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Notice of Workers' Compensation (from insurance carrier)

Caitlin Dillon
  • Updated

Notice to Employees – Workers' Compensation Insurance Coverage
(Reference Rule 110.101)

(a) In addition to the posted notice required by subsection (e) of this section, employers, as defined by Labor Code Section 406.001, shall notify their employees of workers’ compensation insurance coverage status, in writing. This additional notice: 

  1. Shall be provided at the time an employee is hired, meaning when the employee is required by federal law to complete both a W-4 form and an I-9 form or when a break in service has occurred and the employee is required by federal law to complete a W-4 form on the first day the employee reports back to duty; 

  2. Shall be provided to each employee, by an employer whose workers’ compensation insurance coverage is terminated or cancelled, not later than the 15th day after the date on which the termination or cancellation of coverage takes effect; 

  3. Shall be provided to each employee, by an employer who obtains workers’ compensation insurance coverage, not later than the 15th day after the date on which coverage takes effect, as necessary to allow the employee to elect to retain common law rights under Labor Code Chapter 406; 

  4. Shall include the text required in the posted notice (see rule 110.101 (e)(1), (e)(2), (e)(3), (e)(4) for appropriate language); and 

  5. If the employer is covered by workers’ compensation insurance (subscriber) or becomes covered, whether by commercial insurance or through self-insurance as provided by the Texas Workers’ Compensation Act (Act), shall include the following statement: 

NOTICE TO NEW EMPLOYEES
“You may elect to retain your common law right of action if, no later than five days after you begin employment or within five days after receiving written notice from the employer that the employer has obtained workers’ compensation insurance coverage, you notify your employer in writing that you wish to retain your common law right to recover damages for personal injury. If you elect to retain your common law right of action, you cannot obtain workers’ compensation income or medical benefits if you are injured.”

Notice to New Employees – Rev. 07/12
Division of Workers’ Compensation

See attached poster for information.