Just for Injured Workers

Workers' compensation insurance is a way to pay for some of the costs for employees and their families when:

• An employee is injured on the job
• An employee has an occupational disease
• An employee is killed on the job

• If it's an emergency, get care at the nearest facility.
• Report the injury to your employer as soon as possible.
• Your employer must report the injury to Texas Mutual. The sooner it is reported, the sooner we can help.
• Your employer must give you a copy of the injury report and the Employee Rights and Responsibilities.
• If your employer is enrolled in our health care network, please read the Notice of Network Requirements.
• If you already have a claim with Texas Mutual, you can get more information by calling (800) 859-5995 and asking for your adjuster.

Once you report the injury, a specialized adjuster will work on gathering information and additional details needed to determine the eligibility of the claim and benefits. They will reach out to you and your employer to get this information. If your claim is accepted, the adjuster, who is your claim partner, will be assigned to help you through the process. Your adjuster will also contact you and let you know what to expect in the coming days and gather any additional information to make sure you get the medical care and benefits you need. Once you have received medical care, your adjuster works with your doctor to find out what activities you can do while you're recovering. Your adjuster will continue to stay in touch with you during your recovery.

For a more in-depth look at the process, view our info sheet on the Steps of a Claim with Texas Mutual.

As an injured employee you have rights and responsibilities under the Texas workers' compensation system. You can visit the Office of Injured Employee Council's site to see the full list of Injured Employee Rights and Responsibilities, offered in several different languages.

The assigned adjuster to your claim will let you know what information they may need from you. Generally, they will ask you incident details about your injury, explain how workers' compensation works, go over benefits and talk to you about getting medical care. Once a claim has been established on your behalf you will receive a claim number specific to you, which is needed throughout the process.

Your adjuster will let you know what forms you need to sign. Depending on your communication preferences, your adjuster will send you the forms via email or mail.

If you already know what form you need, see the Forms section on the Just for Injured Workers page.

When your employer reports your injury to Texas Mutual, an adjuster is assigned to help you with everything from getting medical care to receiving benefits. It is important to communicate with them and stay in contact so they can answer any questions that may come up.

You can call (800) 859-5995 and ask for your assigned adjuster. Please be prepared to provide your claim number, date of injury or employer information.  

Yes, the Texas Mutual Provider Directory app helps you:

• Locate an urgent care facility or treating doctor
• Find a specialist
• Locate pharmacies
• See injured employee articles and additional resources

The app is available for injured employees, employers and physicians to download on the App Store and on Google Play.

We also have a Claim Assist app that gives injured employees access to their claim information, status of their benefit payments and other additional resources. Your adjuster will let you know if you are a good candidate for the app.

Your adjuster works with you to make sure you have access to all the resources you need. They will ask you if you prefer to receive forms and other necessary information through email or mail.

Speak to your adjuster to help address any concerns you may have about your claim. If you are not in agreement with Texas Mutual's decision, you have the right to dispute and can contact the Division of Workers' Compensation Customer Line at (800) 252-7031 or visit their site to learn more.

For additional resources to help with your recovery, visit our Injured Worker Resources page.

You can visit the Texas Department of Insurance, Division of Workers' Compensation to find more information and resources related to the workers' compensation system in Texas.

For resources related to recovery, visit our Injured Worker Resources page.

If your employer does participate in the network, WorkWell TX, you are required to choose a network doctor for any regular and specialized treatment. If you see a doctor out of network immediately following any initial emergency procedures, you may be responsible for paying your medical bill from your visit.

If your employer does not participate in the network, you do not need to choose a network doctor.

Your employer will let you know if they are a network participant. You can also call (800) 859-5995 to find out.

You can find a medical provider using our online Provider Directory or download our app from the App Store or Google Play.

• If your employer does participate in our health care network, you are allowed to change your treating doctor once. After that, requested changes must be approved.
• If your employer does not participate in the health care network, you have to file a DWC-053 with the Texas Department of Insurance, Division of Worker's Compensation.

Optum, our pharmacy provider, has many pharmacies, including Walgreens, CVS, Walmart, Kroger, Target, Costco, Sam's Club, Brookshire, HEB and Tom Thumb. You can find a network pharmacy near you using our online Provider Directory or download our app from the App Store or Google Play.

Medication and treatment related to your work injury are covered by workers' compensation. However, there are some prescriptions and procedures that are subject to pre-authorization. If your prescription is for a generic medication, but you prefer the brand name, you must pay the difference in price to get the brand name.

To see a specialist, your treating doctor will need to make the referral. If your employer is part of our health care network, you are required to see a specialist that is also in-network.

The Division of Workers' Compensation selects a designated doctor to perform a maximum medical improvement (MMI) examination. A designated doctor resolves questions or issues related to an injured employee's medical condition or injury. 

Maximum medical improvement (MMI) is a term to describe when an injured employee has completed and received all treatment necessary for their injury. MMI means the work injury has improved as much as it's going to improve.

Once an injured employee has reached MMI, a certified medical provider will give them an impairment rating (IR). An IR is a percentage that represents an injured employee's impairment. Based on that percentage, injured employees may be eligible to receive three weeks of impairment income benefits (IIBs) per percentage.

If your claim is accepted by Texas Mutual, you may receive two kinds of benefits:

• Medical benefits: These benefits pay for reasonably required medical treatment of your injury or occupational disease.
• Indemnity benefits: If you are off work because of your injury, these benefits may repay you for some lost wages. If a doctor determines that you have permanent impairment from your injury, indemnity benefits pay for this loss in accordance with the state law. There are four types of indemnity benefits, each with their own criteria for eligibility:

• Temporary income benefits (TIBs): You may be eligible for these benefits if you are off work for more than seven days.
• Impairment income benefits (IIBs): These benefits are paid after you reach maximum medical improvement (MMI) with an impairment rating (IR).
• Supplemental income benefits (SIBs): You are eligible for these benefits if you receive an impairment rating (IR) of 15% or above.
• Lifetime income benefits (LIBs): There are certain serious injuries that make you eligible to receive income benefits for your entire lifetime.

An injured employee must be off work for more than seven days to become eligible for income benefits, also known as, indemnity benefits. Your adjuster will let you know what to expect should you miss work for more than seven days.

You can call (800) 859-5995 and ask for your workers' compensation specialist.

We request your wage information from your employer in order to calculate your average weekly wage (AWW). This number reflects the average amount of wages you make per week. You are eligible to receive a percentage of your AWW depending on the type of indemnity benefits you are receiving. See the benefits question to learn about the four different types.

You should notify us of any change of address as soon as possible. This will help ensure you receive your benefit checks and other important information about your claim in a timely manner.

To notify us of any address change, call (800) 859-5995, or write to:

Texas Mutual Insurance Company
P.O. Box 12029
Austin, Texas 78711-2029

We also suggest that you submit a change of address form with the U.S. Postal Service. Go to the U.S. Postal Service website for additional details about changing your address.

Please note: We only accept change of address calls or correspondence from the injured worker or the injured worker’s legal representative.

Return-to-work programs help injured employees get back to work quickly and safely with job modifications or light duty work. With a return-to-work program, you are able to maintain your pre-injury income, steer clear of the disability mindset and heal sooner.

Your doctor will let you know when you are able to return to work. Your doctor will also let you, your adjuster and employer know what you can safely do while you are recovering.

Contact your adjuster to discuss return-to-work opportunities and they will inform you of any next steps.

Como parte de nuestro compromiso de apoyar a los empleados lesionados, tenemos ajustadores bilingües y traductores especializados disponibles para ayudarle en cada paso de su reclamo.

Nuestras páginas de Solo para trabajadores lesionados y Recursos para trabajadores lesionados están disponibles en español. 

Sí, la mayoría de ellos lo están. Visite la sección de Formularios on the la página principal de los trabajadores para el acceso a los formularios en español.