What is Workers' Compensation Insurance?
Workers' Compensation Insurance is a type of insurance specifically designed to provide medical benefits and, in some cases, financial payments to employees on the payroll of The University of Texas System (UT System)who suffer injuries or occupational diseases in the course and scope of employment.
In instances of injury or illness arising out of or in the course of employment, the employee is entitled to all medical aid, hospital services and medication reasonably required at the time of injury and anytime thereafter to cure and relieve the effects naturally resulting from the injury.
In some instances, financial benefits will be available to offset a temporary loss of wage earning capacity and/or to compensate for permanent impairment due to the injury.
Workers' Compensation Insurance is not health insurance, nor does it provide compensation for damage to or loss of personal property.
How do I file a workers' compensation claim?
If an employee sustains injuries or an occupational disease as a direct result of employment, the employee must inform their supervisor immediately. For details on what information an employee must provide provide to a supervisor, please refer to Reporting an Injury.
Who will be handling my workers' compensation claim?
All workers' compensation claims are managed by a CCMSI
UT System Dedicated Adjuster at The University of Texas System.
If I am injured on the job, what do I do?
Failure to report the injury within 30 days of the occurrence of the injury (or the manifestation of the occupational disease) may result in the denial of a claim.
If you are injured while performing work on behalf of your employer or if you acquire an occupational disease as a direct result of your employment, you should immediately inform your supervisor of the injury or disease. In reporting your injury, or occupational disease, you must provide your supervisor with the following information:
- Your name, current address and current telephone number.
- The date, time and place the injury occurred.
- A description of the circumstances and the nature of the injury.
- The names of any witnesses.
- The name of the doctor who has treated, or will treat you for the injury, if any.
Your supervisor will work with your employer's WCI Representatives to ensure that a First Report of Injury form is completed and filed with CCMSI. An adjuster with CCMSI will be handling your claim.
If you miss time from work:
- Your supervisor or your WCI Representative should receive written note from your treating doctor indicating you are unable to work. You must continue communicating with your employer throughout any period of disability unless you are physically unable to do so.
- You should receive a Notice of Injury and Claim for Compensation (NICC) form from the Texas Department of Insurance, Division of Workers' Compensation (TDI/DWC), along with instructions for completing the form. The NICC forms should be completed as soon as possible and mailed directly to DWC.
- You are expected to return to work as soon as you are physically able. If you are released to return to work by your doctor with restrictions, please work with your employer and your WCI Representative to comply with these restrictions.
- Your employer may have other specific rules for you to follow while missing time from work. Please communicate with your supervisor to make sure you are complying with any other policies.
- If you choose to miss work on your own without your treating doctor's order, your lost time, for purposes of calculating income benefits will be disputed.
An injury is not covered if it:
- occurred while the employee was intoxicated;
- was caused by the employee's willful intention and attempt to injure himself or another person;
- was caused by the employee's horseplay;
- arose out of an act of a third person intended to injure the employee because of personal reasons;
- arose out of voluntary participation in an off-duty recreational, social, or athletic activity not constituting part of the employee's work-related duties; or
- arose out of an act of God unless the employment exposes the employee to a greater risk than ordinarily applies to the general public.
Filing a false claim
Filing a workers' compensation claim for an injury that did not occur while performing work on behalf of your employer is an administrative violation punishable by a penalty up to $5,000. These offenses include knowingly or intentionally doing one of the following in an attempt to obtain workers' compensation benefits for yourself or for another person:
- make a false or misleading statement;
- misrepresent or conceal a material fact;
- fabricate, alter, conceal, or destroy a document; or
- conspire to commit one of the above acts.
In addition to being an administrative violation, intentional commission of any of the above acts in an attempt to obtain workers' compensation benefits may also result in criminal charges (Class A Misdemeanor to Second Degree Felony).
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