Employee Frequently-Asked Questions
- I've been injured on the job, what should I do?
- There has been a work-related death in my family - does workers' compensation cover this?
- Do I have to receive my income or death benefit payments through an access card program?
- I have questions regarding my claim, who can help me?
- What are medical benefits and how do I get them?
- How can I find a doctor who will treat me for my injury?
- My doctor has taken me off work due to my injury. Will I be compensated for my time off? What benefits am I entitled to? How will I get paid?
- I haven't been released to return to work yet, but I think I am ready. What should I do?
- The insurance carrier is denying my claim, what should I do?
- Do I need an attorney to assist me with my workers' compensation claim?
- What is an Ombudsman? How do I obtain the assistance of an Ombudsman?
- I have just received a letter that says I am scheduled for a designated doctor appointment. Do I have to go and what will the designated doctor do?
- How does an employee report an unsafe work environment?
- Is my claim file information confidential?
- I am having problems paying my bills, where can I get help?
- What is a Letter of Clarification (LOC)?
- Can the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) provide me a copy of the workers' compensation claim file maintained by TDI-DWC?
- You must report your injury to your employer within 30 days from the date of the injury, or from the date you knew your injury or illness was related to your job. If you do not notify your employer within these 30 days, your right to obtain benefits could be lost.
- You must send a completed Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC Form-041) to the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) within one (1) year of the date of injury to protect your rights.
- For more information please see the Injured Worker Rights and Responsibilities or call Customer Assistance at 1-800-252-7031
- What are Injured Worker Rights and Responsibilities?
- How do I file a claim?
- My employer has a Return to Work Program. How will this affect me?
- I am having trouble working with my adjuster, what can I do?
- My employer is treating me differently since my work-related injury, what can I do?
- What is fraud?
- What information do I need to provide TDI-DWC/the carrier/the doctor/my employer?
They are your rights and responsibilities as an injured worker under the Texas Workers' Compensation Act.
You may file a claim by filling out the paper form DWC Form-041 Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease.
You also may send the completed DWC Form-041 paper form to the following address:
Texas Department of Insurance, Division of Workers' Compensation
7551 Metro Center Drive, Suite 100 MS-93
Austin, TX, 78744-1645
Online forms can be completed at local field offices. You may find your field office information by clicking on the following link and locating your county name: DWC Offices by County.
It is very important to communicate with your insurance carrier adjuster. Providing information to your adjuster that is related to your claim will help build a solid working relationship with your adjuster.
If you have problems with your adjuster and have attempted to work out your differences without reaching a resolution, ask to speak with the adjuster's supervisor. If you continue to experience problems, contact Customer Assistance at 1-800-252-7031.
If you believe you are being treated unfairly by your employer because of your injury, please contact Customer Assistance at 1-800-252-7031. It is against the law for an employer to discriminate against you for filing a workers' compensation claim.
Fraud occurs when a person knowingly or intentionally conceals, misrepresents, or makes a false statement to either deny or obtain worker's compensation benefits or insurance coverage, or otherwise profit from the deceit.
- Completed DWC Form-041, within one year
- Any change of address and/or phone number as soon as possible
- Any information regarding a change to your employment status or wages
The insurance carrier:
- Date of injury
- Copy of Form DWC Form-041 filed with TDI-DWC
- Any information regarding your work-related injury or illness
- Any medical information, regarding your work-related injury or illness, past or present
- Change of address and/or phone number, as soon as possible
- Any information regarding a change to your employment status or wages
- Information regarding how, where and when the injury occurred
- Medical information, regarding your work-related injury or illness, past or present
- Information regarding how, where and when the injury occurred
- Any pertinent information regarding work status
Death benefits may be paid for legal beneficiaries of a person who dies as a result of a work-related injury or occupational illness. If the deceased's employer carries workers' compensation insurance, a spouse, children, grandchildren, other dependents or parents could be eligible for death benefits. A person who incurred liability for the costs of burial may also be eligible for payment of up to $10,000.00 for burial expenses if the death results from a compensable injury. For answers to your questions about whether you may be an eligible beneficiary and whether you may be entitled to death benefits, see the Death Benefits webpage, or contact Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) Customer Assistance at 1-800-252-7031.
How do I file a claim for death benefits?
Eligible beneficiaries should complete and file DWC Form-042, Beneficiary Claim for Death Benefits, with TDI-DWC within one year of the death of the employee. This form is available here http://www.tdi.state.tx.us/forms/dwc/dwc42.pdf or a copy may be obtained by contacting TDI-DWC Customer Assistance at 1-800-252-7031. A copy of the death certificate and other documentation that establishes legal beneficiary status must be filed with this form. If you have additional questions or need help completing the DWC Form-042, you can contact TDI-DWC Customer Assistance at 1-800-252-7031.
Send the completed DWC Form-042 to the TDI-DWC at the following address:
Texas Department of Insurance, Division of Workers' Compensation
7551 Metro Center Drive, Suite 100, MS-94
Austin, Texas, 78744-1645
No, access card programs are optional (28 TAC §124.6(a) and (b)). Both you and the insurance carrier have to agree to use an access card program in writing before you can receive your income or death benefit payments through an access card. As part of your written agreement, the insurance carrier is required to provide you with a disclosure that will explain details about the access card program including the potential fees, liability for unauthorized electronic fund transfers, and network ATM locations (28 TAC §124.6(f)).
- Where can I find the rules and statutes regarding receiving my workers’ compensation benefits through an access card program?
- Are access card programs available for all types of benefits?
- Do I have to receive my income or death benefits payments through an access card program?
- How else can I receive my income or death benefit payments?
- Will I be charged any fees?
- How can I find out which ATMs are in my network?
- What if my card gets lost or stolen?
- Will I be informed if the access card program’s terms and conditions change?
- What if I change my mind and want to go back to receiving my income or death benefits through a check?
Where can I find the rules and statutes regarding receiving my workers’ compensation benefits through an access card program?
The rules and statutes are available at http://www.sos.state.tx.us/tac/index.shtml. Title 28 Texas Administrative Code §124.5 and §124.6 outline the requirements for access card programs used to deliver your workers’ compensation income or death benefit payments. Labor Code §409.0231 requires insurance carriers to give injured employees entitled to workers’ compensation benefits for a period of sufficient duration the option of receiving the payments by electronic funds transfer.
No, access card programs are only available for income or death benefit payments.
No, access card programs are optional. Both you and the insurance carrier have to agree in writing to use an access card program before you can receive your income or death benefit payments through an access card.
You can also receive your income or death benefit payments through either direct deposit or a check.
Insurance carriers are permitted to charge a fee for expedited card replacement, international transactions, and use of out-of-network ATMs. The insurance carrier cannot charge you any other fees for the access card.
The insurance carrier is required to provide a full list of network ATMs and bank locations as part of their required disclosure before you agree to participate in the access card program.
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 service number and website address will be located on your access card. Customer service personnel must be available by telephone Monday through Friday during normal business hours 8 a.m. to 5 p.m.
The insurance carrier is required to provide you with a written notice at least 21 days before the effective date of any change in the access card program's terms or conditions, including terminating the access card program, increasing fees, or determining liability for unauthorized electronic fund transfers.
What if I change my mind and want to go back to receiving my income or death benefits through a check?
You have the option of switching back to payments by check or direct deposit if one of those methods works better for you, but you must notify the insurance carrier in writing. The insurance carrier will start the income or death benefit delivery by check starting with the first benefit payment due to the claimant on or after the seventh day after receiving your written request. If you or the insurance carrier close your access card account, the insurance carrier will send you a check with your remaining balance.
The Texas Department of Insurance, Division of Workers' Compensation staff is available to answer questions regarding your claim. For more information, please call Customer Assistance at 1-800-252-7031 or you may find your local field office information by clicking on DWC Offices by County and locating your county name.
Read more about your right to receive information and assistance with your claim.
Medical benefits pay for the medical care necessary to treat a work-related injury or illness. If you were injured on-the-job, you may be eligible to receive medical benefits. For more information please click on Medical Benefits or call Customer Assistance at 1-800-252-7031.
What if my injury poses a life threatening risk to me?
If you are injured on the job, use your best judgment in seeking medical care. If your injury or illness poses a risk to your life and your treating doctor is unavailable to treat you, you may seek the help of another doctor other than your own treating doctor. For more information please see the Benefits page or call Customer Assistance at 1-800-252-7031.
If your employer provides workers' compensation medical care through a certified workers' compensation health care network, you must select a treating doctor from the network's approved provider list. The insurance company is required to provide your employer with a contact list of participating treating doctors. Ask your employer for the list so that you can select a treating doctor. The treating doctor will supervise your treatment and be your liaison with any other providers in the network. If your employer does not provide care through a network, there are several ways to find a doctor to treat your injury or illness:
- Talk to your primary care provider and ask if they treat workers' compensation patients. Your family doctor may be able to treat you. If not, ask your doctor to help you find a doctor to treat your injury. Ask your doctors' office staff, then family and friends about doctors who treat workers' compensation patients.
- Use your local telephone directory. Many doctors list workers' compensation services in their advertisements. Not all doctors treat workers' compensation injuries. When calling a doctor for an appointment, ask whether the doctor accepts workers' compensation patients and be sure to ask if the doctor is accepting new workers' compensation patients.
- Additional Information
- Only doctors licensed to practice in Texas may treat workers' compensation injuries and illnesses.
- If you are receiving care in another state, the doctor must be licensed in that state.
- A list of some doctors who may be willing to treat a workers' compensation injury can be found at the following link: http://www.tdi.state.tx.us/wc/hcprovider/locatedoctor.html (Select the Locate Doctor option from the Main Menu option, choose the type of doctor and/or the geographic location in which you need a doctor, and view the selected individual's information.)
7. My doctor has taken me off work due to my injury. Will I be compensated for my time off? What benefits am I entitled to? How will I get paid?
It depends. Qualifying for wage replacement benefits ( Temporary Income Benefits, or TIBs) is determined on a case-by-case basis. TIBs replace a portion of wages a worker loses because of a work-related injury or illness. If you are eligible to receive these benefits, you will be paid by your employer's workers' compensation insurance company. Please note that your eligibility is dependent on your ability or inability to return to your job.
There are four different types of benefits:
There are four different types of "income" benefits, each with their own qualification criteria. To learn more about these benefits, please click on the corresponding links.
- Temporary Income Benefits, known as TIBs
- Impairment Income Benefits, known as IIBs
- Supplemental Income Benefits, known as SIBs
- Lifetime Income Benefits, known as LIBs
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 him about your regular job and other jobs in the company. This will help him to determine what type 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 within your restrictions, if any.
- My employer says they have a Return to Work Program. What is that?
- Where can I find out more about Return to Work?
Return to Work is a program set up by an employer to help injured workers go back to work more quickly and safely while they heal - either with changes to their regular job or in a temporary, alternate work assignment.
TDI-DWC has developed Return to Work information for injured workers or you can call Customer Assistance at 1-800-252-7031.
See also information on temporary income benefits.
Call your adjuster to discuss your claim. Very often, speaking with the adjuster can clear up your concerns quickly and easily.
However, if that does not resolve the problem, you should contact Customer Assistance at 1-800-252-7031 to see if you should request a Benefit Review Conference. At that point, Division staff can help you try to resolve your dispute. If they are unable to resolve it you may need to attend a Benefit Review Conference (and possibly additional dispute resolution proceedings.)
What is Dispute Resolution?
Dispute Resolution is a series of proceedings to resolve disputes brought before TDI-DWC and include the following:
- Benefit Review Conferences (BRC)
- Contested Case Hearings (CCH)
- Appeals Panel
- Judicial Review of Division decisions
For more information, please call Customer Assistance at 1-800-252-7031 or see the Resolving Workers' Compensation Claim Disputes page.
You are not required to have assistance from an attorney, however you do have the right to obtain the services of one at any time. The attorney may attend dispute resolution proceedings with you and may present your evidence and your side of the dispute.
Read more about the right to hire an attorney.
Division employees cannot recommend an attorney to you. For a listing of attorneys in Texas, please see the State Bar of Texas website.
An attorney may charge a maximum of $150 per hour, plus expenses, for work performed on your workers' compensation claim. A maximum of 25% of your benefits may be withheld to recover the attorney's fees. For additional information please see Attorneys' Fees in TDI-DWC Rules.
An Ombudsman is a specially trained employee of the Office of Injured Employee Counsel (OIEC) who can assist you if you have a dispute with your employer's insurance carrier free of charge. For more information on Ombudsman assistance see http://www.oiec.state.tx.us/topics/ombudsman.html.
General information questions (not related to a proceeding) should be directed to Customer Assistance at 1-800-252-7031 or see the Resolving Workers' Compensation Claim Disputes page.
12. I have just received a letter that says I am scheduled for a designated doctor examination. Do I have to go and what will the designated doctor do?
You are required to attend a designated doctor examination. A designated doctor is a doctor selected by TDI-DWC to make an recommendation about your medical condition or 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 the parts of your body affected by the work-related injury or illness;
- determine if you have reached maximum medical improvement and, if so, when;
- give you an impairment rating if you have reached maximum medical improvement. If you have not reached maximum medical improvement, the designated doctor cannot give you an impairment rating; and
- submit a medical evaluation report, including a narrative report and documentation of your impairment rating, to TDI-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 Customer Assistance at 1-800-252-7031.
If you believe your work environment is unsafe, please contact the Safety Violations Hotline at 1-800-452-9595 or you may send your information via e-mail. Reports are taken in both English and Spanish and can be made anonymously.
For more information regarding the Safety Violations Hotline or how to e-mail your report, click on the following link: Safety Violations Hotline
Your claim file information is confidential and only those parties dealing with your claim have the right to obtain that information. For more information, please call Customer Assistance at 1-800-252-7031.
Read more about your right to confidentiality.
How can I authorize my spouse to speak on my behalf?
To authorize another person to speak with TDI-DWC on your behalf, you will need to provide a written notice stating the name of the authorized person with your original signature and submit it to your local field office. For more information, please contact Customer Assistance at 1-800-252-7031.
There are agencies within your own community that may be able to provide you with assistance while your claim is being resolved. For instance, some agencies provide assistance with utility bills. Each county or city has its own set of services. To learn more about services in your area, please call Customer Assistance at 1-800-252-7031.
A Letter of Clarification (LOC) is a letter drafted by the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) and sent to a designated doctor requesting clarification on certain issues in a report the designated doctor submitted following the examination of an injured employee.
Under 28 Texas Administrative Code (TAC) §127.20 parties to a workers' compensation claim who want clarification of a report of a designated doctor may file a request with the TDI-DWC for a LOC. 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 address.
The TDI-DWC may contact the designated doctor requesting a LOC, "if it determines that clarification is necessary to resolve an issue" regarding the report [28 TAC §127.20(a)].
Under 28 TAC §127.10(j), disputes regarding entitlement to benefits affected by a designated doctor's report shall be resolved through the dispute resolution process.
- How does a party request a LOC?
- When may a party submit the request of LOC?
- Do parties have a right to an LOC?
- Who will approve or deny my request for letter of clarification?
- What happens after a request is approved?
- When may the TDI-DWC reviewing officer order an examination?
- What happens if the designated doctor believes a reexamination is necessary?
- Who will schedule the TDI-DWC ordered examination?
- What happens if the TDI-DWC denies a request for a LOC?
- What are the options if a request for LOC is denied?
Parties to a workers' compensation claim can submit a request for a LOC to the TDI-DWC via fax at 512-804-4011.
Parties may submit a request for a LOC to the TDI-DWC at any point in the dispute resolution process [i.e., prior to a Benefit Review Conference (BRC), during a BRC or during a Contested Case Hearing (CCH)]. Historically, most requests have been submitted prior to a BRC.
Parties are allowed by TDI-DWC rule to request an LOC. The ultimate determination of whether a Letter of Clarification is granted rests with the TDI-DWC.
All LOC requests are approved or denied by TDI-DWC Benefit Review Officers or TDI-DWC Benefit Contested Case Hearing Officers. LOC requests received by the TDI-DWC prior to a proceeding being scheduled 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 regarding the report pursuant to 28 TAC §127.20.
Should the TDI-DWC determine clarification is necessary, a letter is sent to the designated doctor setting out the questions to be answered. Additional medical records or other information may be provided for the designated doctor's consideration. The designated doctor has five working days to provide a response to the request for clarification.
In some instances the TDI-DWC may order a designated doctor examination in lieu of approving a request for a letter of clarification. The TDI-DWC will issue an order for a designated doctor examination.
Benefit Contested Case Hearings Officers and Benefit Review Officers have been delegated authority from the Commissioner of Workers' Compensation to order designated doctor examinations 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 that necessitates an examination by the designated doctor, the Benefit Review Officer or Hearing Officer may order an examination.
The doctor must notify the TDI-DWC in writing of the need for an additional examination within five (5) working days of the doctor's receipt of the request and provide copies to the parties.
If the TDI-DWC orders the reexamination the doctor must conduct the reexamination within 21 days from the date the TDI-DWC order is issued at the same examination address as the original exam; and, respond to the LOC request based on that reexamination with seven (7) working days of the examination providing copies of the response to the parties. [28 TAC §127.20(d)]
The order will inform the parties of the need for a new examination stating the reason for the examination and order the appropriate party to prepare and submit a DWC Form-032 to the TDI-DWC. The purpose of the new DWC Form-032 is to ensure that the designated doctor is qualified and available to address the issue in question and, if not, to facilitate the appointment of the next available and qualified designated doctor by the TDI-DWC.
If the TDI-DWC denies a request for a LOC, a denial letter will be sent to the requesting parties specifying the reasons for the denial.
A party whose request for a LOC is denied or a party who opposes the approval of a request for a LOC by the TDI-DWC may challenge that official action by requesting a:
- Benefit Review Conference (BRC) by filing a DWC Form-045, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC), with the TDI-DWC field office handling the injured employee's workers' compensation claim [28 TAC §141.1];
- Benefit Contested Case Hearing (BCCH) following a BRC or by requesting a Benefit Contested Case Hearing without the need for a BRC [28 TAC §§142.5, 142.6]; or
- Expedited proceedings by requesting an expedited setting of either a BRC or BCCH [28 TAC §§140.3, 142.6(b)(2)].
17. Can the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) provide me a copy of the workers' compensation claim file maintained by TDI-DWC?
Yes, the TDI-DWC can provide you a copy of the workers' compensation claim file we maintain. To request a copy, complete and submit a DWC Form-153, Request for Copies of Confidential Claimant Information. The form can be downloaded from http://www.tdi.state.tx.us/forms/form20other.html or you can call 1-800-252-7031 to request that a blank form be mailed to you.
You must mail the completed form to the TDI-DWC. Faxed or e-mailed submissions of the DWC Form-153 are not accepted. Complete the form in its entirety and have it notarized before submitting to the TDI-DWC. If you have multiple workers' compensation claims, submit a separate DWC Form-153 for each workers' compensation claim you are requesting.
There may be charges associated with requesting 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 may request to have your workers' compensation claim file certified by TDI-DWC for an additional $1 charge.
For assistance with a workers’ compensation claim, please contact Claims & Customer Services at 800-252-7031, option 1.
Last updated: 04/05/2016