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.
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:
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.
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
Use the links below to get forms or documents you may need in managing your claim.