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Medical Benefits

Return to Work

Your insurance carrier will pay for work-related treatment

If you are injured or become ill at work, you may be able to get medical benefits that pay for necessary medical care. Your employer's workers' compensation insurance carrier pays these medical benefits to the health care provider who provides your medical treatment.

The insurance carrier will not pay to treat other injuries or illnesses, even if they are treated at the same time as your work-related treatment.

You are allowed to get necessary medical treatment immediately after the work-related injury or illness.

If you are in a workers' compensation health care network:

Your employer must tell you if your claim is in a health care network, so that you can use a doctor in that network if you are hurt. If you get treatment from a doctor who is not in the network without getting approval from the network, you could have to pay for the cost of the treatment.

If you are not covered by a network:

If you are not covered by a network, you have the right to choose a doctor. Make sure the doctor is not on the list of doctors who don't provide workers' compensation health care. If you need help finding a doctor, call TDI-DWC at 1-800-252-7031.

If you want to change doctors:

After you choose a treating doctor, the local TDI-DWC Field Office handling your claim must approve any change in doctors. If you or your treating doctor move, or the doctor becomes unavailable, you can choose another treating doctor without permission from TDI-DWC. This is considered an exception, not a request to change doctors. If you want to change treating doctors other reasons, you will need to provide adequate information about the request.

You must 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. TDI-DWC will notify all parties that your treatment will be managed by a different doctor.

Your treating doctor must approve all medical treatment for a work-related injury or illness. Some medical services or treatment may require your doctor to get pre-authorization through the insurance carrier or its representative before those services or treatment can be provided.

If your work-related injury or illness poses a risk to your life, and your doctor is not available to treat you, you may get emergency treatment without permission or approval from TDI-DWC or the insurance carrier.

When a doctor can bill you:

A doctor can't bill you for treatment of a work-related injury or illness. The doctor can send you a copy of the bill marked "information only" if you ask for it.

The doctor is not allowed to:

  • 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 against you.

If you have any questions, call 800-252-7031 Ext. 1.

For more information:

Texas Labor Code (TLC) §§ 408.021, 413.042
28 Texas Administrative Code (TAC) § 126.9

Return to Work

Getting back to work quickly as part of a recovery or treatment plan will help you heal faster and retain your job skills. There is no specific end date for medical treatment for your work-related injury or illness if the treatment is reasonable and necessary.

Injured employees who don't return to work once they are medically able to do so are more likely to:

  • take longer to recover and require more treatment;
  • become depressed;
  • lose important job skills while they are out; and
  • focus on their pain and injury.

Many employers offer return-to-work programs that will make changes to your regular job or placing you in a temporary or alternate work assignment that fits your abilities. Ask your employer about return-to-work programs, and make sure your doctor agrees that any program you choose is right for you.

If you have questions about return to work, call 800-252-7031 Ext. 1.

Last updated: 4/23/2018