Workers Compensation in Texas: How to File a Claim

Workers' compensation is primarily a state-administered system, not a federal program. However, federal law sets baseline standards through the Occupational Safety and Health Act (OSHA), 29 U.S.C. § 651 et seq., which requires employers to maintain safe workplaces and report serious injuries. The Federal Employers' Liability Act (FELA), 45 U.S.C. § 51 et seq., applies specifically to railroad employees and allows them to sue employers for negligence rather than claim workers' comp. Additionally, the Longshore and Harbor Workers' Compensation Act (LHWCA), 33 U.S.C. § 901 et seq., provides workers' comp coverage for maritime employees.

For most private-sector employees, workers' compensation benefits are administered at the state level. The federal government enforces workplace safety standards through OSHA and the National Institute for Occupational Safety and Health (NIOSH), but does not directly provide workers' comp benefits. Employers with federal contracts may be subject to the Defense Base Act, 42 U.S.C. § 1651 et seq., which extends workers' comp coverage to employees on military bases and in overseas locations.

Federally, workers' comp claims are generally protected from federal income tax under 26 U.S.C. § 104, meaning benefits received are not taxable income to the employee.

Texas workers' compensation law is codified in the Texas Labor Code, Title 4, §§ 401.001 et seq., and is fundamentally different from most states because coverage is largely optional for private employers. This creates a unique dual system: employers who elect coverage provide workers' comp benefits in exchange for immunity from civil lawsuits; employers who opt out retain the right to be sued but do not provide workers' comp benefits.

Coverage requirements differ by employer type. Most private employers can legally opt out of workers' compensation. However, certain employers are required to carry coverage: all construction companies (including subcontractors), most governmental entities, school districts, and any employer with three or more employees in certain industries. If an employer has workers' comp coverage, it is required by law; if they opt out, they must post notice in a conspicuous location.

Under Texas Labor Code § 408.001, a "compensable injury" is one arising out of and in the course of employment. This includes acute injuries, occupational diseases, and aggravation of pre-existing conditions. Texas law covers employees, but excludes independent contractors, sole proprietors, partners, and corporate officers with ownership interest (unless they elect coverage).

Benefits available under Texas workers' comp include: (1) all reasonable and necessary medical treatment related to the injury (no cap on medical benefits); (2) temporary income benefits at 60% of average weekly wage, capped at the state maximum ($1,275 per week as of 2024); (3) permanent disability payments based on the nature and extent of the injury; (4) supplemental income benefits for wage loss; and (5) death benefits for families of workers killed on the job.

Texas differs from federal law and most states by allowing employers to opt out entirely. This means Texas employees cannot always count on workers' comp coverage. The state does not mandate coverage for private employers, making it weaker than federal OSHA protections or state workers' comp systems in other states. However, for employers that do carry coverage, benefits are more generous in medical care (no lifetime cap) compared to some states.

Texas workers' compensation law contains several critical exceptions and defenses that limit or exclude coverage.

First, employers with fewer than three employees in most industries are not required to carry coverage and may opt out. If they opt out, the employee loses access to workers' comp benefits but gains the right to sue the employer for negligence. The employer's common-law defenses—assumption of risk, comparative negligence, and fellow servant doctrine—may apply, giving the employer a defense even if the employee sues.

Second, independent contractors are explicitly excluded from coverage under Texas Labor Code § 401.011(a). This is a significant exception because Texas courts apply a multi-factor test to determine whether a worker is truly an independent contractor or misclassified as one. If an employer misclassifies an employee as an independent contractor to avoid workers' comp premiums, the employee may challenge this classification and claim benefits.

Third, sole proprietors, partners, and officers with ownership interest are excluded unless they elect coverage. Family members of business owners are also excluded in certain circumstances.

Fourth, intentional self-inflicted injuries are not compensable. Injuries caused by the employee's violation of safety rules, while working under the influence of drugs or alcohol, or while committing a felony may be denied or reduced. However, Texas courts have narrowed this exception—simple violation of a safety rule or ordinary negligence does not disqualify a claim.

Fifth, if an employee fails to report the injury within 30 days of discovery, the claim may be barred unless the employer had actual knowledge of the injury earlier. Some exceptions apply if the delay was due to the employer's misconduct or the employee's lack of knowledge.

Sixth, occupational disease claims have a separate 1-year statute of limitations running from the date the employee becomes aware of the disease and its connection to employment, not from the date of initial exposure.

Seventh, if an employee is injured while working for multiple employers simultaneously, coverage depends on which employer's policy was in effect at the time of injury. Disputes between carriers may arise, complicating the claim process.

Step 1: Document Your Injury and Gather Evidence. Immediately after your injury, write down the date, time, location, and detailed description of how the injury occurred. Take photographs of the accident scene, equipment involved, and any visible injuries. Obtain contact information from witnesses and ask them to describe what they saw. Keep all medical records, including emergency room reports, doctor's notes, imaging studies (X-rays, MRIs), and prescriptions. Document lost wages by collecting pay stubs, employment verification, and a letter from your employer confirming your hours and salary. Save all communications with your employer, insurance company, and medical providers—emails, texts, and call logs are valuable evidence. Medical documentation is critical because it establishes the causal link between your injury and your work.

Step 2: Report the Injury to Your Employer and Comply with Internal Processes. You must notify your employer of the injury within 30 days under Texas Labor Code § 406.012. Do not delay—this is a strict deadline that can result in loss of benefits if missed. Report the injury verbally to your supervisor or manager immediately, then follow up with a written report if your employer requires one. Ask your employer for the name and contact information of their workers' compensation insurance carrier or claims administrator. Request a copy of the workers' compensation insurance certificate (Form LS-1) to confirm your employer is covered. Your employer must file a claim with their insurer within 60 days of receiving notice of the injury. Ask for written confirmation that the claim has been filed and obtain a claim number. Keep records of all conversations with your employer—note the date, time, person spoken to, and what was discussed.

Step 3: File or Verify the Claim with the Appropriate Agency or Insurance Carrier. In Texas, claims are typically filed with the employer's workers' compensation insurance carrier, not a state agency (unlike many other states). Contact the insurance carrier directly and confirm that your claim has been filed. If your employer is self-insured, contact the self-insurance administrator. Request a copy of the claim form (usually the Employees' Notice of Injury form) and ensure all information is accurate. If your employer failed to file the claim within 60 days or is denying that the injury is compensable, you may file a complaint with the Division of Workers' Compensation (DWC), Texas Department of Insurance. The DWC can be reached at 888-958-9674 or www.tdi.texas.gov/wc. You do not need to wait for the employer to file—you can initiate the claim yourself by contacting their insurer or filing with the DWC. There is no filing fee. The deadline to file a claim is generally 1 year from the date of injury, though certain circumstances may extend this. You must include your full name, address, employer's name and address, injury date, nature of injury, and description of how the injury occurred.

Step 4: Understand the Investigation and Claims Process. Once a claim is filed, the insurance carrier has 60 days to accept or contest (deny) the claim. During this time, the carrier investigates the injury, reviews medical records, and contacts witnesses. You may be contacted for a recorded statement—be honest but careful, as anything you say can be used against you later. Cooperate with the insurer's requests for medical documentation, but do not sign authorization forms without understanding what records will be reviewed. The carrier will likely arrange for you to see an authorized treating doctor (unless your employer offered you a choice of doctors). Medical treatment will begin, and temporary income benefits (if applicable) should commence. The investigation typically takes 30-60 days. If the carrier accepts the claim, benefits begin immediately. If the carrier contests the claim, you will receive a notice of denial explaining the reason. You have the right to appeal a denial. The appeal process involves filing a dispute with the Texas Department of Insurance, Division of Workers' Compensation, and may require a hearing before an administrative law judge. This process can take 3-6 months or longer.

Step 5: Know When to Consult an Attorney. Consult an employment law or workers' compensation attorney immediately if: (1) your claim is denied or contested by the insurance carrier; (2) you disagree with the medical treatment being provided; (3) you are offered a settlement and are unsure if it is fair; (4) your employer retaliated against you for filing a claim (e.g., termination, demotion, reduced hours); (5) you believe you were misclassified as an independent contractor; or (6) your employer did not carry workers' compensation insurance. Texas allows you to consult an attorney at any stage, and you have the right to have an attorney represent you in an appeal or hearing before the DWC. Attorney fees are typically contingent (the attorney takes a percentage of your recovery if you win) or negotiated with the DWC. Many attorneys offer free consultations. You do not need an attorney to file an initial claim, but having one review your claim or represent you in a denial appeal significantly increases your chances of success.