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 (DWC-1 Form) 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 The University of Texas System Workers' Compensation Insurance Office and to The Texas Department of Insurance, Division of Worker's Compensation (TDI/DWC) of any potential compensation claim.
When does the First Report of Injury (DWC-1 Form) need to be completed and filed?
An employer must file a DWC-1 Form as follows:
- For each work-related death;
- For each occupational disease of which the employer has knowledge (even if there is no lost time from work); and
- For each injury that results in more than one day's absence from work for the injured worker.
Penalty
A monetary penalty may be accessed against the employer (i.e. The University of Texas System Institution responsible for the injured employee) for failing to file the DWC-1 Form on time. A $25,000 fine may be assessed for repeat violations. Therefore, it is extremely important to file the DWC-1 Form within the prescribed time period.
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.
If an employee's supervisor knows the employee has sustained a work-related injury, but the employee never formally reports the injury, must the Employer's First Report of Injury (DWC-1 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.
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.
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