Workers’ Compensation

Worker’s Compensation Law, The Basics

Workers’ compensation is a system of insurance that provides medical and income benefits to employees who are injured on the job or suffer work-related illnesses. For personalized help, speak with an experienced Texas workers’ compensation lawyer to ensure your rights are protected. In Texas, the workers’ compensation system is governed by the Texas Workers’ Compensation Act, administered by the Texas Department of Insurance, Division of Workers’ Compensation (DWC).

Opt-Out State

One of the unique features of Texas workers’ compensation law is that Texas does not require most private employers to carry workers’ compensation insurance. Employers who choose not to participate in the state-regulated system are known as “non-subscribers.”These non-subscribers are exposed to potential lawsuits if an employee is injured due to the employer’s negligence. In contrast, employers who carry workers’ compensation insurance are typically protected from most employee lawsuits related to workplace injuries.

Covered Benefits

For those employers who do subscribe to the system, Texas workers’ compensation provides several types of benefits to injured workers:

• Medical Benefits: Covers all reasonable and necessary medical care related to the work injury, with no deductibles or co-pays.
• Income Benefits: Compensates for lost wages when a worker is unable to work due to injury. Types of income benefits include Temporary Income Benefits (TIBs), Impairment Income Benefits (IIBs), Supplemental Income Benefits (SIBs), and Lifetime Income Benefits (LIBs).
• Death Benefits: Paid to eligible family members of a worker who dies as a result of a work-related injury or illness.
• Burial Benefits: Helps cover funeral expenses for a deceased worker.

Reporting and Filing Requirements

Injured workers must report their injury to their employer within 30 days of the injury or the date they knew the injury was work-related. Employers must then report the injury to their insurance carrier within 8 days of becoming aware of the injury. Workers must file a formal claim with the DWC within one year to preserve their right to benefits.

Dispute Resolution

Disputes about benefits, medical care, or return-to-work issues may arise. Texas has a structured process to resolve these disputes, starting with informal dispute resolution, benefit review conferences, and potentially moving to contested case hearings before an administrative law judge. Appeals can go to the DWC Appeals Panel and eventually to the courts if necessary.

Limitations and Challenges

While the system is designed to be no-fault (i.e., workers do not need to prove their employer was negligent), disputes over the extent of injuries, appropriate medical treatment, and eligibility for certain income benefits are common. Moreover, because Texas allows employers to opt out, not all workers are protected under the state system.

Conclusion

Texas workers’ compensation law provides essential protections for employees injured on the job, but the system is distinct due to the state’s opt-out provision. Workers should promptly report injuries, understand their rights, and seek legal advice if disputes arise. Employers, in turn, must carefully weigh the risks and responsibilities of subscribing or not subscribing to the system.