TEXAS OFFICE OF THE GOVERNOR

ACCESSING WORKERS' COMPENSATION BENEFITS

APRIL 22ND, 2026
11:00 AM TO 12:00 PM CST

Services provided by:
Visual Language Professionals
957 Nasa Parkway #914
Houston, TX 77058

Phone ‑ 832‑564‑0844
Email ‑ visuallanguagepro.com

This text, document, or file is based on live transcription.  Communication Access Realtime Translation (CART), captioning, and/or live transcription are provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.  This text, document, or file is not to be distributed or used in any way that may violate copyright law.

>> OPERATOR:  Recording in progress.  
>> MATT DICKENS:  Good morning, everyone.  Thank you for participating with the Governor's committee Disabilities.  Today we have an Office of Injured Employee Counsel here to present about accessing workers' comp benefits.  
     And before we get started and turn it over, we want to talk about a few basic guidelines.  First of all, if you want to change the captioning settings, you can ask that in your Q & A ‑‑ access that in your Q & A and access that link to accommodate yourself and if you need a sign language interpreter you can access the sign language button in the sign language interpreters.  The chat is not available in our webinar that means if you have questions you can click the Q & A button and ask a queues for presenters, and we will ask the questions after the conferenced.  
     You have a chance to fill out a survey for feedback, and we'll also send you an email later on if you would like to send ‑‑ there's a link to our page if you went a copy of the recording or to see the PowerPoint to see the materials.  Let's go ahead and turn it over to our guests, and it will be Kaitlyn and Alex.  
>> KAITLYN KELLY:  Hello, everyone I want to say thank you for joining us today.  My name is Kaitlyn Kelly.  I'm the communications director.  
>> Good morning, my name is Alexander I'm the regional manager for the Region 5 for the Office of Injured employee counsel I have an office in Austin and Houston west, and I thank you for the invite.  
>> KAITLYN KELLY:  He is the brains of our operation here today, so he will be here to answer any of your questions and give some of his hands‑on experience with workers' compensation.
     We can go to the next slide.
     So I'll start with giving kind of an overview of what is workers' compensation, so workers' compensation is a state‑regulated insurance program.  It helps cover medical bills and pays a portion of lost wages if someone is injured on the job.  As long as their employer has workers' compensation coverage under the Texas Workers' Compensation Act.  
     So in Texas, workers' comp is not required for most employers.  The main exceptions are certain government entities, educational institutions and some private employers, sometimes if they have a contract ‑‑ a construction contract with a government agency or if they're in the same building as a government agency, they have to adopt a workers' comp policy you go ‑‑ workers' comp policy.
     The key concepts in workers' comp is the grand bargain.  That means employees can receive medical treatment and income benefits if they're hurt at work but in exchange, they generally give up the right to sue their employer except in very limited situations.  
     There are several groups involved in the system.  This ‑‑ workers' compensation system healthcare providers, attorneys, and OEC ombudsman and customer service specialists and things like that.
     We can go to the next slide.
     Okay.  And then I'll give you an overview what is OIC the Office of Injured employees was created by the Texas legislature.  It's purpose is to help employees or the beneficiary who don't have an attorney, so they can benefit navigate the workers' compensation progress.  It's a state agency and led by public counsel Robert Rucker, and it's administratively attached to the Texas Department of Insurance, and I'll get into that more a little bit later.  We can go to the next slide.  We have 20 field offices in the state of Texas plus a central office located in Austin.  All of our offices are also co‑located with the Texas Department of Insurance division of workers' compensation.  Statewide we have over 160 employees and most importantly our dispute resolution services are completely free and available to any ‑‑ or to injured employees in any city in Texas.  Next slid.
     So a little bit more the division of workers' compensation and Office of Injured employee counsel's role in workers' compensation.  The Texas Department of Insurance division Texas compensation also known as TWC running OIEC on the other hand we serve to we advocate for injured employees, so DWC is monitoring compliance across the system and that usually includes injured employees, employers, healthcare providers, insurance carriers and attorneys.  When necessary, DWC will also take enforcement action to make sure that the Texas Workers' Compensation Act, the Texas labor code and other regulations are being followed.  
     Next slide, please.
     So disputes versus complaints ‑‑ it's important to understand the difference between the two because that determines how the issue gets solved.  A dispute is a disagreement between two parties so, for example, an insurance carrier might accept a back strain as part of the injury or deny a neck injury, so that would be a dispute.
     A complaint is an allegation that someone in the system violated the law so, for example, if an insurance carrier issues a payment late that would be considered a complaint, so complaints are handled by DWC.  Since they regulate the system and disputes are handled by OIEC.  
     OIEC can also help with complaints.  We can help file complaints, but we do not regulate or handle them, so that's a big distinction that we try to make, and overall disputes typically involve disagreements about a workers' compensation claim, either medical issues or income benefits, and we'll go into that more a little bit later too.
     Next slide.
     So OIEC's mission is carried out by different program areas.  Our mission again is to educate, assist, and advocate on behalf of the injured employees of Texas, so our customer service program ‑‑ they educate customers by answering questions, making referrals to other agencies and resolving informal disputes that can be resolved fairly easily.
     Our ombudsman program, they assist injured employees who do not have an attorney through the workers' compensation comp resolution services and our lawyers advocate to workers in a class, and they address issues he through legislative and rulemaking processes.
     Next slide.
     So what happens when there is a dispute?  Even in the best situations, disputes can come up in a workers' compensation claim that aren't easy to resolve.  An income benefit dispute involves disagreements about compensability or eligibility for income or death benefits.  In simple terms this often comes down to whether the injury is work‑related.  Meaning, it arose out of ‑‑ and in the course and scope of employment, and whether the benefits should be paid, and then a medical dispute typically involves issues like preauthorization, medical necessity or medical fees.  OIEC helps with both of these types of disputes and for now we'll go into a little bit more of the income ‑‑ income benefit disputes.
     Next slide, please.
     So income benefit dispute resolution ‑‑ if an injured employee has a question or dispute, OIEC customer service specialists are often the first point of contact.  In some cases they can resolve the issue quickly with a phone call or some brief research.  If the issue be can't be resolved at that level, then it is referred to the ombudsman program for more in‑depth assistance.  The ombudsman will meet with the injured employee, gather relevant information, help develop the claim and work to resolve the dispute ‑‑ dispute.  In many cases this is successful but, however, if the dispute still can't be resolved, it may move in to the DWC dispute resolution process, and this can include one or more of the following steps, so a benefit review conference, then a contested case hearing, and then a review by the appeals panel, and the ombudsman can assist the injured employee through each step of the this ‑‑ step of this process.
     Next slide.
     So medical disputes.  Medical dispute resolution is a process used to address different types of medical disagreements in medical compensation claims.  These involves three areas of its preauthorization disputes, retrospective disputes and medical fee disputes.  It's core proves whether medical treatment is reasonable and necessary, so reasonable medical care means treatment that meets the standard of care generally accepted by the medical community and necessary medical care means treatment needed to care or relieve the effects of a work‑related injury.
     So in order for the insurance carrier to be responsible for the payment, the care must be both reasonable and necessary.  These types of disputes involve questions about the severity of the injury.  Or whether certain treatment can be achieved.  OIEC has compensable injuries or denied injuries, so, for example, if someone slips and falls at work and is diagnosed with a knee sprain and a torn ACL, the insurance carrier might accept the sprain but then they dispute the ACL tear.  In that situation a dispute is created and the burden of playoff is on the injured employee.
     Next slide.
     So in the dispute process, if you do have a dispute, this would be the beginning.  Benefit review conference or BRC is a nonbinding mediation, and it's typically held online.  A DWC conducts a conference, and this person is trained to help both parties work through the disputes.  The ombudsman can assist the injured employee before and during the Brach so before the conference they'll meet with the injured employee to help them prepare, and this comes with reviewing the case, gathering information, collecting any necessary documentation to support the disputes.
     The ombudsman also requests copies of medical records on behalf of the injured employee, and those records should be provided at no cost.  
     During the BRC itself the ombudsman will attend and assist the injured employee by helping to present their position and participating in the informal discussion.  If the parties reach an agreement did, it is documented as a dispute resolution agreement and ‑‑ dispute resolution conference.  The possible outcomes of a BRC it's resolved on the same day as a conference sometimes another BRC is resolved so additional information can be gathered.  In other cases it's not resolved, and it's moved to another contested hearing.
     Next slide.
     So once an injured employee has gone through the benefit review conference and the dispute is still not resolved, the case moves on to a contested case hearing or a CCH.  This is a formal hearing or a trial where evidence is presented and testimony is taken.  It typically lasts about 2 hours and a decision is binding unless it is appealed.  The hearing can be held virtually phone call parties agree.  That's actually new, so that is important to mention.  
     If the injured employee chooses to have ombudsman assistance, the ombudsman will meet with them again to prepare for the hearing and plan what is needed to present the strongest case possible.
     So a key part of preparation exchanging all documenting evidence that may be used at the CCH and the ombudsman may also recommend using discovery tools such as subpoenas to obtain additional information.
     And then at the hearing, the ombudsman will attend and assist by presenting opening and closing statements as well as questioning or cross‑examining the witness.  The hearing is presided by the administrative law judge who makes he a decision based on the evidence and testimony presented because of this it's very important that the injured employee is fully prepared.
     So then after hearing ‑‑ after the hearing, the judge issues he a written decision on the disputed issue in most cases either party has 10 days to appeal if they disagree.  If an appeal is filed, the appeals panel will review the case and decide whether to uphold the decision, reverse it or send it back to the judge for further review.
     In most cases, the injured employee should also expect to be cross‑examined by the carrier's attorney during the hearing, and we can also assist through the appeals process if needed.  Which we can get to in the next slide.
     Next slide, please.
     So then ‑‑ oh?  The appeals panel ‑‑ if any party disagrees with the decision made by the contested case hearing administrative law judge, they can file an appeal.  After the hearing the ombudsman can provide information to the injured employee about requesting a review by the appeals panel and the ombudsman can also help with filing and responding to an appeal, but this is the final step where OIEC is involved.  We're not authorized to assist with legal representation to that ‑‑ to that extent, so the appeals panel is made up of 3 judges who are the administrative law judge's decision, their.  Their role is to determine whether the law was applied correctly, so the panel may affirm a decision, reverse it or remand it for further review or kind of issue a combination of any of those.
     It's also important to note that the appeals panel can only review the evidence that was already presented during the contested case hearing, so if you file an appeal you can't come back with more evidence.  It's just the evidence that you had in your CCH.  
     If a party still disagrees after the appeals panel, they may file a lawsuit in it district court and like I mentioned earlier, OIEC is not authorized to assist with state court lawsuits, so legal representation is typically needed at that stage.  
     Next slide, please.
     So disability in the workers' compensation system.  The most important thing to understand is that disability in the workers' comp system is a little bit different than how it's used in Social Security or other laws so in workers' comp, disability is considered an economic concept.  That means it's about wages and earning ability and not about physical impairment or medical condition.  
     So disability is defined as the inability because of a compensable injury to obtain and retain employment at wages equivalent to the preinjury wage.  
     In it simpler terms it means the injured employed is earning less than they did before the injury because of the work‑related injury.  There are different types of evidence that can show disability, so, for example, if someone is unable to work at all or can only return with light duty restrictions, that may support a finding of disability.  It's also important to know, that disability can change or end, so, for instance, if an injured employee is no longer working or is earning less for a reason unrelated to the injury such as being terminated, then disability may no longer exist.
     It can also end if the worker returns to earning the same wages as they did before the injury.  Disability is important because it is required to receive temporary income benefits, and we'll go more into detail about that next.  Or I think later.  
     Now let's talk about a couple of topics about a person's physical condition, maximum medical employment, or MMI.  These are medical concepts how much an employee has recovered from their recovery, and there's are two types of MMI.  It's clinical MMI and statutory MM his work clinical MMI means no meaningful recovery is expected, so it's in other words when you reach as good as you're going to get.  It's like a vase that falls and breezy.  You can glue it together, but the cracks in the vase are still there, and it won't fully return to how it was before, so a doctor reviews the medical records and determines the clinical MMI date based on the individual's case.  Unlike clinical MMI, statutory MMI is set by law.  That determines after 104 weeks so about 2 years from the day of the income benefits beginning.  This means there is a legal limit how long someone can remain in the recovery period.  Before reaching MMI.  In it both cases and an MMI must be certified by a doctor who is approved by the state of Texas.  Once a doctor determines MMI has been reached, they can assign an impairment rating or IR, so this is the percentage of permanent impairment to the whole body resulting from the worker that had the injury, so, for example, a doctor might assign an impairment rating that reflects the lasting effects of the injury.
     So I thought I had a better example.  That's, okay.  
     Only doctors certified by the state can assign impairment ratings, and they also use the American Medical Association's guide to the evaluation of permanent impairment as the standard ‑‑ standard reference for doing so.  
     Next slide.
     Okay.  Now this is our income benefit overview.  In workers' compensation there are four different types of the benefits to employees.  I'll briefly go through each of them, and I have these three on the slide because these three will terminate after 401 weeks after the date of injury, so the temporary income benefits or TIBs may be available when an injured employee has a disability, so these benefits are based on the injured employee's average weekly wage, and they are meant to help replace lost income when the employee is off of work or earning less, and they will continue until the employee reaches the maximum medical improvement or MMI like I mentioned earlier.  Whether it's the clinical or statutory or until the disability ends.
     And then impairment income benefits or IIBs beginning the days after the income benefits end, so these are based on the impairment rating assigned by a certified doctor after the evaluation and at this stage we are no longer looking at disability or the maximum medical improvement.  It's based solely on the impairment rating.  The calculation is simple.  The injured employer receives three weeks of benefits for every percentage point of the impairment, so, for example, an impairment rating of 10% would equal 30 weeks of IIBs, and supplemental income benefits or SIBs may begin after IIBs ends, so at the end ‑‑ as the name suggests, while the employee attempts to recover and return to work and to qualify there are there are several requirements, and one of the most important is work search activity, meaning the injured employee must look for work, working in some capacity or has a doctor certification that they cannot work.  SIBs can continue for an extended period of time as long as the eligibility is meant.
     Next slide, please.
     This is still the income benefits.  These are the last two.  These do not end lifetime income benefits or LIBs they do not have a time limit and are paid for the lifetime of the injured employee, so to qualify the injured employee must meet specific severe criteria such as amputations, paralysis, traumatic brain injury, things like that.
     Finally there are also death benefits.  These are paid to the legal beneficiaries of the deceased employee.  When a compensable work‑related injury results in death.  
     Next slide, please.  
     Okay.  So our ADA accommodations.  We assist many injured employees who are dealing with temporary or permanent disabilities and one of our ongoing priorities is making sure that all of our injured employees can access our services and employee participate in the dispute process, so one important improvement that I mentioned earlier from the most recent Texas legislature is that the CCHs can now be held remotely.  This can be especially helpful for individuals with limited mobility or those who are able to participate more easily from home using their own resources.  
     One thing to note is that remote hearings typically must be agreed by both parties.
     However, the division of workers' compensation also has the discretion to set a hearing as remote.  Currently, about 11 to 12% of injured employees choose to participate in hearings remotely, and anyone who needs an accommodation, axillary aid or service for effective communication or a modification to policies or procedures in order to participate in a program, service or activity can contact our ADA coordinator Kathleen Contreras.  Her employee a Kathleen.Contreas@OIEC.Texas.gov.  We ask for at least 48 hours before the scheduled event.  Sometimes providing certain accommodations may require coordination with outside resources, so we ask for as much notice as you're able to give but by at least 48 hours.
     Next slide.
     Okay.  And then our ‑‑ so we have an early assistance program.  Our early assistance program consists of a manager, assistant manager, ombudsman and customer service specialists, so when a claim comes in, it is first routed to the early assistance program.  At this stage our customer service specialists, they provide immediate contact with the injured employee, and they'll follow up as needed.
     And then the ombudsman, they'll work to help resolve issues or disputes early whenever possible.  They prepare cases before they are sent to higher‑level ombudsman if further assistance is needed.
     Throughout this process we help educate injured employees about their rights and what options are available if disputes arise.
     Overall, the early assistance program helps us get involved sooner, which can reduce delays and shorten the overall dispute resolution process.  
     Next slide.
     We also have a first responder unit, so I don't know if any of you guys are first responders in 2023, OIEC launched a special unit to assist first responders who are involved in workers' comp dispute resolution process, so instead of initially being handled through the early assistance program or is have our field offices, first responder cases are routed to and processed by the first responder unit.  This unit includes a manager, assistant manager, first responder liaisons, and these are designated ombudsman who specialize in helping first responders with their disputes and first responder liaison assistance.
     So this dedicated staffing is put into place to develop first responder cases earlier in the process, maintain regular contact with injured first responders to provide updates and address questions or concerns and provide training to ombudsman and staff across OIEC's 20 field offices.
     So a little bit more information about that.  Sometimes cases for first responders just require a little bit more documentation and things like that.  Some of the things ‑‑ qualification wise much ‑‑ are different, so that's why we have a separate ‑‑ like a task force for them.
     Next slide.
     So some general tips for injured employees.  That apply to pretty much every workers' comp claim is that injured employees are responsible for their claim and should remain in contact with their employer, Doctor, insurance adjuster their OIEC ombudsman or attorney if they have one, and it's also important to keep all paperwork.  Paperwork is so, so important.  In workers' comp there's so much paperwork involved it's really important to stay on top of that.
     You also have an obligation to report your injury within 30 days to your employer.  And one year to DWC.  I wanted to mention that because it's really important to be prepared, to be timely and to really get assistance when you need it.  Waiting is never a good option.  We do not advise you to wait.  
     And having the following information would make it a little bit easier.  To get assistance from OIEC, you have to fill out an intake packet, and it usually asks these things so job title, job function, medical history of injury, expert opinion from a doctor.  
     Next slide.
     I'll go over these quickly, but these are our success stories, so OIEC has had a ton of success over the years.  We actually just hit our 20th anniversary, so these two homer Salinas and Carrie Stewart are firefighters, first responders, and I'll kind of explain as I talk about them.  Maybe provide a little bit more information about why first responders are a little bit ‑‑ a little bit more information about why first responders are a little bit harder, so I'll go into each of their stories so next slide, please.
     I'll start with homer, so homer has been a firefighter in mission, Texas, since 1993 and in 2017, he was diagnosed with renal cell carcinoma, so that's that it most common type of adult kidney cancer.
     Something that's important to note is that he was a nontobacco user and his spouse was a nontobacco user, nonsmoker, so that's one of those things where since he was a firefighter they could easily say:  Oh, well, how is that related ‑‑ or, you know, you can't prove that this cancer was because of this job, so he does multiple surgeries to remove the mass and determine his treatment, but he did end up having to receive chemo treatments and because of that he was not automobile to work for a period of time.  I don't know if it mentions it in the video, but the next slide is a video of him returning to work, so that's always nice to see, but he did end up going back to work.
     Next slide, please.  
     If it's needed you can turn on the captions, but the autocaptions might be fine.  You can play it.  Okay.  
>> I'm going to go ahead and adjust the audio.  
>> KAITLYN KELLY:  Okay.  
>> MATT DICKENS:  Okay.  Now you should be, okay.  
>> Homer Salinas is battling for cancer and his fight for workers' compensation.  
>> Channel 5 Carolina Cruz was there at the beginning as a man who lives to protect you returns to work.  
>> What's up, homer.  
>> It's anything but a typical Wednesday morning.  
>> It feels so good to come back to work.  
>> Back up in the truck.  
>> Just a few months ago, this moment was hard to picture.  
>> When I left, I thought I was never going to come back.  
>> Lieutenant homer Salinas was diagnosed with kidney cancer in October of last year.  He battled it for months and won.  This is his first day back.  
>> Making it official.  
>> Seven months waiting for this moment.  
>> There he is.  There it is I'm on the clock.  
>> Time passes, but their bond didn't miss a beat.  
>> Time to make the donuts.  I was like a little kid on the first day of school, you know, daring me to come back to work.  It's just been awesome, and coming back to work, I know things get back to normal.  
>> His routine the past few months was hospitals and medical treatments.  This is his true normal.  
>> I'm so happy to ‑‑ to be out there and helping people.  That's what I live for.  If you asked me how long I've been a firefighter, I think it the day I was born.  That's what I wanted to do.  
>> Salinas argues his kidney cancer was caused by his over 20 Year career.  Some studies back it up.  The fire department made changes to prevent future cases.  Those new lifesaving measures come in the form of a bucket.  
>> Inside the brush, some trash bags, gloves, soap, and this is what they use ‑‑ what's contained in here is what's used to do the decontamination on the scene 
>> Firefighter also get wipes to clean off any debris on their neck the areas easily known to absorb carcinogen particles.  
>> By taking egg off the particles it prevent them from taking it in the truck and hopefully, not bringing it to the station.  
>> If we can prevent any little thing, that is great, and I'm glad that ‑‑ that we're implementing this for ‑‑ yes, not only for other firefighters but, yes, my son.  
>> That's right his son is a firefighter.  It's become a family tradition.  
>> And my youngest son wants to ‑‑ he's still in high school, and that's the first thing he wants to do when he gets out of high school 
>> Salinas hopes these simple changes keeps him, his crew and his children safe from the deadly disease he's overcome.  Salinas is still fighting his workers' compensation claim with the City of Mission with the text municipal league.  He's free of cancer, but his battle continuing he has to go to Houston for checkups.  Care Lena Cruz, channel 5 at 6:00.  
>> 
>> KAITLYN KELLY:  Okay.  We'll move on to Carrie Stewart's.  His was a little bit more not positive.  I mean, he still has to fight his dispute and everything but Carrie kind of went through a tough process so in 2015, she was diagnosed with breast cancer, so they both had to deal with cancer.  And doctors determined that her cancer was work‑related 'cause she is also a firefighter.  They pointed to her working 24‑hour shifts and the city was ordered to offer her a workers' compensation in 2016.  
     The Department of ‑‑ the Texas Department of Insurance division of Workers' Compensation, they ruled in her favor and determined that her cancer was actually work‑related but then the city filed a petition for judicial review to declare that her particular injury is not work‑related, and that she is not entitled to benefits, but they actually drop the lawsuit a few years later, so that was a good outcome for her too.
     Next slide.
     And that will also be her video.  You can start that.  
>> My favorite part of the job is riding around on the big red truck, and there's so many things that can be a part of that, whether it's interacting with the community or waving at little kids who are in the car next to you or going to the grocery store and just interacting with the public, but there's also the parts when people call you on the big red truck they're having a really bad day whether it's a medical emergency or fire or some other car wreck or some other emergency, so being able to respond on that big red truck and make that day better or solve that problem for that person there's so much going along as a firefighter and being on the truck, and that's my favorite part of that is being able to be on that truck and being able to affect the chain.  Firefighters do have higher rates of cancer due to some of the carcinogens in the smoke and fire combustion and burns, and there's higher rates of other cancers from shift work itself is considered a carcinogen.  I was diagnosed with an occupational cancer in May of 2015.  The ombudsmans that I've been able to work with have been amazing, and we're working under presumptive law for firefighters for cancer and some other occupational illnesses, and they're some of the education for that presumptive law and for firefighter occupational illnesses is a really common knowledge sometimes, and so it's kind of been a learning process for both members of the fire department and the fire service and working with the Office of Injured employee counsel, but it's such a collaboration to ‑‑ to work together and to gain that knowledge and experience and education together, and so we kind of have taught each other about the processes or about firefighting or the presumptive law.
     But I've been so amaze at how much people here have been willing to jump in and learn about our job and learn about the presumptive law, so that they can continue to help not only me but other firefighters that are facing the same illnesses or the same issues.  Nancy is a rock star.  She's amazing.  She's willing to come jump in with other cancers, and she's learned so much, and we've been able to teach each other so much that, like ‑‑ like she's who we want to go to now.  
>> These cases do take a lot of work and a lot of research just to ensure that may are covering everything, but the end result is a great feeling.  When these injured employees can ‑‑ especially these first responders.  
>> After filing a claim and learning about the process that I could stay with an ombudsman until I felt like I needed any legal representation if I did, so I went down the ombudsman route just because that was where the process directed me and just filing paperwork and knowing that this is where benefit review conferences happen or contested case hearings or just being ‑‑ it's kind of necessary to become familiar with the office.  
>> KAITLYN KELLY:  Okay.  So that is both of our success stories.  Well, I mean, we have more, but those are the ones I included.  Sometimes it's kind of good to hear from people that have been helped before from their own mouths and something that she mentioned that I wanted to kind of point out is that ‑‑ again, is that all of our services are free.  And people do a lot of research and, like, OIEC is here for injured employees.  It's our job to, you know, look into these cases, help you guys, and I've talked to so many ombudsman where, you know ‑‑ not that they are doctors or anything, but they sound like it to me.  They talk, and they say stuff where I'm like, okay, you did your research.  You looked into this medical procedure.  You looked into this medical diagnosis, and you know what you're talking about, so it does require a lot of research, a lot of effort from our ombudsman.  A lot of collaboration, too, with the injured employees, so I feel like something that is kind of misconstrued a lot ‑‑ I know a lot of people ‑‑ workers' compensation is complicated.  Claims aren't always guaranteed to work out like everyone hopes they do, so we're not here to fight you.  We're not here to, you know, mess up your case or ‑‑ anything like that.  We're here to help assist, educate, advocate.  We're here for you.  
     So to wrap up, I'll talk about some kind of return to work resources so once the whole process is kind of, you know, come to an end, something that will probably happen is a bona fide offer of employment.  This is a written offer of employment.  It's a letter from the employer offering, modified or alternative work to an employee within their medical restrictions due to the work‑related injury, so this offer must be provided to the employee in writing, and it must include several key details so first the job must be consistent with the doctor certification of the employee's work abilities.
     Second, it must include the location of employment, and it has to take into account these factors the employee's physical limitations and how that affects travel, the distance the employee must travel, the availability of transportation and whether the work schedule is similar to what the employee had before the injury.  
     Third, the offer must include the work schedule for.  
     Fourth, it must state the wages being offered and fifth it must include a description of the physical and time requirements of the physical.
     And finally, it must include a statement that the employer will only assign tasks consistent with the employee's physical abilities.  Their knowledge and skills and provide training if needed.
     Next slide, so this next slide is some return to work resources.  The division of workers' compensation ‑‑ they provide a lot of the information and education about return to work programs for both injured employees and for employers and for healthcare providers I believe so too, and they kind of give an overview of what injured employees may need in order to return to work safely, so these resources include things like a return to work checklist.  They have a video guide.  They have employment support resources, and they have a lot of other stuff on there.  
     You can scan this QR code.  That'll take you to the web page.  The return to work web page on their website is also WWW.TDI.Texas.gov/WC/rtw/index.html.  They also have a return to work email address that you may be able to contact it's rtw.services@tdi.Texas.gov.  If you have any questions or want to know more about getting back to work, you can email them.
     Next slide.
     Okay.  I believe this is the last slide.  When do you know when to refer to OIEC, so if you have a Texas work comp. claim if you're not represented by an attorney and if you have a possible dispute.  You can contact us for questions.  If you don't know if your ‑‑ if you don't know if your employer has workers' comp coverage we can check that for you too.  
     We're always here to help injured employees like I mentioned earlier.  We want you to better understand your rights.  We want the dispute process to go well, and we want to give you all of the options available when things arise in a claim, so for more information from us, you can go to our website.  It's OIEC.Texas.gov.  You can call us at 866‑393‑6432.  We also ‑‑ we have a lot of videos that might be helpful.  There's ones that are for the BRCs, CCHs, that kind of gives you an overview how those go on our YouTube channel it's OIECtube on YouTube.  I think our other social medias are OIEC Texas.  We usually provide tips, frequently asked questions, things like that on there as well.
     We also have a main email, so that would be OIEC in‑box at OIEC.Texas.gov if you would prefer to email or have any questions that are easier to email.  
     But besides that, yeah, we encourage all of you to reach out early.  Please, early if you have any questions.  Getting help sooner really makes the process easier to understand, and it really may help prevent delays in your dispute because there are a lot of deadlines that need to be met.
     So I want to thank you, guys, for joining.  I think we'll go into questions now.  There might be a lot.  Does somebody want to take over.  
>> MATT DICKENS:  Yes I can put ‑‑ so I also have a couple questions myself.  If we don't have any questions from the audience.  The first question would be in regards to how important it is for your word choice in the application process because I see, you know, a lot of claims denied because of the wrong word choices.  When they're feeling out that complaint or claim.  
>> ALEXANDER ELIAS:  I'll answer that whenever you report your injury can be very, very important in your claim.  Specifically, how you were injured.  Also, when did you realize you were injured?  We have a lot of injured employees who come in who just feel pain and the keyword is "pain" in itself is not an injury, but they feel it, and they're not aware of an actual injury until they go to an actual doctor and check things out, so you want to make sure when you do go to a doctor, to get checked out for pain, if it's happening because of work, you would express exactly what it is specifically ‑‑ for example, I spent all day sweeping a large industrial room for 5 days a week any discrepancies ‑‑ and you're not lying you're just maintaining how you were injured, and you maintain all that information in all the paperwork that you filed because sometimes when the carrier reviews your claim of workers' comp, once they find discrepancies, it's kind of the green light to say we're not going to prove it because we cannot determine if this injury was suffered within the course or scope of employment, so documentation and also how you were injured that it cause the mechanism of the injury.  It's a fancy word for how you got hurt.  It's very important to be consistent and documenting it in your report to your employer and to the insurance carrier that covers the employer.  
>> MATT DICKENS:  Okay.  Also, I ask that same question because a lot of people out there with disabilities have a language barrier so maybe they don't have, you know, awareness of correct word choice to fill out ‑‑ to file that claim, and then it would become a dispute within your organization.  To get assistance because sometimes when they fill out it's not necessarily what they meant so here need more expansion and more clarification on that.  
>> ALEXANDER ELIAS:  Yes, so what we do have here we have an ADA coordinator ‑‑ remember, you have several days to report to your employer if you have any questions how you can report it, you can contact us.  We do have an ADA coordinator that could give us an ASL interpreter for us if needed.  We also have individuals who may use ‑‑ if that technology is still available or not, but they do it over the phone ‑‑ 
>> MATT DICKENS:  The relay service.  The relay service.  
>> ALEXANDER ELIAS:  But we do have resources available to us to help ‑‑ even when they just report an injury to the employer.  That's what we're here for to give you the resources to make sure you document it correctly to avoid any disputes down the line.  
>> MATT DICKENS:  Okay.  Secondly my next question.  This is in regards to ‑‑ if a person has a disability that's existed before the injury, who would be responsible helping them with those accommodations of their claim initially, you know, with their employer.  Would it be filing with the employer or the insurance company or the employee?  
>> ALEXANDER ELIAS:  The employee ‑‑ even if they have pre‑existing injuries or another condition that exists, that doesn't automatically disqualify you, so if you have a previous injury, and we call it aggravation or a situation where you had ‑‑ it's aggravated because you were furthering the business of your employer you still report it to your employer ‑‑ just say I've had it before, but it just got progressively worse or it got aggravated within the scope ‑‑ you do want to report it to your employer, and then the insurance carrier may have additional questions, and you report it to them if there's a dispute report it to us, and we can assist you to pursue your dispute or pursue your claim turn‑around aggravation.  
>> Okay.  Awesome and thank you that's good to know as well, but it doesn't answer the question.  Who would be responsible for those accommodations.  For example, I believe most of the time the workers' comp claim you would have to go to that doctor they refer you to, so what if that doctor does not know about the accommodations and getting sign language interpreters or braille ‑‑ providing braille or other types of accommodations?  Who would be responsible for that?  
>> ALEXANDER ELIAS:  The injured employee is the advocate for themselves to try to get them, but their employer ‑‑ the human resources department should be able to help them with those accommodations that's needed.  It usually relies on the employer ‑‑ the ‑‑ the insurance carrier does get involved, but that's when they accept the claim or deny the claim, but the employer is the resource of contact to try to make those accommodations for the injured employee.  
>> Okay.  Perfect, thank you, thank you.
     I'm looking to see if we have any other questions.  
     Okay, so we might have one more question in regards to Social Security disability benefits.  Can they still apply for Social Security benefits if they're going through a workers' comp claim or do they have to use up the workers claim benefits first?  
>> ALEXANDER ELIAS:  So are you talking about Social Security benefits like the monthly payments ‑‑ just because ‑‑
>> Yes, for disability benefits yes.  
>> ALEXANDER ELIAS:  You still want to call in the process to report the injury to your employers.  I do know some insurance carriers do their research when it comes to lost income.  If you're earning any Social Security benefits while also employed, it doesn't automatically mean you're not entitled to any additional benefits, so it's on a case‑by‑case basis so still you don't want to not report something because you're on Social Security.  We have many people who are retired and go back to work, and they get injured, and they do receive Social Security benefits, but they may not be earning the income that they were because of the injury, so it is a possible denial by the carrier, but it doesn't mean that the carrier is right all the time so just because you're earning it, doesn't mean that you don't have the right to pursue it.  
>> Okay.  Okay.  So whenever an individual applies for their Social Security benefits if they don't have anything previous to that will workers' comp claim impact their ability to get their benefits from Social Security?  
>> ALEXANDER ELIAS:  Repeat your question one more time.  
>> So with Social Security disability benefits they have limitations on your income.  Now some people who have not filed for their claim for disability, but they were injured enough where they're going to be able to get their disability benefits now, and they want to file ‑‑ file a claim for disability benefits but also do the workers' comp at the same time, can you do both?  
>> ALEXANDER ELIAS:  You could make the attempt.  I don't want to discourage anyone from not filing because of Social Security because you were injured on the job you have ‑‑ they're covered.  They're liable ‑‑ they're possibly liable for the missed income as well as the treatment, and, so it could get to a point where they maybe to get treatment but not their benefits, but that's on a case‑by‑case basis, so it's not a situation where I can give you an overall answer or an absolute answer, but you do need to make sure whenever you get injured you still pursue it, and you pursue the benefits but if you're on Social Security we could give you resources to refer you out for Social Security who may be able to answer that question directly.
     But in our situation we're going to just deal with the workers' comp benefits or any missed income they're entitled to and if you are earning Social Security or about to go on Social Security, we can refer you out to the proper individuals to give you the correct overall answer based on your situation.  
>> Okay, okay.  
     I think ‑‑ oh, we do have one more question.  
>> Okay.  So it's kind of worded just with a few words.  I'm assuming it was coming from follow‑up of a previous question so what if it's years past due or if it's an intellectual disability?  
>> ALEXANDER ELIAS:  We do have situations where we have injured employees who were hurt years prior, but they reported the injury, and they just didn't follow up with it, but it was record, there are some claims that are time‑sensitive that have to be handled within a specific timeframe, but we do have other injuries that are not bound by any type of deadlines, for example, the extent of the injury.  You had an injury at work but then you were diagnosed with a rotator cuff.  At the time there was no doctor willing to provide you a letter to assist you, you know, to get your injury there ‑‑ and then a year passed, and you found the best doctor to get you proved that the extension much your injury was caused by the original injury, and you can pursue it now.  They gave you the evidence, and you can pursue it there's no timeframe, so if there's a situation where you were not able to report it because of a disability, you can see U‑still try to pursue later, and you may fall under the exceptions of the law that gives you the opportunity to pursue it down the line.  Even though we have some claims that are time‑sensitive they have to be filed there are some exceptions to the law on a case‑by‑case basis.  
     I'll give you an example of one that is a little bit different but ‑‑ there was a death claim that's down by a specific timeframe that they have to report it, but we were able to find a loophole, and this was years later that the employer never reported it to the actual insurance carrier when it happened and the ‑‑ once the employer for whatever reason decided to report it, the insurance carrier automatically denied it because it was past the deadline but passed what deadline because you weren't aware of it until September, and they pursued it in October, and so I'm glad to say that loophole was a very legitimate loophole that the claimant was able to get.  The beneficiary was able to get death benefits years after the initial unfortunate death of the actual injured employee but ‑‑ so there is possibilities that even if you're delayed in pursuing it, you can still pursue it.  
>> Well, so one more question for you then before we wrap it up, so I have a notice that you're doing a lot of support for employees who were injured or have disabilities but what about the employers if the employer has a question about supporting their employees with those disabilities or how to apply or they feel like maybe something was done incorrectly, and they made the wrong decision, can you help them as well.  
>> ALEXANDER ELIAS:  Unfortunately, we only assist the injured employees because that's our main focus, but I do know employees ‑‑ that's the reason why it's strongly encouraged them to get workers' comp insurance, so that way the workers' comp adjusters and their representatives are very trained in the workers' comp law, and they're able to provide the resources for the employees to prevent injuries.  No one wants to get injured at work, and so we assist the injured employees, but the employers themselves can also refer ‑‑ get covered by workers' comp insurance, and they have very trained professionals.  I deal with them every day.  The Texas workers' comp insurance companies here in Texas, and they're very, very knowledgeable, and that's good resources for the employers, for any workers' comp‑related injuries or any prevention that they need.  
>> I also ‑‑ I'm so sorry.  I want to jump in.  I wanted to add that that would be probably be something that you could contact the division of workers' comp for there.  Since they're like the regulatory agency.  I think that they would provide information to any of the groups that I mentioned earlier.  Like employees, insurances carriers, I think even attorneys ‑‑ so if you're an employer, and you want to know more about workers' comp or things of that sort, I would probably reach out to them.  
>> Okay, awesome I believe we're out of time so thank you so much for taking the time to share this important information with us.  We do know that workers' comp ‑‑ we don't think a lot about these things until we ‑‑ the incident happens to us, so being well‑informed would help us to be more well‑informed so for something that happens to them.  So again, thank you for your time and have a great rest of the week.  
>> Thank you so much.  You too.  
>> Thank you.  
>> OPERATOR:  Recording stopped.