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Workers' Compensation - Frequently Asked Questions

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What is Workers' Compensation Insurance?
A form of coverage specifically designed to provide for medical payments, and in some cases financial payments, to employees whose name appear on the payroll.  Coverage is only extended to employees who suffer injury, occupational diseases, or work related death in the course and scope of employment while doing some activity that furthers the affairs of the employer.
What is a compensable injury?
An injury that arises out of and in the course and scope of employment for which compensation is payable under the Texas Workers' Compensation Act.
What is course and scope?
An activity of any kind or character that has to do with and originates in the work, business, trade, or profession of the employer and that is performed by an employee while engaged in or about the furtherance of the affairs or business of the employer.
Are there any exceptions to what may be covered by Worker's Compensation?

You may have the right to receive benefits regardless of who was at fault for your injury with a few 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
  • Your injury occurred while voluntarily participating in an off-duty recreational, social, or athletic activity
What does the employer need to provide to the Office of Risk Management ?
  • First report of Injury
  • Supplemental Report of Injury
  • Request for Paid Leave
  • Wage Statement
If I am injured on the job and need to seek emergency medical attention (ER), will I have to use my paid leave to seek such attention?

No. If you are injured on the job and need to seek immediate medical attention, such as the emergency room, you will not be required to use your Paid Leave. However, for follow up visits and medical attention that is not considered to be emergency care, the injured employee will need to use paid leave to cover the time he/she is out. The injured employee must schedule his/her follow-up visits along with non-emergency care appointments so that it does not deter or place a hindrance on the daily operations of the business.

What is the employer required to provide to the employee?
  • Upon hire a Notice of Coverage is given to all employees to sign.
  • When an injury occurs the injured employee will receive a Copy of employee's rights and responsibilities along with a copy of the first report of injury via mail to the last known address of the employee.
  • A Notice of the Ombudsman Program is posted for employees to review along with a notice regarding certain work-related communicable diseases on the employer's premises.
What should the injured employee provide to the employer?

The injured employee is responsible for informing his/her employer and Insurance Carrier about any changes regarding the following items:

  • Changes in home address or phone number
  • Changes in work address or telephone number
  • Changes in salary, such as income increase or decrease, or change in employer
What is a Bona Fide letter of employment?
It is a letter that is put into place when employee is returned to work at light duty status.  It should be signed and dated before employee returns to work.
What makes a Bona Fide offer valid?
  • Offer must be in writing
  • Offer must include copy of Work Status Report the offer is based upon
  • Location where the employee will be working
  • Schedule the employee will be working
  • Wages the employee will be paid
  • Description of the physical and time requirements of the position
  • Statement that the employer will only assign tasks consistent with the employees physical abilities, knowledge and skill, and will provide training if necessary