Houston Texas Workers' Compensation Law

Work injury attorney Michael Grossman gives 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.

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 Offices' 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.