Workers’ compensation insurance is optional for most Texas businesses. However, many employers choose to carry coverage because it’s a cost-effective option that can save a business money in the long run.
Texas is different from most other states because it doesn’t generally mandate workers’ compensation insurance.
Even when workers’ compensation insurance is not required, it’s often in the employer’s best interest to provide coverage. If an employee is injured on the job, the employer could be held liable to pay for expenses associated with medical treatment, ongoing therapy, and lost wages.
Business owners that decide not to purchase workers’ comp insurance are called nonsubscribers. They must report to the state that they do not have coverage, and they must report workplace injuries.
If an employee is injured on the job at a business with no coverage, that person can sue the employer. In that case, the employer is not allowed to defend itself in court with an argument of employee negligence.
There are a few industries that must provide employees with workers’ compensation. Texas requirements for coverage include:
To secure workers' comp coverage, Texas employers may either buy commercial insurance or become certified as self-insured.
A commercial insurance policy must be issued by a company licensed by the Texas Department of Insurance to underwrite workers’ compensation policies or be purchased from Texas Mutual Insurance Company. Insureon helps small business owners compare quotes from leading insurers licensed in Texas with a free online application.
Workers’ compensation rates are based on classification codes that convey the level of risk associated with a job. The codes are established by the commissioner of insurance, the insurer’s own system of classification (on file with TDI), or the National Council on Compensation Insurance (NCCI) classification system.
The Division of Workers' Compensation (DWC) administers and operates the Texas workers' compensation system. Insurance companies and self-insured employers pay benefits on workers' compensation claims.
There are three types of workers’ compensation benefits in Texas:
Workers’ compensation medical benefits cover medical care that is reasonable and necessary for treatment of a work-related injury or occupational disease.
In order for an injured worker to receive medical benefits, the treating doctor must be on the state’s approved list, or the treatment must be approved by a listed physician.
For serious injuries or illnesses, a worker could be eligible to receive lifetime medical benefits, which would prohibit the insurance company from settling for a certain amount of money or time for treatment.
Within the income benefit, an injured employee can be eligible for:
The Texas Workers' Compensation Act also allows for lifetime income benefits for severe permanent injuries, including loss of sight in both eyes.
Typically, unless treatment is received in an emergency situation, the medical provider must be on the list of physicians approved by the Texas Workers’ Compensation Commission for the injured worker to receive income benefits.
If an employee covered by workers’ compensation insurance in Texas dies as a result of a job injury or illness, that person’s survivors are entitled to death benefits. The following family members could be eligible to receive benefits:
A survivor’s death benefit is 75% of the deceased worker’s average weekly wage, up to an amount determined each year by the state. The amount would be split among the deceased person’s beneficiaries.
The workers’ compensation death benefit would also cover burial expenses up to $10,000.
A workers’ compensation settlement in Texas takes place when the injured worker and the insurer agree on the resolution to a claim. The Texas workers' compensation system does not allow lump sum settlements, with the exception of some cases of impairment income benefits.
When a doctor determines that the worker’s condition has stabilized, the worker is considered to have reached maximum medical improvement (MMI) and the case is then permitted to settle. The Texas Department of Insurance must approve every workers’ compensation settlement in Texas.
The State of Texas requires employees to file workers’ compensation claims within one year of the date of injury to be eligible for benefits.
However, it’s the employee’s responsibility to notify the employer within 30 days of the injury so that the employer has the opportunity to resolve the issue or take any necessary steps to remediate the situation.
If you are ready to explore workers’ compensation coverage for your Texas business, start a free online application today to compare quotes from top-rated insurance carriers.