become ill as a result of their work. This program provides coverage through self-insurance, at no cost to state employees. Funds are appropriated by the Legislature to pay compensation benefits and judicial cost of bona fide claims resulting from job-related injuries.

The State Office of Risk Management Workers’ Compensation Division of the Office of the Attorney General serves as the state’s insurance carrier and claims adjuster.

The Texas Workers’ Compensation Commission (TWCC), a separate state agency, regulated both public and private workers’ compensation insurance, including the State Employees Program. The Commission sets the rules for all insurance carriers, and is charged with protecting the rights of all parties concerned.

WHAT IS COVERED BY WORKERS’ COMPENSATION?

The Workers’ Compensation Act covers on-the-job injuries that occur in the course of work and result in damage or harm to the body. It also covers occupational diseases, which are diseases or infections directly caused by exposure in the workplace. It can provide…

• weekly income benefits in the event income is lost as a result of your injury;
• payments for doctor bills, hospital, medicine, ambulance, and other necessary medical care;
• lifetime Income Benefits for certain severe injuries specified by state law; and
• for death benefits, qualified persons will receive benefits as prescribed by state law.

Weekly income payments are based on your average weekly wage during the 13 weeks prior to the injury. Maximum and minimum payments are established by statute, and payments are almost always less than your full regular wages.

Compensation payments are exempt from all liens except those for attorney fees, court-ordered child support, and recovery of state costs.

Your workers’ compensation benefits are a no-fault type of insurance. Therefore, it is not necessary to prove anyone was at fault for your injury in order to file a claim for state benefits. However, if a private lawsuit shows that a third party caused your injury or illness, the state may recover its costs from the proceeds of the lawsuit.

While it covers payments for medical expenses and lost work time, workers’ compensation is not a form of health insurance, nor does it provide compensation for damage to or loss of personal property.

WHO IS COVERED BY THE STATE EMPLOYEES PROGRAM?

To qualify for benefits under the State Employees Workers’ Compensation Program, you must be an employee of a state agency. Employees of the University of Texas System, Texas A&M University System, and the Texas Department of Transportation are NOT covered by the state employees program, but are covered through their own agencies. The program also does not cover county and local government employees. If you work for one of these, contact your supervisor or personnel office for information on filing a workers’ compensation claim.

If you do not work for the state and are injured on the job, ask if your employer carries workers’ compensation insurance.

HOW DO I FILE A CLAIM FOR WORKERS’ COMPENSATION?

If you have an injury on the job, notify your supervisor, personnel office or agency claims coordinator immediately - no later than 30 days after the injury occurs. The claims coordinator will submit the required forms to our office. If you cannot contact your supervisor, personnel office, or claims coordinator, please call us directly at (512) 465-1440.

Your claims coordinator will complete a Notice of Injury form and send it to our office. Before you sign the form, make sure it includes the following information…

• your name, address, and telephone number;
• the date, time, and place the injury occurred;
• a description of the circumstances and the nature of the injury;
• the names of any witnesses;
• the name and location of your health care provider; and
• the name of the person, if any, acting on your behalf in filing the claim.

After receiving the Notice of Injury, our office will assign an adjuster to process your claim. You should contact the adjuster if you need information that is not available from your claims coordinator.

Ask your doctor to promptly file a medical report on your injury or illness with the Office of the Attorney General, Workers’ Compensation Division, P. O. Box 13777, Austin, Texas 78711-3777. The doctor’s bills may not be paid until a report of your condition if filed.

File a claim with the Texas Workers’ Compensation Commission within one year of your injury. You must do so in order to preserve your legal rights in the event there is dispute over benefits.

The Commission will send you the proper form for filing. The Commission’s address is 4000 South IH-35, Austin, Texas 78704.

HOW ARE BENEFITS PAID?

There is a seven-day waiting period before benefits may be paid. Temporary Income Benefits may be paid for time lost from work beginning with the eight day of disability. Benefits will be paid for the first sevens days (the waiting period) if your disability continues for four weeks. These benefits continue until maximum medical improvements have been reached or 104 weeks have elapsed (whichever comes first). At that time, Impairment Income Benefits and/or Supplemental Income Benefits may become available. Lifetime Income Benefits and death benefits may also be available in some cases.

When you apply for workers’ compensation benefits, you may choose from among several payment options. As an employee, the most advantageous option is to use accrued sick leave before collecting workers’ compensation benefits. You will continue to draw your full salary for the duration of your sick leave (workers’ compensation benefits are almost always less than full salary). Contact your agency claims coordinator for information on other payment options.

WHAT ARE MY LEGAL RIGHTS?

Our workers’ compensation laws govern the rights and responsibilities of both the employee and the employer, and provide remedies in case of a dispute. As an employee…

• You are entitled to necessary medical care provided by a conveniently located doctor and hospital at a reasonable cost.
• You are entitled to an initial choice of doctors. You may change your doctor once if you give the Texas Workers’ Compensation Commission your reasons in writing. A referral by your doctor to another doctor does not count as a second choice.
• You may be entitled to income benefits if you lost income as a result of your injury.
• You may be entitled to partial compensation if an injury permits you to work, but less than your regular wages.
• You may hire an attorney to represents you, if you so choose.
• You may get advice from a Texas Workers’ Compensation Commission ombudsman by calling (800) 252-7031 or (512) 440-5676. The ombudsman will handle all grievances and complaints arising from claims, and will recommend solutions to problems.
• You may request that the Texas Workers’ Compensation Commission arrange a benefit review conference with you, and OAG representative, and the Commission if there is a dispute about your claim.

WHERE CAN I GET MORE INFORMATION?

If you have questions about an injury or claim, contact your agency’s claim coordinator. You may contact the OAG claims adjuster assigned to your case if you need information that is not available from your claims coordinator.

Office of the Attorney General
State Office of Risk Management
Workers’ Compensation Division
P.O. Box 13777
Austin, Texas 78711-3777
Telephone: (512) 475-1440

If you have other questions regarding your claim, you should contact the TWCC office in your area, or:

Texas Workers’ Compensation Commission
4000 South IH-35
Austin, Texas 78704
Telephone: (512) 448-7900

EMPLOYEE RIGHTS AND RESPONSIBILITIES UNDER THE
TEXAS WORKERS’ COMPENSATION SYSTEM

Employers must provide this information to the employee at the time the first report of injury is filed, in two languages: in Engli