Workers’ compensation insurance in Texas is a system that can provide benefits to employees who suffer a work-related injury or illness. Depending on the circumstances, benefits may help pay for necessary medical treatment, replace part of lost income, and provide benefits to eligible family members when a work-related injury or illness results in death.
Texas has an important distinction from many other states: most private employers are not required to carry workers’ compensation insurance. Employers that choose to provide coverage are generally called subscribers, while employers that do not provide coverage are known as non-subscribers. Understanding whether your employer carries workers’ compensation insurance is important because it can affect the benefits available after an injury and the legal options you may have. A Houston work injury lawyer can help you determine how your employer’s workers’ compensation status may affect your claim and what steps you can take after a workplace injury.
Workers’ Compensation Insurance in Texas
Workers’ compensation insurance is designed to provide benefits for qualifying work-related injuries and illnesses without requiring an injured employee to prove that the employer was negligent.
Covered injuries generally must arise out of and in the course and scope of employment. The Texas workers’ compensation system is regulated by the Texas Department of Insurance, Division of Workers’ Compensation (DWC).
Depending on the circumstances, a qualifying claim may provide medical benefits, income benefits, impairment benefits, supplemental income benefits, lifetime income benefits, or death and burial benefits.
Texas Employers and Workers’ Compensation Coverage
Unlike states that generally require private employers to purchase workers’ compensation insurance, Texas allows most private employers to decide whether to provide coverage.
An employer that provides workers’ compensation coverage is commonly referred to as a subscriber. An employer that chooses not to provide workers’ compensation coverage is a non-subscriber. Texas governmental entities, including public schools, utilities, cities, and counties, must have workers’ compensation coverage, although the coverage may be provided through different arrangements.
Subscriber and Non-Subscriber Employers
The difference between a subscriber and a non-subscriber can be significant after a workplace injury.
Subscriber Employers
A subscriber employer provides workers’ compensation benefits through an insurance carrier or an approved self-insurance arrangement. When a qualifying work injury occurs, the employee may seek workers’ compensation benefits through the system.
Workers’ compensation can provide benefits without requiring the employee to establish that the employer caused the injury through negligence.
Non-Subscriber Employers
A non-subscriber employer does not provide workers’ compensation coverage. Texas requires non-subscribers to notify employees that they do not have coverage and to meet certain reporting requirements.
An employee injured while working for a non-subscriber may have different legal options than an employee covered by workers’ compensation. The specific facts of the injury and the employer’s conduct can affect what claims may be available.
Read Related: Civil vs Criminal Law in Texas
Medical Benefits for Work-Related Injuries
Medical benefits are one of the primary components of workers’ compensation. When an injury or illness qualifies as work-related, the insurance carrier may pay for reasonable and necessary medical treatment related to that condition. If you are unsure about your rights or available options after a workplace injury, a personal injury lawyer Houston can help you understand the legal issues that may apply to your situation.
Treatment may include medical appointments, diagnostic testing, medications, physical therapy, surgery, rehabilitation, and other medically necessary care depending on the injury.
Employees should understand the healthcare requirements that apply to their particular workers’ compensation claim. For example, an employer’s claim may be subject to a healthcare network, in which case the injured employee generally must use an approved network provider unless an exception applies.
Income Benefits After a Workplace Injury
A work-related injury may prevent an employee from earning the same wages as before the accident. Workers’ compensation can provide several types of income benefits designed to replace some lost income.
Texas recognizes:
- Temporary income benefits
- Impairment income benefits
- Supplemental income benefits
- Lifetime income benefits
- Death benefits
The type and amount of benefits available depend on factors such as the nature of the injury, the employee’s ability to work, the employee’s average weekly wage, and the requirements of Texas law.
Workers’ compensation does not necessarily replace an employee’s entire paycheck. Income benefits are calculated according to statutory rules and applicable benefit limits.
Temporary Income Benefits
Temporary income benefits, commonly called TIBs, may be available when a work-related injury causes an employee to lose the ability to earn wages.
The amount of a benefit depends on the employee’s average weekly wage and statutory requirements. Texas establishes minimum and maximum weekly benefit amounts that can change by fiscal year. An employee’s disability under the workers’ compensation system generally concerns the ability to earn income rather than simply whether the employee has a physical impairment.
Impairment and Supplemental Income Benefits
Some employees may qualify for additional types of income benefits depending on the severity and lasting effects of a work-related injury.
Impairment income benefits may be based on an employee’s impairment rating after reaching maximum medical improvement.
Supplemental income benefits may be available to qualifying employees with certain impairment ratings who meet additional statutory requirements.
The eligibility rules can be complex, so an injured employee should review the circumstances of the claim carefully before assuming which benefits are available.
Lifetime Income Benefits
Texas workers’ compensation law also provides lifetime income benefits for certain qualifying severe injuries.
These benefits are reserved for specific types of serious injuries and circumstances established by law. They are different from temporary income benefits and ordinary impairment benefits.
Because eligibility depends on statutory requirements and the nature of the injury, an employee with a catastrophic workplace injury should carefully evaluate the available benefits.
Death and Burial Benefits
When a work-related injury or illness results in an employee’s death, eligible family members may receive death benefits under the Texas workers’ compensation system.
Potential beneficiaries can include a surviving spouse, eligible children, dependent family members, and certain other individuals who meet statutory requirements.
Burial benefits may also be available to help reimburse qualifying funeral expenses. Texas currently provides for reimbursement of certain burial expenses, subject to applicable limits and requirements.
Injuries Covered by Workers’ Compensation
Workers’ compensation may cover a broad range of injuries and illnesses when they arise out of and in the course and scope of employment.
Examples can include:
- Back and neck injuries
- Broken bones
- Muscle and joint injuries
- Traumatic brain injuries
- Repetitive stress injuries
- Occupational illnesses
- Burns
- Chemical exposure injuries
- Injuries caused by workplace equipment
- Injuries sustained during qualifying work-related travel
Coverage depends on the circumstances surrounding the injury and whether the condition meets Texas workers’ compensation requirements.
Common Workplace Accidents
Workplace injuries can happen in many different environments. Common causes include:
- Falls from heights
- Slips and trips
- Machinery accidents
- Construction accidents
- Vehicle collisions
- Falling objects
- Exposure to hazardous substances
- Repetitive workplace activities
- Overexertion and lifting injuries
- Fires and explosions
The type of accident does not automatically determine whether a claim is covered. The relationship between the injury and the employee’s work is an important part of the analysis.
Work-Related Illnesses
Workers’ compensation is not limited to sudden accidents. Certain illnesses and medical conditions may also qualify when they are related to an employee’s work.
Examples may include conditions caused by repeated exposure to hazardous substances, workplace environments, or other occupational factors.
An employee may not immediately recognize that an illness is connected to work. Texas provides specific reporting requirements for employees who discover that an injury or illness is work-related after the initial event.
Reporting a Workplace Injury in Texas
Employees should report workplace injuries as soon as possible. Under Texas workers’ compensation rules, an injured employee generally must notify the employer within 30 days of the injury or within 30 days after learning that an injury or illness is related to the job. Failing to report within the required period can affect eligibility for benefits.
Employees should provide enough information for the employer to understand what happened, when the injury occurred, and what part of the body or condition was affected.
It is also important to keep copies of written reports, medical records, correspondence, and other documents related to the injury. Get a free consultation to discuss your situation.
Filing a Workers’ Compensation Claim
Reporting an injury to an employer and filing a workers’ compensation claim are not necessarily the same step.
The Texas Division of Workers’ Compensation states that an injured employee generally must file DWC Form-041, Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease, with DWC within one year of the date of the injury to protect the employee’s rights.
Because deadlines and exceptions can affect a claim, employees should not wait until the end of a filing period to address an injury.
Situations That May Affect Workers’ Compensation Coverage
Workers’ compensation does not cover every injury that occurs during the workday.
Texas guidance identifies circumstances that can prevent an injury from being covered, including intentionally self-inflicted injuries, certain injuries involving intoxication or horseplay, injuries occurring outside work, and certain off-duty recreational or social activities.
The circumstances surrounding an injury matter. An employee should not assume that a claim is automatically covered or automatically excluded without reviewing the specific facts.
Workers’ Compensation and Third-Party Claims
A workplace accident can sometimes involve someone other than the employer. For example, an employee could be injured in a motor vehicle accident caused by another driver while performing job duties.
Depending on the circumstances, an injured employee may have workers’ compensation benefits as well as a potential claim against a responsible third party.
Third-party claims can involve different rules and damages from workers’ compensation claims. An attorney can review the accident circumstances and available insurance coverage to determine whether additional legal options may exist.
Employer Retaliation and Workplace Injury Rights
Employees may have concerns about reporting an injury because they are worried about losing their job or facing workplace consequences.
Texas workers’ compensation law includes protections concerning retaliation for certain actions related to workers’ compensation rights. The specific facts and circumstances determine whether a particular employment action violates the law.
An employee who believes they experienced retaliation after reporting a workplace injury should preserve relevant communications and employment records and seek legal guidance about the situation.
Disputed Workers’ Compensation Claims
Not every workers’ compensation claim is accepted without disagreement. Disputes can involve issues such as:
- Whether the injury was work-related
- The extent of the injury
- Medical treatment
- The employee’s impairment rating
- The amount or duration of benefits
- Whether the employee can return to work
- Whether additional benefits are available
The Texas Division of Workers’ Compensation provides a dispute-resolution process for workers’ compensation disagreements. Depending on the issue, the process may involve a benefit review conference and additional proceedings.
Workers’ Compensation Benefits and Legal Claims
Workers’ compensation provides a specific statutory benefits system, but an injured employee’s legal options can depend heavily on whether the employer is a subscriber or non-subscriber.
For employees covered by workers’ compensation, the system generally provides medical and income benefits without requiring proof that the employer was negligent.
When an employer does not carry workers’ compensation coverage, different legal considerations may apply. Texas non-subscriber employers must meet specific notice and reporting requirements, and an injured employee may have legal claims that would not arise in the same way under a traditional workers’ compensation claim.
Steps to Take After a Workplace Injury
Taking appropriate steps after an accident can help protect your health and your legal rights.
- Report the injury promptly. Notify your employer as soon as possible and within the applicable deadline.
- Seek medical attention. Get appropriate treatment and explain that the injury occurred at work.
- Follow medical instructions. Attend appointments and follow prescribed treatment.
- Keep documentation. Save medical records, bills, wage information, accident reports, and employer communications.
- Determine your employer’s coverage status. Find out whether your employer is a workers’ compensation subscriber or non-subscriber.
- Avoid signing documents you do not understand. Review settlement or claim-related paperwork carefully.
- Seek legal guidance when necessary. An attorney can help explain your rights and potential options.
Legal Help for Injured Houston Workers
A workplace injury can affect your health, income, and ability to support your family. Understanding whether your employer carries workers’ compensation insurance and knowing the deadlines that apply to your claim can be important when protecting your rights. Trust Him With Your Freedom. Trust Him With Your Injury. At Juan L. Guerra, Jr. & Associates, our Houston legal team has more than 15 years of experience representing personal injury and criminal defense clients. If you were injured at work, our attorneys can review your circumstances, explain your legal options, and help you understand the next steps.
At Juan L. Guerra, Jr. & Associates, we provide personalized legal guidance and strong representation for clients throughout Houston. Our approach focuses on understanding each client’s circumstances, building the facts of the case, and pursuing the legal remedies available under Texas law. Learn more about our firm or call (713) 489-6839 to discuss your case.
