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Texas Workers' Compensation Questions & Answers

2 Answers | Asked in Workers' Compensation for Texas on

Q: Can workers comp doctor's make one use their own private insurance?

I work for a veterinarian and I got bit at work by a dog. The WC doctor said my thumb is fractured so on my third visit he said I was able to use it. Now I have a lot of pain and a not where my thumb meets my hand he said its arthritis now. I didn't have this issue before its painful to turn the... Read more »

S. Michael Graham answered on Sep 12, 2019

If the arthritis is due to the dog bite, then this would be workers' comp provided your employer carries workers' comp coverage for its employees. Most Carriers have networks in place which means you have to choose a network doctor. I would advise you to contact an work comp attorney to discuss the... Read more »

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1 Answer | Asked in Employment Law and Workers' Compensation for Texas on

Q: I have two jobs and I was hurt while at one. The dr took me off work. WIll having the second job affect my claim?

My first job is a school bus driving, the second job is a desk job. I tore my meniscus on my left leg.

Roy Lee Warren answered on Sep 11, 2019

Of course, but perhaps not in the way you may believe. If you are taken off work from both jobs the carrier must base your income benefits on your total earnings from both jobs. [Total wages (and benefits if stopped while off work) for the past 13 weeks divided by 13 to arrive at your average... Read more »

1 Answer | Asked in Workers' Compensation for Texas on

Q: Can an injured worker pay a consultant for review of his/her w/c file vs an attorney?

Roy Lee Warren answered on Aug 22, 2019

Yes, I believe so. While a lawyer c/n be paid directly by an injured worker (IW), I do not recall any prohibition on what you ask. However a medical provider is forbidden from sending bills to IWs but you ask about a consulting expert type of person.

1 Answer | Asked in Workers' Compensation for Texas on

Q: What if the WC Dr tells you you have to find your own dr for a second opinion?

Roy Lee Warren answered on Aug 14, 2019

It depends on whether you have a "network doctor" that you were required to use as your doctor. Even so you have the right to request a change in treating doctor but be wise; do not change to obtain a different MMI/IR.

If it is not a network doctor you can request the DWC to appoint a DD to...
Read more »

1 Answer | Asked in Workers' Compensation, Business Law, Civil Litigation and Gov & Administrative Law for Texas on

Q: Does making False statements to OSHA qualify as violation of the False Claims Act?

e.g. if Someone makes false statements to an administrative agency of the United States in order to get out of a fine, will this qualify to be potentially prosecuted under the False Claims Act (31 U.S.C. 3729 et seq.) in addition to qualifying under other appropriate federal laws?

Roy Lee Warren answered on Jul 29, 2019

I am sorry but this does not appear to be a wc type of question. Also most wc cases are governed under state law, not federal. However, according to the state wc laws a person can be prosecuted for fraud if they knowingly lie to obtain benefits. I'm not sure if that answers your question but I... Read more »

1 Answer | Asked in Workers' Compensation for Texas on

Q: why Have they drop my daughter

I got injured on job couple months ago Had to have a couple surgery. Still haven’t got released to attend work So I take my daughter go get dental exam they drop from insurance is this legal if so why

S. Michael Graham answered on Jul 25, 2019

I believe you are asking if your employer can stop paying for your private health insurance premiums when you are not at work due to a work related injury. If this is the question, I believe your employer can stop paying for your health insurance until you return to work. You can continue to make... Read more »

2 Answers | Asked in Workers' Compensation for Texas on

Q: I fractured my index finger and mangled my tendon on middle finger Do I get IR b4 therapy or After

I already had 1 surgery and scheduled for 2nd to remove pin placed in hand case was only approved 5/16—8/3 Estimate of what case is worth

Roy Lee Warren answered on Jul 13, 2019

Your MMI/IR should be after you have gotten as well as you will ever be from your injury. Typically it would be AFTER therapy, however that is not always the way medical providers determine it. I wish you the best of luck.

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1 Answer | Asked in Workers' Compensation for Texas on

Q: My husband passed away while under WC.

He fell at work that caused trauma to the head, a seizure and heart attack. When his meds ran out he tried getting them refilled and contacted WC and his doctors. He was going back and forth with both with no help. He went 13 days without his meds when he had a fatal heart attack. Who is negligent?

Roy Lee Warren answered on Jul 8, 2019

Your question is simple but the answer is very complex. To establish the heart attack (HA) was related you have the burden of proof and must prove essentially what is a "but for" test. It is one of the most onerous burdens to prove; you must prove his job was a "substantial cause" of the HA. The WC... Read more »

2 Answers | Asked in Workers' Compensation and Medical Malpractice for Texas on

Q: I would like to know if I have a possible medical malpractice case.

Back in November of 2019, I injured my knee stepping off of a bus at work, I started a workmans comp claim the following day. My first MRI showed a tear in my miniscus, and I was recommended physical therapy. I went for about 2 months, a few times a week. During the harder weeks of therapy, I had... Read more »

S. Michael Graham answered on Jul 1, 2019

If the Carrier is denying the tear to your knee and possible subsequent re-tear, my advice would be to contact a qualified workers' comp attorney. This matter will most likely need to go to the administrative hearing level to force the Carrier to accept your injury.

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1 Answer | Asked in Appeals / Appellate Law and Workers' Compensation for Texas on

Q: Advise on workers comp case needing to go to district court.. ombudsmen didn't file a timely appeal..

S. Michael Graham answered on Jun 26, 2019

If you didn't get the appeal from your decision and order filed on time, you would have a very difficult time filing in district court. Also, if you lost at the administrative level (CCH), there are almost no attorneys that would be willing to take your case in district court since we have no way... Read more »

1 Answer | Asked in Workers' Compensation for Texas on

Q: Are you able to change jobs while seeking treatment under workers comp/Sedgwick?

I want to change jobs, but I was told once you leave your job your treatment through workers comp/Sedgwick stops at the door.

S. Michael Graham answered on Jun 18, 2019

If your claim is through the Texas Department of Insurance, Division of workers' compensation, you can change jobs without effecting your workers' comp. Your claim is with the Insurance Carrier and not the employer. However, before you change jobs you want to make certain that you actually have new... Read more »

1 Answer | Asked in Employment Law and Workers' Compensation for Texas on

Q: I'm still on WC, and DR. care and restrictions have not got an MMI... Employer call said about FMLA is about to expire.

Not sure they are getting the 73. ask about if I was on restrictions, to see if they can find something for me or said maybe I would have to resign... Kind of confuse why would they put me on FMLA when it's a work injury not ask to for leave to take care of a family member...

S. Michael Graham answered on May 15, 2019

FMLA is based upon a federal statute that allows an individual to be off from work for 12 weeks and the employer cannot fire them "for being off work". After the 12 weeks expires, unless the company has a different policy, they can terminate your employment despite the fact that you are off for an... Read more »

1 Answer | Asked in Workers' Compensation for Texas on

Q: How do I find out if I have a case? Had carpal tunnel surgery and may need a 2nd

Roy Lee Warren answered on May 4, 2019

You may have a claim depending on if you gave notice.

Did you report (does not have to be in writing) an injury w/i 30 days of the date you knew or should have known the condition was caused from your job? The date of injury (DOI) is seldom the first onset of symptoms but rather when the...
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2 Answers | Asked in Workers' Compensation for Texas on

Q: I work for a public school district. I got my foot tangled in an electrical cord and fell on concrete breaking my hip.

I took sick leave in lieu of a workers comp check. WC approved that but didn’t tell me it would cause problems. I also worked another job before breaking my hip in several places. Now they say I can’t draw compensation for the second job. Is this right or should I be able to draw a percentage... Read more »

Roy Lee Warren answered on May 4, 2019

I am sorry you made that election to take your "earned" sick time and/or PTO. Governmental jobs are unique in that way (they can elect accumulated sick pay and the election cannot be reversed). I have tried and tried to come up with an instance when it is better for the injured worker to elect... Read more »

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1 Answer | Asked in Workers' Compensation for Texas on

Q: I tore my ACL ,meniscus etc in my leg so I am receiving workers comp but now aggravated a previous back injury WTD?

So how does this injury affect my current case ?

I feel like I’m unfit for even light duty now .

Also my employer knew about the back injury and made me sign a paper stating I couldn’t sue them for any future back problems if I returned to work which I obliged due to bills and... Read more »

S. Michael Graham answered on Apr 22, 2019

You would definitely need to go to a BRC hearing before the division to sort this out. This is essentially an "follow on injury". These are very hard to prove up at a hearing. You should consult a workers' compensation attorney directly to discuss the matter.

1 Answer | Asked in Employment Law and Workers' Compensation for Texas on

Q: Can an Employer threaten your job for requesting to file an on the job injury, i work for the post office

I work at the post office and i had injured my back and shoulder and when i requested to file an injury for workmans comp to pay the supervisor said that if i tried to file it would jeopardize my employment with them

Roy Lee Warren answered on Apr 15, 2019

They absolutely cannot terminate your job for filing a wc claim. However you could lose your job if your injuries prevent you from being able to perform your job, but that would be true whether you filed a claim or not. Also once you told the supervisor about your claim (s)he must file the claim,... Read more »

1 Answer | Asked in Workers' Compensation for Texas on

Q: I live in Amarillo Texas and on WC. Do they have to pay me for wages lost due to drs appointments and physical therapy?

I have lost a lot of time due to Dr’s appointments and physical therapy I even missed time to go see a neurosurgeon 250 miles away during work hours. Do the have to pay for the time time that I missed during the day when these appointments?

S. Michael Graham answered on Feb 18, 2019

You should be entitled to partial temporary income benefits, if you are not earning your average weekly wage. If you have doctor's appointments that are over 30 miles one-way and there are no other closer doctors, then you would be entitled to mileage too. My advice would be to get a workers' comp... Read more »

2 Answers | Asked in Workers' Compensation for Texas on

Q: The insurance adjuster I have said they are not workers comp the have there own insurance. I have been trying to get the

adjuster to call me back. I left several messages on her voicemail, she would not call me back until Monday February 11/2019. She said she closed my case because the doctor released me. I told her that the doctor said I should get a second opinion, and I left her messages. She said she was going to... Read more »

Roy Lee Warren answered on Feb 15, 2019

SORRY FOR YOUR SITUATION. I do not always trust employers, call Texas Department of Insurance,Division of Workers Compensation (I think the main line is 512 804-400; but you can look it up online). Or you can go to the website and look it up yourself.

If the employer is truthful and they...
Read more »

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1 Answer | Asked in Workers' Compensation for Texas on

Q: How do I find out if my employer has workers compensation? Do they have to file a claim or not? The doctor they sent me

to did not put down everything I said was wrong. The last time I saw the doctor he said that he was going to release me back to full duty, I told him new things of pain, numbness, and other things down my arms. He said he didn't think it was from the fall, but then he said he could be wrong and I... Read more »

Roy Lee Warren answered on Feb 8, 2019

You can call DWC in Austin or look your employer up online at the Texas Department of Insurance, Division of Workers' Compensation (DWC) to see if they are covered. The employer has the DUTY to report all lost time injuries to DWC and its carrier or it can be penalized for failure to do so. It is... Read more »

1 Answer | Asked in Workers' Compensation for Texas on

Q: If your employers fires you while you are on workers comp in Texas . Does workers comp stop paying you wages ?

Roy Lee Warren answered on Feb 8, 2019

Depends (I hate saying that) on whether you were terminated for cause or for a reason not your fault. If you are fired because you are no longer able to perform the functions of your job demands you may still be entitled to income benefits if you are not otherwise disqualified. A reason your... Read more »

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