Challenging a Workers' Compensation Benefit Cutoff
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Reviewed & verified by A. Jason Velez, Esq.*
Founding Attorney, 1LAW · Last reviewed December 2022
Legal Inquiry
Consumer Legal Issue
Some years ago I had a rollover accident in my employer's delivery truck. Traumatic brain injury, broken legs, pelvis, arm, degloved right leg. Stayed in a rehabilitation hospital two years. Was paid workers' compensation by the carrier since then, and last month they discontinued my pay.
Attorney Answer
A carrier stopping payment is not the end of the matter. The Texas workers' compensation system has a formal dispute process for exactly this, and it runs on short administrative deadlines — which is why this needs a Texas workers' compensation lawyer now rather than after the next missed payment.
Start with what the carrier owes you in explanation. Benefits in a Texas comp claim are not open-ended: income benefits are of defined types and durations, and a carrier that stops paying is normally asserting that a particular benefit has ended, that your condition has been assessed a certain way, or that some other dispute exists. The specific benefit rules and the division's dispute procedure — the steps, the forms and the deadlines for contesting a termination — are detailed, and they are not worth guessing at. That is precisely the information a comp lawyer or the division itself can give you in one conversation, and it is time-sensitive.
What I can tell you is the shape of the system you are in. Tex. Lab. Code § 408.001(a) makes recovery of workers' compensation benefits the exclusive remedy of a covered employee against the employer or an agent or employee of the employer for a work-related injury. That is why the fight over benefits is with the carrier and the division rather than a lawsuit against the company — subject to two exceptions worth knowing: § 408.001(b) preserves exemplary damages for a surviving spouse or heirs where a death was caused by the employer's intentional act or gross negligence, and an employer that does not carry workers' compensation coverage at all is outside § 408.001 and loses the usual defenses.
The front-end deadlines in the statute — Tex. Lab. Code § 409.001, requiring notice to the employer not later than the thirtieth day after the injury, and § 409.003, requiring a claim to be filed with the division not later than one year after the injury — are behind you. You reported, you claimed, and you were paid for years. They are worth knowing only so that no one confuses them with the deadline that matters now, which is the one attached to disputing the stoppage.
One more protection: under Tex. Lab. Code § 451.001 a person may not discharge or in any other manner discriminate against an employee because the employee filed a workers' compensation claim in good faith, hired a lawyer to represent them in a claim, instituted a proceeding in good faith, or testified or is about to testify in one. If pressure follows from your pursuing this, that section is the answer to it.
What you can do
1. Ask the carrier in writing for the reason it stopped payment, the date it stopped, and the benefit type it says has ended. Keep the reply and note the date you asked.
2. Gather the file you already have: benefit payment records, medical records from the hospital and rehabilitation stay, any impairment rating, and every letter from the carrier.
3. Contact the Texas Division of Workers' Compensation, say your benefits were discontinued, and ask what the dispute process is and what deadline applies to you. The division also has an office that helps unrepresented injured employees, at no charge.
4. Do not sign any agreement, settlement or benefit-related form the carrier sends until someone independent has read it.
5. Speak to a Texas workers' compensation lawyer this week and bring the payment records and the last correspondence from the carrier.
6. Ask that lawyer, in the same conversation, whether anyone other than your employer may be responsible for the crash itself, and whether that window is still open.
Most lawyers offer a brief initial call at no cost, and a few minutes on your specific facts is worth more than any general guidance, including this page.
⏱ Time limits apply. The deadline that matters most here is administrative and short, set by the division's dispute process, and you should ask about it immediately. Separately, Tex. Civ. Prac. & Rem. Code § 16.003(a) generally requires suit for personal injury to be brought not later than two years after the day the cause of action accrues, which is the clock on any claim against a person other than your employer arising from the crash; for an accident several years old that window has very likely closed. I will not calculate any of these dates for you — have a Texas attorney fix them from your records now.
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Frequently Asked Questions
Can a Texas workers' compensation carrier stop paying benefits that it has been paying?
It can, and that decision can be disputed. Income benefits under the Texas system are of defined types and durations rather than being open-ended, and a carrier that stops paying is normally taking a position about which benefit applies, about the worker's condition, or about some other issue in the claim. Texas provides an administrative dispute process through the Division of Workers' Compensation for contesting such a decision, and the deadlines in that process are short. An injured worker whose benefits stop should ask the carrier in writing for its reason and contact the division promptly rather than waiting.
Can an injured worker sue their employer in Texas?
Usually not, if the employer carries workers' compensation coverage. Tex. Lab. Code § 408.001(a) makes recovery of workers' compensation benefits the exclusive remedy of a covered employee, or a legal beneficiary, against the employer or an agent or employee of the employer for a work-related injury or death. There are two significant qualifications: § 408.001(b) preserves exemplary damages for a surviving spouse or heirs where a death resulted from the employer's intentional act or gross negligence, and Texas permits employers to go without coverage, so an employee of a non-subscribing employer is outside the exclusive remedy and that employer loses its usual common-law defenses.
What are the deadlines for reporting a work injury in Texas?
Tex. Lab. Code § 409.001(a) requires an employee, or someone acting on the employee's behalf, to notify the employer of an injury not later than the thirtieth day after the date the injury occurs, or after the date the employee knew or should have known an occupational disease may be work-related. Tex. Lab. Code § 409.003 requires a claim for compensation to be filed with the division not later than one year after the date the injury occurred, with a parallel discovery date for occupational disease. Sections 409.002 and 409.004 can relieve the carrier of liability where those deadlines are missed, unless the employer had actual knowledge, good cause exists, or the claim is not contested.