Workers' compensation in Texas provides medical and income benefits to workers who suffer work-related injuries or illnesses. However, Texas is unique because private employers are not required to carry workers' compensation insurance. Here's how the system works, from employer requirements to filing a claim and receiving benefits.
Is Workers' Compensation Required in Texas?
Unlike most states, Texas allows private employers to choose whether to provide workers' compensation coverage. Employers who opt out are called non-subscribers and may be sued by employees for workplace injuries. Employers who carry workers' compensation insurance are protected from most lawsuits but must comply with the Texas Department of Insurance, Division of Workers' Compensation regulations.
Who Qualifies for Workers' Compensation in Texas?
Employees qualify for benefits if:
- They're injured or develop an illness while performing work-related duties.
- Their employer carries workers' compensation insurance.
- They report the injury within 30 days of the incident.
Independent contractors, some agricultural workers, and domestic workers may not be covered under traditional workers' comp policies.
Filing a Workers' Compensation Claim in Texas
- Report the Injury: Notify your employer within 30 days of the injury or diagnosis.
- Seek Medical Treatment: Choose a doctor from your employer's Workers' Compensation Health Care Network (if applicable).
- Employer Files a Report: The employer must report the injury to their insurance provider and TDI-DWC.
- Submit a Claim: Employees must file DWC Form-041 with TDI-DWC within one year of the injury to claim benefits.
- Claim Decision: The insurer reviews the claim and determines eligibility.
Types of Workers' Compensation Benefits in Texas
Medical Benefits
- Covers doctor visits, surgeries, prescriptions, therapy, and rehabilitation.
- No deductible or copay is required.
Income Benefits
- Begin after a seven-day waiting period if the employee misses work.
- Includes Temporary, Impairment, Supplemental, and Lifetime Income Benefits, depending on injury severity.
Death and Burial Benefits
- Provides financial support to the family of a worker who dies from a job-related injury.
- Covers funeral expenses up to $10,000.
Can You Appeal a Denied Claim?
Yes. If a claim is denied, employees can request a Benefit Review Conference (BRC) with TDI-DWC to dispute the decision.
Conclusion
Texas workers' compensation provides essential protections for employees, but because coverage is optional for employers, it's crucial for workers to understand their rights and the claims process.