Work Injuries and Workers' Compensation Care

Key facts

How workers' compensation care works in Texas

Texas workers' compensation is regulated by the Division of Workers' Compensation within the Texas Department of Insurance. When an injury is accepted as work-related ("compensable"), the employer's insurance carrier pays for reasonable and necessary medical care related to that injury, and the worker may receive income benefits for time lost from work. Texas does not require private employers to carry workers' compensation; if your employer is a "non-subscriber," care runs through the employer's own injury plan or your health insurance instead.

Two details matter at the first visit. First, some employers use a certified workers' compensation health care network; if yours does, you must choose a treating doctor from the network list, and a referral to a specialist such as a pain physician usually comes from that treating doctor. If your employer is not in a network, you may choose any doctor willing to treat under DWC rules. Second, Texas requires treatment to follow adopted treatment guidelines (the Official Disability Guidelines) and a defined preauthorization list, which is why some steps in care take longer to arrange than they would under commercial insurance. Gulf Coast Pain & Spine treats injured workers at its Houston, Webster and Pearland (opening November 2026) offices.

What you need before the first visit

A workers' compensation visit cannot be billed or treated properly without the claim information. Bring, or have your employer or adjuster send ahead:

• Claim number and the insurance carrier's name
• Adjuster's name, phone and fax or email
• Date of injury and a short description of how it happened
• Employer name, contact person and phone, and your job title and physical duties
• Referral from your treating doctor if you are in a network, or from any physician who has seen you for the injury
• Records from the emergency room, urgent care, occupational medicine clinic or other doctors, and any imaging reports or discs
• Any DWC forms you have received, such as prior DWC Form-073 work status reports
• Photo ID and your health insurance card

If you have not yet reported the injury, do so in writing to your employer now; Texas requires notice within 30 days. If you have not filed a claim with DWC, file DWC Form-041, Employee's Claim for Compensation for a Work-Related Injury, within one year. The employer files its own report (DWC Form-001).

The first visit and what your employer receives

The first visit is a full evaluation of the injury: mechanism, prior history of the same body part (which matters for compensability), examination, review of imaging, and a working diagnosis. Two documents are produced for the claim:

• DWC Form-073, Work Status Report. Texas requires the treating physician to complete this at the first visit, whenever your work status or restrictions change, and at intervals during care. It states whether you can return to work without restrictions, with specific restrictions (for example, no lifting over 20 pounds, no overhead work, sit-stand option, 6-hour days), or not at all, and for how long. Copies go to you, your employer and the carrier.
• Medical records and the treatment plan. The carrier and adjuster receive visit notes and requests for authorization. Records go to your employer only in the form of the work status report and any information you authorize; your employer does not receive your full medical record.

You are entitled to copies of everything sent about you.

Treatment, preauthorization and timelines

Treatment options are the same as for any patient with the same injury: physical therapy, medication, image-guided injections and diagnostic blocks, radiofrequency ablation, and, for severe nerve pain, spinal cord stimulation. The difference is the approval process. Under Texas rule (28 Texas Administrative Code, Section 134.600), the carrier must preauthorize certain services before they are provided, including:

• Physical or occupational therapy beyond the first six visits
• Outpatient surgical or ambulatory surgical services, which is how most injection procedures done at a surgery center are classified
• Repeat MRI or CT of the same body part
• Spinal cord stimulators, and all spinal surgery
• Work hardening, work conditioning and chronic pain management programs

The office submits preauthorization requests with the supporting notes. Carriers must respond within three working days for most requests; if a request is denied, there is a reconsideration step and then an independent review process through DWC, and we participate in both. Expect one to three weeks from recommendation to procedure.

Medications are prescribed under the Texas workers' compensation closed formulary. Our approach to medication is the same as for every patient: non-opioid-first, with any controlled-substance decision made by the physician after evaluation and records review, described on our medication management page.

Return-to-work planning

Returning to work, in some form, as early as is safe is part of the treatment, not something that waits for full recovery. Workers who return to modified duty recover faster and are far more likely to return to full duty than those who stay off work entirely. From the first visit we plan for it:

• Specific, graded restrictions on the DWC Form-073 that let your employer offer modified duty, updated at each visit as you improve
• Therapy aimed at your job's demands, including work conditioning or work hardening programs when the gap between your current capacity and the job is large
• Timing procedures to support the return, for example scheduling an ablation before a planned increase in duties
• Coordination with your employer's return-to-work program when one exists, and with a DWC or carrier case manager if one is assigned
• Functional capacity evaluation by referral when a formal measurement of what you can safely lift and carry is needed

If your employer offers a written, bona fide offer of modified work that fits the restrictions we have set, declining it can affect income benefits, so bring any such offer to your visit and we will confirm whether it matches the restrictions.

Maximum medical improvement, impairment ratings and disputes

At some point in every claim, the treating physician determines that you have reached maximum medical improvement (MMI), meaning further recovery is not expected, even if some symptoms remain. Texas sets a statutory MMI date of 104 weeks after income benefits begin, and MMI can be certified earlier when recovery has plateaued. At MMI, an impairment rating is assigned by a physician certified by DWC to do so. Reaching MMI does not end medical care; treatment that maintains function or manages ongoing pain continues to be covered when it is reasonable and necessary.

Disputes about MMI, the impairment rating, or what is part of the injury may lead DWC to order a designated doctor examination by an independent physician. The Office of Injured Employee Counsel (OIEC) provides free help to injured workers without an attorney. Our role in disputes is to provide accurate records and, when asked, our medical opinion.

Related pages: low back pain, neck pain, auto injuries, physical therapy coordination, insurance, new patients.

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