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Workers' Compensation - Frequently Asked Questions

ExpandWhat is Workers' Compensation Insurance?
A form of coverage specifically designed to provide for medical payments, and in some cases financial payments, to employees whose name appear on the payroll.  Coverage is only extended to employees who suffer injury, occupational diseases, or work related death in the course and scope of employment while doing some activity that furthers the affairs of the employer.
ExpandWhat is a compensable injury?
An injury that arises out of and in the course and scope of employment for which compensation is payable under the Texas Workers' Compensation Act.
ExpandWhat is course and scope?
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.
ExpandWhat is not covered by Workers' Compensation Insurance?
  • Heart Attack
  • Repetitious mental trauma
  • Ordinary disease of life
  • State of intoxication
  • Willful attempt to injure oneself or another
  • Participation in off-duty recreational social activity
  • An incident that arose out of an act of God
  • Employee's Horseplay a producing cause of injury
ExpandWhat does the employer need to provide to the ORMS?
  • First report of Injury
  • Supplemental Report of Injury
  • Request for Paid Leave
  • Wage Statement
ExpandHow does the WCI claim process work?

NO LOST TIME - A job related injury occurs, then a First Report of Injury is faxed to HR and is maintained by the employer.

LOST TIME - If the employee misses 7 days or less, after a Bona Fide Letter of Offer is completed and the employee returns to work, loses additional days, resigns, has a salary change.  The employee's department faxes Supplemental to HR and then HR sends it on to Risk Management and Safety.  If the employee misses 8 days or more, the employee's department faxes a wage statement and Request for Paid Leave to HR.  After a Bona Fide Letter of Offer is completed and the employee returns to work, loses additional days, resigns, has a salary change.  The employee's department faxes a Supplemental to HR and then HR sends it to Risk Management and Safety.

ExpandWhat is the employer required to provide to the employee?
  • Notice of Coverage
  • Copy of employee's rights and responsibilities
  • Copy of First Report
  • Notice of Ombudsman Program
  • Notice regarding certain work-related communicable diseases
ExpandWhat should the injured employee provide the employer?
All Work Status Reports received from his treating doctor.
ExpandWhat is a Bona Fide letter of employment?
It is a letter that is put into place when employee is returned to work at light duty status.  It should be signed and dated before employee returns to work.
ExpandWhat makes a Bona Fide offer valid?
  • Offer must be in writing
  • Offer must include copy of Work Status Report the offer is based upon
  • Location where the employee will be working
  • Schedule the employee will be working
  • Wages the employee will be paid
  • Description of the physical and time requirements of the position
  • Statement that the employer will only assign tasks consistent with the employees physical abilities, knowledge and skill, and will provide training if necessary