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EMPLOYEE’S RIGHTS, RESPONSIBILITIES…

1. DWC rules apply to the injured worker regardless of who is at fault for an injury, with the following exceptions:

  • The injured worker was not intoxicated at the time of the injury
  • The injury was self induced or while trying to injure someone else
  • The injury resulted from another person for personal reasons
  • The injury occurred by an act of God.
  • The injury occurred as a result of horseplay
  • The injury occurred while voluntarily participating in an off-work activity.

2. The injured worker has the right to receive medical care to treat the workplace injury or illness and there is no time limit for this medical care assuming the injury was reported timely.

3. There is no longer an approved doctor list under DWC. If you are not in a Network, you can choose any doctor that accepts Workers Compensation.

4. It is important to follow all the rules in the workers compensation system. If you don’t follow these rules, you may be held responsible for payment of medical bills.

5. You have the right to hire an attorney at any time to help you with your claim.

6. You have the right for your claim information to be kept confidential.Exceptions to this include:

  • Your employer or your employer’s insurance carrier
  • An employer that is considering hiring you may receive limited information about your claim from the Division of Workers Compensation.

7. As an injured employee in Texas, you have the right to free assistance from the Office of Injured Employee Counsel(OIEC). This assistance is offered at local offices across the state. These local offices also provide other workers compensation system services from the Texas Department of Insurance. This is the state agency that administers the system through the Division of Workers Compensation. You can contact the Office of Injured Employee Counsel by calling the toll free telephone number 1-866-EZE-OIEC (1-866-393-6432).

TREATMENT PATHWAYS

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(3) STEPS AFTER…

The following presents three steps an injured worker must take when faced with an injury that interferes or impedes them from performing their work.

STEP I: Injury Documentation Method

1. Document in writing if possible, your injury with your immediate supervisor or someone in a managerial capacity. The documentation should include all the events surrounding the injury and how your symptoms came about. When describing your symptoms, include when your symptoms started, how they started, what symptoms are present including pain, numbness, weakness, presence of a wound and so on. Document all body parts affected. Include all body parts having symptoms, because what is not included in writing will later not have treatment permitted.

2. Define specifically the mechanism of injury (MOI) which is simply means that you describe in detail how the injury occurred. This is like describing the actions witnessed in a movie with attention to detail being important. As an example, let’s use the description of a fall to clarify this point. When a fall occurs, note the circumstances of the fall. Was it the result of tripping on a cord, rug, or other object? Was the surface where the incident occurred wet, slippery, unlevel, hard, or soft? Was the fall on level ground, or from a height of how many feet? Did you fall forward, to the side, or backwards? What position was your body when contact with the ground occurred and what part of the body struck the ground first? After impact, did you roll or strike another surface or object. After the impact, was there a wound, swelling, bruising, pain, loss of consciousness etc.?

3. Were you referred to an employer nurse or doctor? If so, what does that documentation show?

Employees responsibility of injury documentation

1. You have the responsibility to inform your employer if you have been injured at work or in the scope of your employment. You must tell your employer within 30 days of the date you were injured or first knew your injury or illness might be work related.

2. You have the responsibility to know if you are in a workers compensation health care network. If you do not know whether you are in a network, ask your employer where the injury occurred. If you are in a network, you have the responsibility to follow the network rules. Your employer must give you a copy of the Texas Department of Insurance network rules. Read the rules carefully. If there is something you do not understand, ask your employer or call the Office of Injured Employee Counsel (OIEC).

3. You have the responsibility to inform your doctor how you were injured and whether the injury occurred during work activities.

4. You have the responsibility to send a completed claim form (DWC-41) to the Division of Workers Compensation. You have one year to submit this form after you are injured or first knew that your illness might be work related. Send the completed DWC-41(employee’s claim for compensation for a work related injury or occupational disease) form even if you are already receiving benefits. You may lose your right to benefits if you do not send the completed claim form to the Division of Workers Compensation. Call 1-800-252-7031 or 1-866-393-6432 for a copy of the DWC-41 form.

5. You have the responsibility to provide your current contact information including address, working telephone number, and employer information to the Division of Workers Compensation and the insurance carrier. At any time you change address or phone numbers, you are required to notify DWC and your insurance adjuster of the change in address or phone number.

STEP II: Treatment History

1. Do you have a job description from the employer? Have you sent a DWC 74 form to the employer?

2. How was your injury report handled? Were you sent to a doctor on the premises, in a clinic or to an emergency room?

3. How did you choose your doctor? Did your company, emergency room, a friend, an advertisement refer you? Who has been directing your care? A doctor, Case manager, an Adjuster or attorney?

4. What objective tests have been performed to document and quantify your injury? Plain x-rays, MRI, CT scan, EMG/NCS, blood work, or none at all.

5. What treatment was rendered? Rest, Medication, injections, therapy, splints, work modification or were you taken off work? How did you respond to the treatment provided? Has your condition improved, stayed the same or gotten worse?

6. Work status: Were you taken off work, placed on restricted duty that allowed you to perform your work safely?

STEP III: Making an appointment at ROC

To make a productive initial appointment at ROC, you will be asked by the ROC scheduler Demographic information, Insurance information, Injury information, and Treatment information:

Demographic Information:

1. Name
2. Date of Birth
3. Address
4. Social Security number
5. Home phone
6. Cell phone
7. Employer Information.

Insurance Information:

1. Type of insurance,
2. Insurance number
3. Adjuster name & contact information,
4. Case manager & contact information
5. Claim number

Injury Information:

1. Date of injury
2. Location/State where the injury occurred
3. Mechanism of Injury (MOI)
4. Compensable body part
5. Whether you have had impairment rating performed
6. Been placed at maximum medical improvement (MMI)
7. Work status

Treatment Information:

1. Treating doctor
2. Referring doctor
3. Case manager
4. Treatment provided and a copy of all of the studies you have had. 5. Do not rely on the treating doctor sending the information. It is imperative that you collect and bring your medical information (including any diagnostic information, prior treatment and other tests performed) with you for you to be seen. Do not rely on the Treating doctor’s office to send it, even if they state they will send it because it is often not done.

Disclaimer: The information provided in this section is a compilation of the experience gathered from medical professionals in the field of workers compensation and the DWC website and is not intended to override or supplant what is offered in the DWC website. With the information provided, ROC hopes to assist the injured worker in better understanding the workers compensation process and assistance provided by DWC after sustaining a work related injury. ROC desires to facilitate the injured workers ability to navigate their medical care with clarity and effectiveness to assist them in returning to their pre-injury condition.

Our chosen profession allows us to provide for ourselves and our loved ones. Through our professional productivity, we earn self-respect and contribute as productive members of our society, to the freedoms afforded to us as American citizens. During the course of employment, a productive worker may unexpectedly become injured and sustain a temporary or permanent disability. Employers and Workers form the foundation of our productive society and an injury during work activities impairs this productive union. Whether an injury is a one-time traumatic event or the result of repetitive microtrauma, a workers productivity, social standing, financial and family stability as a result of the injury, is challenged. The Reconstructive Orthopedic Center of Houston participates in the care of the injured worker and TDI-DWC because we believe in the Mission and purpose of this organization. This however, does not imply that the Workers’ Compensation system is easy to understand or navigate, and it is for this reason we offer this document.

In order to optimize how the system functions for the injured worker, it is imperative for the injured worker to understand the process, the individuals involved and the decisions that must be made along the way. Every person involved has a role and responsibility to play and each individual must be personally accountable for the system to work effectively. This includes the patient, employer, Insurance adjuster, treating doctor, consulting doctors, and case manager. At ROC, our goal of treatment is to restore the patient to the pre-injury condition and back to gainful employment as soon

To care for an injured worker and assist in restoring the injured worker to their pre-injury condition, the workers’ compensation insurance program, a State governed program was established. The Workers compensation program is financially responsible for the medical costs incurred from a work related injury, provides Temporary Income Benefits (TIB) that pays a portion of lost wages when placed off work, pays Impairment Rating wages when the injured worker reaches maximum medical improvement and Supplemental Income Benefits (SIB) when the injury is of such magnitude requiring further assistance.

The Workers Compensation Insurance program is governed by the Texas Division of Insurance (TDI), having responsibilities under both the insurance code and the labor code. The Division of Workers Compensation (DWC) falls under TDI and serves to provide direction to the resources required to assist the injured employee. The Office of injured employee Counsel (OIEC) falls within DWC and was established to represent the interests of workers compensation claimants in the state of Texas. More information about DWC can be found on their web site www.TDI.state.tx.us or by calling 1-800-252-7031. Once in the website, go to the left of the page to the resources section and click Employees. Click here for the OIEC website their direct number is
1-866-EZE-OIEC (1-866-393-6432).

Texas private employers have the option of choosing to join the Workers Compensation Insurance plan but are not mandated to do so. On the other hand, State employers or Political Subdivisions are mandated to participate. Examples include: School Districts, Cities and Municipalities, Counties, and Junior Colleges. Federal employees (USL & H, Jones Act, etc) are covered under the Federal program. All participants in the Workers compensation program have responsibilities to fulfill. The following are some of the rights and responsibilities of employees under DWC rules.

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