Compensability/Injury (Existence) (C06)
Compensable injury means an injury that arises out of and in the course and scope of employment for which compensation is payable under the Texas Workers’ Compensation Act. TLC Section 401.011(10) . Injury means damage or harm to the physical structure of the body and a disease or infection naturally resulting from the damage or […]
Voluntary Social/Recreational Activity (C13)
[Cross reference. Course and scope of employment (C00)]. Generally, an injury is not compensable if it arose out of voluntary participation in an off-duty recreational, social, or athletic activity that did not constitute part of the IE’s work-related duties, unless the activity is a reasonable expectancy of or is expressly or impliedly required by the […]
Act of a Third Person/Personal Reasons (C12)
[Cross reference. Course and scope of employment (C00)]. An injury is not compensable if it was caused by an act of a third person intended to injure the IE because of a personal reason and not directed at the IE in his or her capacity as an employee or because of the employment. TLC Section […]
RME Request/Failure to Attend (I08)
On the IC’s request, or by the Commissioner’s order, an IE may be required to submit to a required medical examination (RME) to resolve issues on: appropriateness of health care received by the IE; the designated doctor’s determinations on impairment rating (IR), attainment of MMI, extent of injury, disability, ability to work, and any other […]
Willful Attempt to Injure Another or Self (C11)
[Cross reference. Course and scope of employment (C00)]. Willful Attempt to Injure Another. An injury is not compensable if it was caused by the IE’s willful attempt to unlawfully injure another person. TLC Section 406.032(1)(B). An injury caused by the IE’ s willful attempt to injure another person is not in the course of employment, […]
Failure to Attend Designated Doctor Appointment (I24)
An IE who, without good cause, fails or refuses to attend a scheduled designated doctor examination has committed an administrative violation and is not entitled to TIBs for the time during which he or she fails to submit to the examination. TLC Section 408.0041(i) and (j). Good cause is a question of fact for the […]
Compliance With Choice Of Doctor Requirements (M01)
Initial Choice Of Treating Doctor. “Treating doctor” means the doctor who is primarily responsible for the employee’s health care for an injury. TLC Section 401.011(42). An IE is entitled to an initial choice of treating doctor from the list of DWC-approved doctors. TLC Section 408.022(a); 28 TAC Section 126.9(a). The first doctor providing health care […]
Timely Dispute Of Treating Doctor (M03)
With good cause, an IE or an IC may dispute the order regarding a change to an alternate treating doctor within 10 days after receiving the order. The dispute will be handled through the dispute resolution process described in 28 Texas Administrative Code (TAC) Chapters 140 – 143. 28 TAC Section 126.9(g). Although filing a […]
Reimbursement For Medical Travel Expenses (M02)
An IE may request reimbursement from an IC for travel expenses incurred for medical treatment for the IE’s compensable injury when: medical treatment for the compensable injury is not reasonably available within 30 miles from where the IW lives; and the distance traveled to secure medical treatment is greater than 30 miles one-way. 28 TAC […]
Income Benefits Accrual Date (I04)
“Accrual date” means the day an IE’s income benefits begin to accrue. 28 TAC Section 124.7(a). Income benefits do not begin to accrue until the eighth day of disability. 28 TAC Section 124.7(b); APD 032435. [Cross-reference: Existence/Duration of Disability Raised by Other Evidence (I03)]. Income benefits may not be paid for an injury that does […]