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Injured employee FAQ

For help with a workers’ compensation claim, please contact Claims & Customer Services at 800-252-7031, option 1.

Injured employee resources | Preguntas frecuentes en español

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Related questions

What are my rights and responsibilities?

Here are your rights and responsibilities as an injured employee under the Texas Workers' Compensation Act.

How do I report an injury to DWC?

You can report your injury to DWC by filling out DWC Form-041, Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease. You can fill out the form online or send the completed form to this address:

Division of Workers' Compensation
PO Box 12050
Austin, TX 78711

You can fax the form to DWC at 512-804-4378.

My employer has a Return to Work Program. How will this affect me?

See the Return to Work page, or read Question 8.

More resources:

I am having trouble working with my adjuster, what can I do?

It is important to talk to your insurance adjuster and keep them updated on your injury.

If you have problems with your adjuster and have tried to work out your differences without reaching a solution, ask to speak with the adjuster's supervisor. If you cannot fix the problem or cannot get your adjuster to call you back, call DWC customer service at 800-252-7031.

My employer is treating me differently since I got hurt at work. What can I do?

If you think you’re being treated unfairly by your employer because you filed a workers’ compensation claim, you can file a complaint with the Texas Workforce Commission. It’s against the law for an employer to treat you differently for filing a claim.

What is workers’ compensation fraud?

Workers’ compensation fraud happens when someone makes a false statement or hides information to get benefits. It can also happen when someone keeps another person from getting benefits. If you think you’ve seen fraud happening, report it to DWC.

What information do I need to provide DWC, the insurance carrier, the doctor, or my employer?

DWC:

  • completed DWC Form-041, within one year;
  • any change of address and/or phone number as soon as possible; and
  • any information about a change to your work status or wages.

The insurance carrier:

  • date of injury;
  • copy of DWC Form-041 that you filed with DWC;
  • any information about how you got hurt at work including information about your medical care;
  • change of address and/or phone number, as soon as possible; and
  • any information about a change to your work status or wages.

Your doctor:

Information about how you got hurt at work, including information about your medical care.

Your employer:

  • information about how, where, and when you were hurt; and
  • any information about changes to your work status.

If a family member dies because of a work-related injury, and the employer has workers’ compensation insurance, you or others in your family, may be able to get death benefits. If you paid for burial services, you could be paid back up to $10,000, depending on the date the injury happened. Learn more about death benefits or call DWC customer service at 800-252-7031.

Related question

How do I file a claim for death benefits?

Eligible beneficiaries must complete a DWC Form-042, Claim for workers’ compensation death benefits and send it to DWC or the insurance carrier within one year from the date the employee died. A copy of the death certificate and other documents that prove legal beneficiary status must be filed with this form. If you have questions or need help completing the form, contact DWC customer service at 800-252-7031.

Send DWC Form-042 to:

Division of Workers' Compensation
PO Box 12050
Austin, TX 78711

You can also fax the form to DWC at 512-804-4378 or send it in electronic format by secure upload.

An insurance carrier may choose to pay you your benefits using an access card which takes the place of paper checks or direct deposit. It’s like a debit card that your insurance carrier uses to transfer income benefits to every pay period. Both you and your insurance carrier must agree in writing to use this type of payment. If you don’t want to get your income benefits through an access card, you don’t have to.

Related questions

Where can I find the rules and laws about getting my workers’ compensation benefits through an access card program?

Title 28 Texas Administrative Code (TAC) §§124.5 and 124.6 outlines rules for using access card programs to get your workers’ compensation income or death benefit payments. Under Texas Labor Code, insurance carriers must give injured employees who will be getting workers’ compensation benefits over a certain period of time, the choice to get their benefits paid to them electronically.

Are access card programs available for all types of benefits?

No. Only income or death benefit payments can be paid through access card programs.

Do I have to get my income or death benefits payments through an access card program?

No. Access card programs are optional. Both you and the insurance carrier must agree in writing to use an access card program before you can get your income or death benefit payments through an access card.

Are there other ways I get my income or death benefit payments?

You can also get your income or death benefit payments through direct deposit or a check.

Will I be charged any fees?

Insurance carriers can charge a fee for rush replacement of a card, international payments, and use of out-of-network ATMs. The insurance carrier cannot charge you any other fees for the access card.

How can I find out which ATMs are in my network?

The insurance carrier must give you a full list of network ATMs and bank locations before you agree to use the access card program.

What if my card gets lost or stolen?

If your card is lost or stolen, you should call the access card program’s customer service number as soon as possible. A toll-free number and website address is located on your access card. Customer service staff must be available by phone Monday through Friday, 8 a.m. to 5 p.m.

Will I be told if there are changes in the access card program’s terms and conditions?

The insurance carrier must let you know in writing at least 21 days before the date of any changes to the access card program's terms or conditions. Changes would include ending the access card program, increasing fees, or determining responsibility for unauthorized electronic fund transfers.

What if I change my mind and want to go back to getting my income or death benefits through a check?

You can choose to go back to getting payments by check or direct deposit if one of these works better for you, but you must ask the insurance carrier in writing. The insurance carrier will begin delivery of your benefits by check starting with the first benefit payment due on or after the seventh (7) day after getting your written request. If you or the insurance carrier close your access card account, the insurance carrier will send you a check with any balance left on your card.

DWC staff can answer questions about your claim. For help with your claim please call customer service at 800-252-7031.

Learn more about your right to get information and help with your claim.

If you were hurt at work, you may be able to get medical care to treat your work-related injury or illness.  For more information go to our Medical Benefits page or call customer service at 800-252-7031.

Related Question

What if my injury is life threatening?

If your work-related injury or illness is life-threatening and your treating doctor is not available to treat you, you may need to go to the emergency room. You may also get help from another treating doctor. For more information please see the Medical Benefits page or call customer service at 800-252-7031.

How you find a treating doctor depends on how your employer has set up their workers’ compensation coverage. Some employers choose to provide coverage through a certified health care network, while others don’t. If your employer is in a network, you must choose a doctor from the network’s provider list. Your employer can give you this list. If your employer isn’t in a network, you can ask your current doctor if he or she treats workers' compensation patients. If the answer is “no”, ask your doctor to help you find a doctor who does. You can also ask your doctor’s staff, your family, and friends if they know doctors who treat workers' compensation patients.

  1. Use your local telephone directory or an online search tool. Many doctors list workers' compensation services in their ads or websites. When you call a doctor for an appointment, ask if the doctor takes new workers' compensation patients. If you still need help, call DWC customer service at 800-252-7031.
  2. There is a list of some doctors who may be willing to treat a workers' compensation injury (select the “Locate Doctor” option from the “Main Menu” option, choose the type of doctor and/or the location where you need a doctor, and view the doctor’s information).

Here is a list of doctors who are not allowed to treat workers' compensation patients in Texas.

When you find a doctor give them:

  • your employer’s name, telephone number, and address where you work;
  • name of your employer’s workers’ compensation insurance company and carrier claim number; and
  • name and telephone number of the insurance adjuster handling your claim.

Changing your doctor

If your employer provides care through a network and you are not happy with your doctor, you can pick a new doctor from the list. You must contact the network to let them know, and the network can’t deny your request. If you are not happy with the new doctor, the network may have to approve the next change.

If you are not covered by a network, you have to ask DWC to approve your request to change doctors. Use DWC Form-053, Employee’s Request to Change Treating Doctor.

If your doctor says your injury keeps you from returning to work, you may be able to get temporary income benefits. These are paid by the insurance carrier for as long as your doctor says you’re unable to return to work. Learn more about temporary income benefits or call DWC customer service at 800-252-7031.

Related questions

What benefits may be available to me?

There are four types of benefits:

*More information about death and burial benefits are on the death and burial benefits page and in FAQ #2. For more information please call DWC customer service at 800-252-7031.

What are income benefits and how do I get them?

There are four different types of "income" benefits. To learn more about what kind of benefits you may be able to get, please click on these links.

See also information about average weekly wage.

You don't have to be completely recovered to go back to work - in fact, you might be able to return to work while you are still healing. To do this, you should:

  • Talk to your doctor. Tell them about your regular job and other jobs in the company. This will help your doctor decide what kind of work you can do safely.
  • Talk to your employer. Let them know you want to come back to work. When your doctor says it is safe to return to work, let your employer know so that they can try to find work that your doctor allows you to do.
  • Make sure your doctor fills out the DWC Form-073, Work Status Report. It tells your employer about the parts of your job you can do safely - such as lifting, standing, and driving.

Related questions

My employer says they have a return to work program. What is that?

Return to Work is a program set up by an employer to help injured employees go back to work more quickly and safely while they heal - either with changes to their regular job or in a different, temporary work assignment.

Where can I find out more about Return to Work?

DWC has return to work resources for injured employees or you can call DWC customer service at 800-252-7031.

Additional Resource:

See also information on temporary income benefits.

Call your insurance adjuster to talk about your claim. Very often, talking with the adjuster can clear up your concerns quickly and easily.

If that does not solve the problem, contact DWC customer service at 800-252-7031 to see if we can help you. If you are still not happy, you can ask for a benefit review conference. During this meeting, DWC staff will work with you and the insurance carrier to try and resolve the dispute.

Related question

What is dispute resolution?

Dispute resolution is a series of proceedings to resolve disputes brought before DWC and may include the following:

For more information, please call customer service at 800-252-7031 or see the Dispute resolution for injured employees page.

You don’t have to have an attorney, however, you have the right to get help from one at any time. The attorney may go with you to dispute resolution proceedings and may present your evidence and your side of the dispute.

Read more about the right to hire an attorney.

Related questions

How can I find an attorney?

DWC staff cannot recommend an attorney to you. For a list of Texas attorneys, please see the State Bar of Texas website.

How much can an attorney charge?

An attorney can charge a maximum of $200 per hour, plus expenses, for working on your workers' compensation claim. A maximum of 25 percent of your benefits may be taken out for the attorney's fees. For more information please see Attorney Fees in DWC rules.

An ombudsman is a specially trained employee of the Office of Injured Employee Counsel (OIEC) who can help you for free if you have a dispute with your employer's insurance carrier.

You can also visit DWC's page: dispute resolution for injured employees.

When you get this letter, you must go to the exam. A designated doctor is a doctor chosen by DWC to resolve a dispute about a work-related injury or illness.

The designated doctor will:

  • Review medical information from your treating doctor and other doctors who have treated you for your work-related injury or illness.
  • Examine, test, and evaluate parts of your body affected by your work-related injury or illness.
  • Determine if no further healing or recovery from your injury can be expected (maximum medical improvement), and if so, when you reached that point.
  • Give you an impairment rating if you have reached maximum medical improvement. The impairment rating is a number that shows what percent the injury affects your body as a whole. If you have not reached maximum medical improvement, the designated doctor cannot give you an impairment rating.
  • File a medical evaluation report, which includes information about the exam and your impairment rating. This report must be given to DWC within seven (7) days of the date you were examined. The designated doctor also must send a copy of the report to you and the insurance carrier.

For more information please call DWC customer service at 800-252-7031.

If you believe your work environment is unsafe, please contact the Safety Violations Hotline at 800-452-9595, or you can send an email to safetyhotline@tdi.texas.gov. Reports are taken in both English and Spanish and you don’t have to give your name.

Also, read about notice requirements in your workplace.

Your claim file information is private and only those dealing with your claim have the right to see that information. For more information, please call DWC customer service at 800-252-7031.

Read more about your right to keep your claim information private.

Related question

How can I allow someone else to speak on my behalf?

To allow another person to speak with DWC on your behalf, you need to give DWC a written notice with the name of the person, along with your signature and fax it to 512-804-4378 or mail it to:

Division of Workers' Compensation
PO Box 12050
Austin, TX 78711

For more information, please call customer service at 800-252-7031.

There are agencies in your town that may be able to help you with bills while your claim is being resolved. For example, some agencies will help with utility bills. Each county or city has its own set of services. Call 2-1-1 to learn about services in your area or call DWC customer service at 800-252-7031.

When a party in a workers’ compensation claim has questions about a designated doctor report, they may ask DWC to send the doctor a letter of clarification (LOC). This letter asks the doctor to provide more information about certain issues in the report that the doctor filed after examining an injured employee.

Parties may only request clarification on issues addressed by the designated doctor's report or on issues that the designated doctor was ordered to address but did not.

DWC may contact the designated doctor to request a LOC if it determines that it is necessary to resolve an issue. For more information see DWC rules for requesting an LOC.

Related questions

How does a party request a LOC?

Parties to a workers' compensation claim can submit a request for a LOC to DWC by fax at 512-804-4011.

When may a party submit the request of LOC?

Parties may submit a request for a LOC to DWC at any point in the dispute resolution process [i.e., before or during a benefit review conference (BRC), or during a contested case hearing (CCH)]. Most requests happen before a BRC.

Do parties have a right to a LOC?

Parties are allowed by DWC rule to request a letter of clarification, but DWC decides whether a LOC is granted.

Who will approve or deny my request for letter of clarification?

All LOC requests are approved or denied by DWC benefit review officers or a DWC administrative law judge. If DWC gets a LOC request before a proceeding is scheduled, the request will be approved or denied by a benefit review officer. LOC requests will be approved if the reviewing officer determines that clarification is necessary to resolve an issue about the designated doctor’s report.

What happens after a request is approved?

If DWC decides clarification is needed, a letter is sent to the designated doctor with the questions that need to be answered. More medical records or other information may be given for the designated doctor to consider. The designated doctor has five working days to respond to the request for clarification.
Sometimes DWC may order a designated doctor exam instead of approving a request for a letter of clarification. DWC will issue an order for the designated doctor exam.

When may a review officer from DWC order an exam?

Administrative law judges  have authority from the commissioner of workers' compensation to order designated doctor exams under Section 408.0041 of the Texas Labor Code. If a valid question regarding the designated doctor's report is presented in a request for clarification and requires an exam by the designated doctor, the benefit review officer or administrative law judge may order that exam.

What happens if the designated doctor believes another exam is necessary?

The doctor must let DWC know that another exam is needed in writing and within five (5) working days of the doctor receiving the letter of clarification and must provide copies to all parties.

If DWC orders a new exam, the doctor must conduct another exam within 21 days from the date the DWC order is issued and at the same address as the original exam. The designated doctor must respond to the LOC request based on the new exam within seven (7) working days of the exam and must provide copies of the response to the parties.

Who schedules an exam when DWC orders it?

The order will let the parties know about the need for a new exam. The reason for the exam will be attached to the order. DWC will make sure that the designated doctor is still qualified and available to address the issue in question and, if not, will schedule an appointment with the next available and qualified designated doctor.

What happens if the DWC denies a request for a LOC?

If DWC denies a request for a LOC, a denial letter will be sent to the requesting parties with reasons for the denial.

What are the options if a request for a LOC is denied?

A party whose request for a LOC is denied or a party who opposes the approval of a request for a LOC by DWC may challenge that order by requesting a:

Speed up the proceedings by requesting an expedited BRC or CCH.

Yes, DWC can give you a copy of the workers' compensation claim file. To get a copy, complete and submit a DWC Form-153, Request for Record Check or Copies of Confidential Claim Information, or call 800-252-7031 to ask that a blank form be mailed to you. If you have multiple workers' compensation claims, return a separate DWC Form-153 for each workers' compensation claim you want a copy of.

Send the completed form to this address:

Division of Workers' Compensation
PO Box 12050
Austin, TX 78711

There may be charges for making a copy of your claim file. If your claim file is more than 100 pages, you will be charged a copying fee of 10 cents for all pages over 100. You can ask to have your workers' compensation claim file certified by DWC for an additional $1 charge.

How do I submit the DWC Form-153?

The original signed form can be attached to an open records request at tdi.texas.gov/open-records.html, faxed to DWC Legal Services at 512-804-4276, mailed, or personally delivered. Do not fax this request to any other DWC fax number. You must submit a separate DWC Form-153 for each injured employee.

Contact your doctor and tell them you think you’ve contracted the coronavirus. They should let you know what to do, and if they need you to come into an office. If you need immediate care, contact a hospital and let them know. They can make sure they’re ready for your arrival and let you know where to go.

If you are not able to attend a scheduled Benefit Review Conference or Contested Case Hearing please call us at 512-804-4010.

Workers’ compensation is an insurance program that pays for medical bills and some lost-time income for employees who have a work-related injury or illness. To qualify, an employer must have workers’ compensation insurance, and an employee must have been injured or contracted an occupational disease as a result of their employment. Whether a workers’ compensation claim is compensable or not is a case-by-case determination by the insurance carrier. If there is a dispute over a claim and you are not able to resolve the dispute with the insurance carrier, then you may ask for dispute resolution by contacting DWC.