Injured Workers | Texas Mutual

What is workers' compensation?

Workers' compensation insurance is purchased by employers to cover some of the costs employees and their families face when an employee is injured on the job, has an occupational disease, or is involved in a fatal workplace accident.

If your employer is covered by Texas Mutual, you have an advocate and partner to help you throughout the claim and recovery process.

Your workers' comp benefits

After an on-the-job injury or occupational disease, your employer will file a claim. Texas Mutual will process the claim and communicate with you and your employer to determine your eligibility for benefits. We'll then work with you, your doctor and your employer to help you recover and return to a productive life. You may be eligible to receive two kinds of benefits:

Medical benefits: These pay for reasonably required medical treatment for your injury or occupational disease.
Income benefits: These benefits may repay you for some lost wages while you are unable to work because of your injury or illness. State law specifies the amount of weekly income benefits based on your pre-injury wages and the number of weeks you may be eligible to receive them.

See common questions about injured employee benefits

In the unfortunate event of a fatal on-the-job injury or illness, workers' comp benefits may extend to eligible surviving, dependent family members. Texas Mutual also offers college scholarships to qualified surviving family members.

Managing your claim

If your claim is accepted, you will be assigned an adjuster who will support you through the claim process. Your adjuster will ensure you get the care and benefits you need and assist with return-to-work options when you’re ready. Here are the steps that most claims will follow:

Report the injury

When you report the injury to your employer, they will contact Texas Mutual to let us know of the incident and start the claim process.

Claim confirmation

We will work with you and your employer to determine whether your claim is accepted. With your employer, we discuss incident details, safe return-to-work options and wage information. With you, we explain workers’ compensation benefits, get incident details and answer your questions. We’ll also contact your doctor to get their diagnosis, treatment plan and work abilities.

Benefits

Within 15 days of receiving the claim, we’ll determine eligibility and will notify you of the decision. You’ll receive a letter called a Plain Language Notice explaining the decision and benefits.

Return to work and recovery

As you recover and go back to work (possibly with modified duties), we’ll stay in contact with you, your employer and your doctor to check progress and work abilities. We will help coordinate safe return-to-work opportunities. If you have any trouble getting care or getting back to work, we are here to help. If your employment status changes or you start earning income, let your adjuster know.

Checking your claim status

Once a claim is reported to Texas Mutual, an adjuster will be in touch with you about your claim and explain whether it has been accepted or denied. You can also check on the status of your claim by calling (800) 859-5995 and asking for your workers’ compensation specialist.

checking your claim

Texas Mutual Online

If your claim qualifies for the online experience, your adjuster will help you get set up with an account on Texas Mutual Online (TMO). In TMO, you can view claim information, income payments and more. If you already have an account, you can login and going forward, access your account through the login from the top menu.

How to find a doctor

WorkWell, TX is the Texas Mutual health care network. This network allows us to contract with medical providers who offer the highest quality care and are focused on helping you return to a productive life.

Search for a network doctor, specialist or other provider online or using the Texas Mutual Provider Directory app from your Apple or Android device.

Find a network provider

What to keep in mind when choosing a doctor

If your employer participates in our health care network, you are required to choose a network doctor. To find out whether your employer is a network participant, call (800) 859-5995.
If you are required to see a network doctor but choose not to, you may be responsible for payment for services rendered.
If your employer does not participate in our health care network, you may choose your provider. If you need help finding one, the Division of Workers' Compensation maintains a list including physicians that handle workers' compensation claims.
If your employer is in the network, you can change treating doctors once. Any changes after that must be approved.

Pharmacist with patient

Finding a pharmacy

Texas Mutual partners with Optum to fill prescriptions for covered on-the-job injuries or illnesses. Participating Optum pharmacies include Walgreens, CVS, Walmart, Kroger, Target, Costco, Sam's Club, Brookshire, HEB and Tom Thumb. It's easy to search for network pharmacies near you.

Find a network pharmacy

Getting a prescription filled

If your employer is covered by Texas Mutual, you can get your first prescription filled even if your employer hasn't yet filed a claim. Present a First Fill form (English PDF, Spanish PDF) at a participating Optum pharmacy to get a seven-day supply for each covered prescription with a maximum of $500 per prescription.

The form is valid only for the first fill and cannot be used if the first prescription fill is being requested more than 10 days after the injury occurred.

Returning to work

Your doctor, your employer and Texas Mutual want to help you return to work as soon as medically reasonable. You play an active role in making that happen. See our tips for effective recovery and return-to-work.

Why work to return to work?

It's important to get back on the job as soon as you can, even if it's to do light duty work. Here's why:

Maintain your pre-injury income - Workers' compensation benefits replace only a portion of your lost wages.
Steer clear of the disability mindset - The longer you are off work, the less likely you are to return to productive employment. After six months, you're 50 percent less likely to ever rejoin the workforce.
Heal sooner - Research shows that working is an important part of the healing process. Staying involved with work and the social interactions and relationships you've built keeps you invested and upbeat about your future and helps keep your self-esteem and attitude positive.

While you are off work due to injury

Stay in communication with your adjuster and your employer. Let your employer know how your recovery is going, and work with both to find ways to return to work while healing.

How to get more support

Let your adjuster know if you need help working with your doctor or employer. We are an advocate for you. You may also find our list of additional resources for overall wellbeing helpful.

Just for Injured Workers