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Medical Benefits

Texas Labor Code (TLC) §§ 408 .021, 413 .042
28 Texas Administrative Code (TAC) §
126 .9

Medical benefits pay for necessary medical care to treat your work-related injury or illness. Your employer's workers' compensation insurance carrier pays medical benefits directly to the health care provider who provides your medical treatment.

Medical benefits are paid only for the treatment of your work-related injury or illness. The insurance carrier does not pay for the treatment of other injuries or illnesses, even if the treatment was provided at the same time you received treatment for your work-related injury. Your health care provider may not bill you for treatment related to a work-related injury or illness, but may bill you for treatment of other injuries or illnesses.

When medical benefits begin and end

You may receive necessary medical treatment immediately after the work-related injury or illness. If your employer has elected to participate in the insurance carrier's certified workers' compensation health care network (network), you are required to obtain medical treatment through the network if you live within a network's service area and receive a copy of the network's notice. You must select a doctor from a list of network providers, which you can obtain from your employer or insurance carrier. If you want to change your doctor, you should contact the network or the insurance carrier for assistance.

If you are not covered by a network, you have the right to an initial choice of doctor, with the exception of doctors previously removed or denied admission to TDI-DWC's former Approved Doctor List. A list of doctors not providing workers' compensation health care can be found on the TDI website. If you need assistance locating a doctor, you may contact TDI-DWC at 1-800-252-7031.

After you have chosen a treating doctor, any request to change treating doctors must be approved by the local TDI-DWC Field Office handling your claim. If you or your treating doctor move or the doctor becomes unavailable to provide medical treatment, you will be allowed, without an order from TDI-DWC, to choose another treating doctor. This will be viewed as an exception rather than an actual request to change doctors. If you wish to change treating doctors for reasons other than an exception, you will need to provide adequate information as to the reason for the request.

You will need to complete the Employee's Request to Change Treating Doctors - Non-Network (DWC Form-053) and file it with the local TDI-DWC Field Office handling your claim. We will notify all parties that your treatment is going to be managed by a different doctor. Your treating doctor, except in an emergency, must approve all medical treatment for a work-related injury or illness. Some medical services or treatment may require your doctor obtain pre-authorization through the insurance carrier, or a representative of the insurance carrier, before those services or treatment can be performed.

If your work-related injury or illness poses a risk to your life, and your doctor is unavailable to treat you, you may seek emergency without permission or approval from TDI-DWC or the insurance carrier.

A doctor may not bill you for treatment of a work-related injury or illness. The doctor may send you a copy of the bill marked as "information only" upon your request.

The doctor cannot try to contact you for payment using any of the following methods:

  • send you a bill when you did not request an information copy;
  • have a collection agency send you a letter or contact you; or
  • file a lawsuit in court against you.

A doctor may only request payment from you when the injury or illness, through dispute resolution hearings before TDI-DWC or the Courts, has been finally determined to be an injury or illness that is not work-related.

It is beneficial to all parties involved that you return to work as quickly as possible. Injured employees that continue to work as part of their recovery/treatment plan, in medically appropriate productive work, heal faster, and may retain their job skills. There is no specific end date for reasonable and necessary medical treatment to your work related injury.

Return to Work

Injured employees who remain off work longer than is medically necessary are more likely to:

  • develop complications that will lengthen their recovery;
  • become depressed;
  • lose physical conditioning; and/or
  • focus on their pain and injury.

Many employers offer return-to-work opportunities. An employer may offer to return an employee back to work after a work-related injury of illness. This can be done by either making changes to their regular job or placing them in a temporary or alternate work assignment that fits the restrictions as determined by their treating doctor. You should contact your employer to check on the availability of return-to-work opportunities.



Last updated: 05/16/2016

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