Texas Workers Compensation: Protecting Employees and Employers Alike

Workers’ compensation provides protection for employees who are injured or become ill on the job. Employers benefit by having an insurance policy that covers workers’ medical expenses and lost wages. Texas has a unique workers’ compensation system that provides benefits to workers while also benefiting the state’s businesses. In this article, we’ll explore the history of Texas workers’ compensation and provide updated information on the current system.

History of Workers’ Compensation in Texas

The history of workers’ compensation laws in Texas dates back to 1913 when the state adopted its first law, commonly known as the “Texas Employers’ Liability Law.” This law allowed employees to sue their employer for work-related injuries, but they had to prove that the employer was at fault. In 1917, Texas adopted a mandatory workers’ compensation law, which provided benefits without the need to prove fault. However, this system was declared unconstitutional in 1923.

Texas did not adopt another statutory workers’ compensation system until 1989. This new system is called the Texas Workers’ Compensation Act and is administered by the Texas Department of Insurance (TDI). Rather than a traditional system run by the state, Texas allows private workers’ compensation insurance carriers to compete for business. This means that employers can choose an insurance carrier that meets their needs and budget.

The Texas Workers’ Compensation Act was revised in 1991, 1993, 2001, and 2005 to enhance benefits for injured workers, increase the choice of medical providers, and make the system more efficient. More on these updates later in the article.

Coverage and Benefits

The Texas Workers’ Compensation Act requires most employers to provide workers’ compensation coverage to their employees. This coverage applies to all employees, including part-time and temporary workers. Employers can choose to provide workers’ compensation insurance coverage through a policy purchased from a private insurance carrier or by choosing to self-insure. The TDI regulates self-insured employers.

Workers’ compensation benefits under the Texas system may include:

– Medical treatment: Workers’ compensation provides coverage for necessary medical care related to a work injury or illness. This may include doctor visits, diagnostic tests, surgery, hospital stays, rehabilitation, and prescription medications.

– Income benefits: Workers who are unable to work due to a work-related injury or illness may be eligible for income benefits. Income benefits start when the worker misses more than seven days of work. The amount of income replacement is based on a percentage of the worker’s average weekly wage and is subject to benefit caps and duration limits depending on the nature of the injury.

– Vocational rehabilitation: If an injury or illness makes it impossible for a worker to return to their previous job, workers’ compensation may provide vocational rehabilitation services to retrain the worker for a new career.

– Death benefits: If a work-related injury or illness results in death, workers’ compensation may provide benefits to the worker’s dependents.

Workers’ compensation benefits are not taxable income, which means that workers receive the full amount of their benefits without deductions for state or federal taxes.

Medical Providers

Under the Texas Workers’ Compensation Act, injured workers have the right to choose their own treating doctor. Employers must provide employees with a list of approved healthcare providers at the time of the injury. If an injured worker chooses to see a doctor who is not on the list, the employer may not be responsible for paying the doctor’s bills.

Employers are allowed to contract with a network of healthcare providers known as a workers’ compensation Health Care Network (HCN) to provide medical treatment to their employees. A HCN is made up of doctors, hospitals, and other healthcare providers who have agreed to provide treatment for work-related injuries at a reduced cost. The goal of HCNs is to provide quality care while also reducing the overall cost of workers’ compensation claims.

Dispute Resolution

The Texas Workers’ Compensation Act provides for a dispute resolution process that allows injured workers and employers to resolve disputes over benefits. The dispute resolution process includes informal dispute resolution, mediation, and a hearing before an administrative law judge.

Informal dispute resolution involves a discussion between the injured worker, employer, and the insurance carrier to resolve the dispute. If informal dispute resolution is unsuccessful, the parties may pursue mediation through the Texas Department of Insurance, Division of Workers’ Compensation.

If mediation is unsuccessful, the parties may request a contested case hearing before the State Office of Administrative Hearings. The administrative law judge makes the final decision on the dispute.

Revisions to the Texas Workers’ Compensation Act

Since its adoption, the Texas Workers’ Compensation Act has undergone several revisions to improve benefits for injured workers and make the system more efficient. Here are a few notable revisions:

– In 1991, the Texas legislature expanded income benefits for injured workers and allowed employers to choose a health care network to provide medical treatment for employees.

– In 1993, an appeals process was added to the dispute resolution process to allow injured workers to appeal decisions made by administrative law judges.

– In 2001, the Texas legislature allowed injured workers to see a doctor of their choice after a 90-day waiting period. This revision also limited the amount of time a worker could receive income benefits for non-catastrophic injuries to 401 weeks.

– In 2005, the Texas legislature created the Office of Injured Employee Counsel (OIEC) to provide assistance to injured workers. The OIEC is an independent agency that provides information, assistance, and representation to injured workers free of charge.

Conclusion

Texas has a workers’ compensation system that provides protections for both employees and employers. It is unique in that employers can choose to purchase insurance from a private carrier or self-insure. The system provides medical treatment, income benefits, vocational rehabilitation, and death benefits to eligible workers. Additionally, injured workers have the right to choose their treating doctor and may use informal dispute resolution, mediation, or a contested case hearing to resolve disputes over benefits. With the help of a skilled personal injury attorney, anyone who has been injured on the job in Texas should experience a smooth workers’ compensation process.

A Quick Guide to Workers’ Compensation in Texas 

Texas Workers’ Compensation Laws

All Texas workers’ compensation laws are located under the Texas Labor Codes.  These laws provide specific qualifying factors, as well as guidelines for employers that will be discussed in this article.

If an employer has workers’ compensation insurance in Texas, they employee who has become injured will have to attend a physical from the employer’s recommended doctor and undergo an examination.  If the doctor sees evidence that the injury was directly sustained because of duties in the workplace, the doctor will then have to fill out specific forms, and the employee must follow specific procedures.

Texas workers’ compensation laws require a person to take reasonable steps for rehabilitation under their employer’s workers’ compensation insurance in Texas.  The employee must take reasonable steps to get better within a certain period of time, and in some cases, meet with a doctor under the employer’s workers’ compensation insurance in Texas or regular checkups.

Who is covered under Texas Workers’ Compensation Laws?

Only some employers are required to provide workers’ compensation insurance in Texas.  Many larger employers carry the insurance regardless if the business requires the insurance or not.  Some small employers don’t carry workers’ compensation insurance in Texas, but any smart employer will usually try to protect themselves.

Under Texas workers’ compensation laws, the following employers are required to carry insurance:

1. Public employers such as cities, state or county agencies, the University of Texas, Texas A&M, and Texas Tech University facilities

2. Building and construction contractors for public employees

3. Motorbus companies

4. People who provide transportation or public highways

5. Liquid propane gas and compressed natural gas dealers

6. Employers of inmates in work furlough programs

Texas workers’ compensation laws provide specific instructions for employers that do not need to offer workers’ compensation insurance in Texas.  These workers are listed below:

1. Workers on offshore drilling rigs and ships, and those involved in loading and unloading sea vessels (these workers are usually covered under the Jones Act)

2. Domestic or household workers

3. Family members who work on their farms or ranches

Benefits under Workers’ Compensation Insurance in Texas

If a worker qualifies for compensation under Texas workers’ compensation laws, they or their family may be able to receive compensation for lost income, medical treatment, a death, or even funeral costs.

If the worker suffers a disability that limits their ability to work for the rest of their life, they may be compensated according to what work they were once able to do compared to what level of work they can now do.  The compensation is meant to decrease the difference between former and current wage earnings.

For all medical expenses, the employers’ workers’ compensation insurance in Texas will pay the medical facility or professional directly who treats the injured person.  The employee has the ability to pick the doctor, but the doctor must be listed and approved by the Commission.

If death benefits are offered, Texas workers’ compensation laws allow a family to receive a portion of possible income that a family member would have made in their lifetime.