The following information is designated to assist University of Texas System employers with processing potential workers' compensation insurance claims.
Even when it is questionable whether or not an accident or disease qualifies under the workers' compensation program, please file an Employer's First Report of Injury Form (DWC-1) with The University of Texas Workers' Compensation Insurance (WCI) for evaluation.
If you have evidence tending to show that a reported injury is not compensable or if you have any information about a questionable claim, please submit this information to WCI by separate memorandum.
What is the First Report of Injury designed to accomplish?
The Employer's First Report of Injury (DWC-1) form provides written notice to WCI and to The Department of Insurance, Division of Workers' Compensation (DWC) of any potential workers' compensation claim.
When does the First Report of Injury form need to be completed and filed?
When a Employer's First Report of Injury Form is required, it must be filed with WCI electronically within 24 hours through *WCMENU. WCI will deliver the form to DWC no later than the eighth day after the first day of the employees absence from work due to injury or death. If the reported injury is an occupational disease, the Employer's First Report of Injury Form must be filed no later than the eighth day after receipt of notice of the occupational disease. The employer must deliver a written copy of the report to the injured employee at the time the report is made to the insurance carrier. In addition, the report must contain a summary written in plain language of the employee's statutory rights and responsibilities.
A monetary penalty may be assessed against the employer for failing to file the First Report of Injury Form (DWC-1) form on time. A $25, 000 fine may be assessed for repeat violations. Therefore, it is extremely important to file the First Report of Injury Form within the prescribed time period.
An employer must file a First Report of Injury for as scheduled:
- All work-related death
- All occupational disease the employer is aware of (even if there is no lost time from work)
- All injuries sustained by an employee that results in more than one day's absence from work
When is an injury compensable?
An injury is compensable under the workers' compensation program if the injury occurs within course and scope of employment. "Course and scope of employment" is defined as 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. The term "course and scope of employment" includes activities conducted on the premises of the employer or at other locations. "Course and scope of employment" generally does not include transportation to and from the place of employment.
When is an injury not compensable?
Even if an injury does occur within the "course and scope of employment," it will not be compensable under Section 406.032, Texas Labor Code if:
- The injury occurred while the employee was in a state of intoxication
- The injury was caused by the employee's willful attempt to injure himself or to unlawfully injure another person
- The injury arose out of an act of a third person intended to injure the employee because of a personal reason and not directed at the employee as an employee or because of the employment
- The injury arose out of voluntary participation in an off-duty recreational, social or athletic activity that did not constitute part of the employee's work-related duties, unless the activity is a reasonable expectancy of or is expressly or impliedly required by the employment
- The injury arose out of an Act of God, unless the employment exposes the employee to a greater risk of injury from an Act of God than ordinarily applies to the general public
- The injury was a direct cause of an employee's horseplay or misconduct
- The injury results in a mental trauma injury or emotional injury that arises principally from a legitimate personnel action, including a transfer, promotion, demotion or termination
Is the injury compensable if an employee sustains a heart attack?
A heart attack is only a compensable injury if:
- It occurs at a definite time and place
- It is caused by a specific event; Physical strain or a "sudden stimulus" not including mental or emotional stress
- It occurs when the work, not a pre-existing condition or disease, is a substantial contributing factor
All determinations regarding compensability will be made by licensed adjusters in The University of Texas System Workers' Compensation Insurance office.
Many forms are in PDF format and require Adobe Reader.
