Workers’ compensation is a crucial safety net for employees who suffer job-related injuries or illnesses. However, Texas has a unique approach to workers’ compensation that sets it apart from other states. This article provides an in-depth look at Workers’ compensation in Texas, including coverage requirements, benefits, and legal considerations.
Is Workers’ Compensation Mandatory in Texas?
Unlike most states, Texas does not require private employers to carry workers’ compensation insurance. This means that businesses can choose whether to participate in the state’s workers’ compensation program. Employers who opt out are referred to as “non-subscribers” and are subject to lawsuits.
Coverage and Benefits
For businesses that do provide workers’ compensation, the insurance covers the following:
- Medical Benefits: Covers necessary medical treatments for job-related injuries and illnesses.
- Income Benefits: Provides partial wage replacement for employees unable to work due to injury.
- Temporary Income Benefits (TlBs): Paid to employees who lose income while recovering from an injury.
- Impairment Income Benefits (IIBs): Given to workers who sustain permanent impairments.
- Supplemental Income Benefits (SlBs): Available for those with lasting disabilities who meet specific criteria.
- Lifetime Income Benefits (LlBs): Provided in cases of severe injuries, such as total blindness or loss of multiple limbs.
- Death and Burial Benefits: Compensation for the family of a worker who dies due to a job- related injury or illness.
Non-Subscriber Employers and Employee Rights
Employers who opt out of the workers’ compensation system must take responsibility for workplace injuries and may face lawsuits from injured employees. In such cases, employees must prove that the employer’s negligence contributed to the injury.
To mitigate risks, some non-subscribers establish alternative injury benefit plans, but these are not regulated by the Texas Department of Insurance, meaning they can vary widely in coverage and benefits.
Filing a Workers’ Compensation Claim
Employees covered under workers’ compensation should follow these steps if injured on the job:
- Report the Injury: Notify the employer as soon as possible, but no later than 30 days from the date of the injury.
- Seek Medical Treatment: As soon as possible and/or obtain care from a provider approved by the employer’s insurance network, if applicable.
- File a Claim: Submit a claim to the Texas Division of Workers’ Compensation (DWC) within one year of the date of injury.
- Follow Up: Stay in communication with the insurance carrier and provide any necessary documentation.
Dispute Resolution and Legal Considerations
If a claim is denied or disputed, employees can:
- Request a Benefit Review Conference (BRC) to resolve issues informally.
- Proceed to arbitration or a formal contested case hearing.
- Appeal to the Appeals Panel if necessary.
Conclusion
Workers’ compensation in Texas offers crucial benefits to employees but also presents unique challenges due to its non-mandatory system. Workers should understand their rights and employers should carefully consider the risks and responsibilities of opting out of the state’s system. If you have questions about a claim or coverage, contact Rendon & Associates.
