A compensable injury is an injury that is covered by your workers' compensation policy. Generally, injuries are compensable if they happened during the course and scope of employment.
That means the injury happened at work and was caused by work. Refer to the Texas Labor Code, Chapter 406, Section 032 for exceptions to the course and scope rule.
Texas Mutual Insurance Company adjusters conduct thorough accident investigations and strictly follow the law to determine whether an injury is compensable. If we decide to pay a claim and you disagree:
- Call the adjuster assigned to the claim and explain why you think the injury is not compensable. If you do not know the adjuster's name, use our online loss run and claim detail tool, or call us at (800) 859-5995. If you and the adjuster cannot resolve the disagreement, move to step two.
- Submit Form DWC-4, Employer's Contest of Compensability. By law, you must file the form with the DWC no later than 50 days after Texas Mutual Insurance Company received written notice of the injury. From there, the dispute enters the administrative phase. Visit www.tdi.texas.gov for more information about dispute resolution.