Frequently Asked Questions
What is Workers’ Compensation Insurance?
Workers’ Compensation Insurance is a type of insurance specifically designed to provide medical benefits and, in some cases, income benefits to employees who suffer injuries or occupational diseases on the job.
An employee with a work-related injury or illness 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 resulting from the injury. In some instances, income benefits will be paid to the employee to offset a temporary loss of earnings and/or to compensate for a permanent impairment due to the injury.
Workers’ Compensation Insurance however is NOT HEALTH INSURANCE, nor does it provide compensation for damage to or loss of personal property.
How do I know if I am covered?
All employees listed on the payroll are covered from the first day of employment.
What types of injuries are covered?
The types of injuries covered under Workers’ Compensation Insurance are called “compensable injuries.” A compensable injury is an injury that arises out of, and in the course and scope of, employment.
“Course and scope of employment” means an activity that has to do with and originates in the work, business, trade, or profession of the employer and is performed by an employee while engaged in or about the furtherance of, the affairs or business of the employer.
“Injury” means damage or harm to the physical structure of the body and those diseases or infections naturally resulting from the damage or harm. The term also includes occupational diseases. Ordinary diseases of life are not covered under worker’s compensation insurance.
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 any 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.
When do benefits begin?
Medical benefits for work-related injuries are payable from the date of injury. An injured employee is specifically entitled to reasonable and necessary healthcare that cures or relieves the effects resulting from the injury, promotes recovery, and/or enhances the ability of the employee to return to or retain employment.
Temporary income benefits begin on the eighth day of disability and are paid weekly. An employee’s inability to work because of a work-related injury should be documented by his or her treating physician.
For purposes of receiving temporary income benefits, an employee may elect to:
- remain on the payroll by using available sick and/or vacation leave throughout the period of disability;
- use a designated portion of available leave and then be placed on leave without pay status until able to return to work;
- be placed on leave without pay status immediately and begin receiving temporary income benefits after an initial seven-day waiting period.
What should I do if I am injured on the job?
If you have an on-the-job injury, TELL YOUR SUPERVISOR IMMEDIATELY. In reporting your injury or disease, your supervisor must complete an incident report online on the Office of Human Resources website that your campus benefits office uses to gather pertinent information regarding your work-related injury. The report must contain the following information:
- Your name, current address, and telephone number
- Date, time and place the injury occurred
- Description of and the nature of the injury
- Names of any witnesses
- Name of the doctor who treated the injury, if any
Failure to report the injury within 30 days from the date of injury (or the manifestation of the occupational disease) may result in the denial of a claim.
Who will handle my Workers’ Compensation Claim?
If you file a claim for a work-related injury, your claim will be managed by a workers’ compensation claims adjuster at the UT System WCI Office.
How do I get medical treatment?
If you require medical treatment for a work related injury, you should immediately choose one treating doctor to coordinate your care. Tell your treating doctor that bills for your work-related injury should be sent directly to:
The University of Texas System
Workers' Compensation Insurance
114 West 7th Street, Suite 600
Austin, Texas 78701
DO NOT SUBMIT CLAIMS TO YOUR HEALTH INSURANCE COMPANY. Payments for medical services will be delayed if your doctor does not send medical bills to the correct address. Bills for services unrelated to a reported on-the-job injury should be sent to your regular health insurer or should be paid by you.
What are my responsibilities to my employer if I am unable to work because of an on-the-job injury?
If you lose time from work due a work-related injury, your supervisor or your campus Benefits Office should receive a written note from your treating doctor indicating you are unable to work. You are expected to continue communicating with your employer throughout the period of disability unless you are physically unable to do so. 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.
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 to comply with any restrictions placed on you.
How can I obtain more information about Workers’ Compensation Insurance?
For more information, contact your UT System WCI Office at (512) 499-4666 or your campus Benefits Office at (956) 882-8205.