Notice To Employees Concerning Workers' Compensation In Texas printable pdf download

Notice To Employees Concerning Workers' Compensation In Texas

NOTICE TO EMPLOYEES CONCERNING

WORKERS’ COMPENSATION IN TEXAS

COVERAGE:

[Name of employer]

does not

have workers’ compensation insurance coverage. As an employee of a non-covered employer, you

are not eligible to receive workers’ compensation benefits under the Texas Workers’ Compensation

Act. However, a non-covered (non-subscribing) employer can and may provide other benefits to

injured employees. You should contact your employer regarding the availability of other benefits for

a work-related injury or occupational disease. In addition, you may have rights under the common

law of Texas should you have an on the job injury or occupational disease. Your employer is required

to provide you with coverage information, in writing, when you are hired or whenever the employer

becomes, or ceases to be, covered by workers’ compensation insurance.

SAFETY VIOLATIONS HOTLINE:

The Division has a 24 hour toll-free telephone number

for reporting unsafe conditions in the workplace that may violate occupational health and safety

laws. Employers are prohibited by law from suspending, terminating, or discriminating against any

employee because he or she in good faith reports an alleged occupational health or safety violation.

Contact the Division at 1-800-452-9595.

Notice 5 (01/13)

TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS’ COMPENSATION

Rule 110.101(e)(4)

Notice To Employees Concerning Workers' Compensation In Texas