Background

What is Causation in a Texas Workers' Compensation Claim?

Posted By Recalde Law Firm || 24-Mar-2016

If you want to establish that an injury was sustained while you were working, an injured employee in Texas you must prove that the injury resulted from an activity related to their employment or is in some way based on your status as an employee. This is the case, whether you are trying to overturn a denial of their entire claim or if there is an extent of injury issue. (An extent of injury issue is a situation where the insurance carrier will accept that an injury happened, but does not accept the full extent of an injury. For example, if your injury resulted in a herniated disc in your back - the insurance carrier may claim that only a back sprain is related to your injury and not the herniated disc.)

On August 27, 2010, the Texas Supreme Court ruled in Transcontinental Insurance Company v. Crump that “producing cause in workers’ compensation cases is defined as a substantial factor in bringing about an injury or death, and without which the injury or death would not have occurred.” In order to ensure that you have the evidence to prove that your work related injury is in fact work related before a Hearing Officer, then it is important to provide a letter of causation from a medical provider establish this.

The treating doctor is an important factor in establishing that your injury is related to your workplace. The treating doctor will need to provide a letter of causation. The letter of causation should fully define the injury and explain how the doctor arrived at their conclusion that the injury is work related. The letter of causation should focus on the mechanism of injury and explain how the incident led to your injury. The causation analysis should not be a blanket statement. A blanket statement without persuasive information will not be helpful to the Hearing Officer.

The TDI-DWC has created a video on letters of causation to provide as a resource for doctors who treat claimants in the workers compensation system. The video can be found at

http://www.tdi.texas.gov/wc/hcprovider/causation.html

Contact our Houston workers’ compensation attorney to schedule your confidential consultation today.