Workers' Compensation Frequently Asked Questions
Workers' Compensation Frequently Asked Questions
Is the date of injury counted in determining whether or not an employee has lost more than one day of work due to a work-related injury?
Yes. If an employee actually loses time from work on the date of injury, that lost time should be counted in determining whether or not the employee has missed more than one day of work. For instance, if an employee misses half a day on the date of injury and then misses the next full day, he or she has missed more than one day of work. [Note: Lost time from work need not be consecutive].
Are partial days missed from work counted in determining whether or not an employee has missed more than one day of work due to a compensable injury?
Partial days missed from work should be counted if an employee is absent because he or she is "disabled." For instance, if an employee's regular daily shift is eight hours long, but the employee is only able to work four hours per day pursuant to doctor's orders, the employee will have lost more than one day of work due to his or her injury after the third day of working only four hours per day.
"Disability" is defined as the inability to obtain and retain employment as a result of a compensable injury.
If an employee's supervisor knows the employee has sustained a work-related injury, but the employee never formally reports the injury, must the form be filed if the employee misses more than one day of work due to the injury?
Yes. An employee who is injured on the job is not required to "formally" report the injury if his or her supervisor (or anyone with supervisory responsibilities) has actual knowledge that the injury was sustained in the course and scope of employment. The supervisor/department should complete a Supervisors' First Report of Injury as soon as they are made aware of the incident.
Who should complete the Supervisor's First Report of Injury?
The Supervisor's First Report of Injury shall be completed and signed by someone designated to act on behalf of the employer.
Texas Department of Insurance, Division of Workers' Compensation (DWC 73) DWC73 form (pdf)
If an employee is missing intermittent periods of time from work, how often must a Texas Workers' Compensation Commission Work Status Report (Form 73) be submitted to the employer/supervisor?
A new form should be submitted each time the employee returns to work after having lost time from work and/or each time the employee, after returning to work, experiences an additional day or days of disability as a result of the injury. This is to be completed by the medical provider.
Is time taken off for appointments with the doctor or physical therapist considered lost time?
No. Lost time is that period of time during which the injured employee is physically unable to work due to a compensable injury.
Request For Paid Leave (Form 23)
Paid Leave form (pdf)
When an employee experiences intermittent periods of lost time, does the employee have to complete a new form each time?
Yes. A new Request For Paid Leave (Form 23) should be completed each time an employee misses work due to an on-the-job injury.
How should the form be filled out if the employee is unable to come in and sign the form?
It is very important to get the employee's signature on the form. However, if this is not possible, the next best alternative is to get the employee's spouse or relative to sign the form on behalf of the employee. If neither the employee nor one of the employee's relatives is able to sign the form we recommend that you call the employee on the telephone and document the employee's decision on the form. After the employee's decision is recorded on the form, please sign the form as follows:
APPROVED BY PHONE (DATE)
_______________________________ Signed: (Department Rep Signature)
Is an employee required to use all of his or her sick and annual leave before he or she is entitled to receive workers' compensation benefits?
No. The employer cannot require an employee to exhaust all accrued leave even if the employee elects to take leave pursuant to the Family Medical Leave Act.
(This form is currently completed by the Workers' Compensation Advisor in Risk Management & Insurance)What should be done when the employee did not work for thirteen consecutive weeks prior to the date of injury and there is no same or similar employee who worked for thirteen consecutive weeks prior to the date of injury?
If no same or similar employee worked for thirteen full weeks prior to the date of injury, use the number of days and hours the employee actually worked and the gross amount the employee earned in wages or salary for each week listed.
If uniforms are provided to an employee, but the uniforms must be returned upon termination of employment, are they considered a "Fringe Benefit?"
Although there has been no definitive ruling on this matter, it is our policy not to consider uniforms a fringe benefit for purposes of calculating an employee's average weekly wage if the uniforms remain the property of the employer and must be returned upon termination of employment.
Should the total amount paid for health insurance during the thirteen weeks covered by the Wage Statement be listed under "Fringe Benefits" on the Wage Statement, or should only the monthly contribution be listed?
List only the monthly contribution for health insurance in the "Amount" column under Fringe Benefits. To calculate the weekly amount for a fringe benefit that is paid monthly, divide the monthly amount by 4.34821.
If a fringe benefit is suspended during the course of a claim, is it necessary to submit a revised wage statement?
Yes. If a fringe benefit is identified as being continued, and the employer later suspends that benefit, the employer must file an amended TWCC-3 within 7 days, reporting the date of suspension.
Employees Workers Compensation Benefits
If an employee is receiving weekly workers' compensation benefits for loss of wages, how does it affect the State contribution toward benefits?
An employee who is off work and receiving weekly workers' compensation benefits is in a "Leave Without Pay" status. If the leave without pay covers a period of one month or more in which no paycheck is to be received, the employee is not entitled to the State contribution toward his or her insurance premiums. This does not mean that the employee may not retain his or her insurance coverage by paying premiums. Questions regarding continuation of insurance coverage should be directed to the institutional Benefits Office.
May an injured employee who is receiving workers' compensation benefits intermittently use sick and/or vacation leave in order to retain entitlement to the State contribution toward insurance premiums?
Is an employee entitled to mileage reimbursement when he or she must travel to receive medical care?
An employee will be entitled to reimbursement for travel if it becomes reasonably necessary to travel more than 20 miles (one way) in order to obtain appropriate and necessary medical care.
Can an employee who is receiving workers' compensation benefits also be eligible for Long Term Disability, Unemployment Compensation, and/or Social Security Disability benefits?
Yes. Receipt of workers' compensation income benefits does not automatically make a person ineligible for the benefits listed above. However, the amount of benefits due under other programs may be affected by receipt of workers' compensation income benefits. The institutional Benefits Office should be contacted for specific information regarding eligibility for Long Term Disability.
Are workers' compensation benefits taxable?
Workers' compensation benefits are currently not subject to federal income taxation. If an employee has specific questions about this matter, we recommend the employee be directed to the Internal Revenue Service or to his or her legal advisor.
When do medical benefits become available to an employee who sustains an on-the-job injury?
Medical benefits are available immediately to a worker who is injured in the course and scope of employment. [NOTE: An employee should not use his or her health insurance card to obtain medical treatment for a compensable on-the-job injury.]
What if an employee attempts to obtain workers' compensation benefits to which he or she is not entitled?
An employee who attempts to obtain workers' compensation benefits to which he or she is not entitled should be warned that there are serious penalties for making false or misleading statements, misrepresenting or concealing material facts, and/or fabricating, altering or concealing documents in order to obtain workers' compensation benefits. Monetary penalties of up to $5,000 may be assessed against an employee by the Texas Workers' Compensation Commission for any of these deceptive actions. Additionally, it is a criminal offense (up to a second degree felony, depending on the dollar amount involved) to knowingly commit any of the above listed acts in an attempt to wrongfully obtain workers' compensation benefits.