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What You Need to Know About Workers Comp in Texas

What does it mean for a state to be an “opt-out” state for workers’ compensation? The majority of states place requirements on employers to cover employees under a workers’ compensation policy to help them with things like medical bills and lost wages when the employees suffer injury.

This is not true in Texas, however. Here, employers are not required to carry any form of workers’ comp insurance. That means that in Texas, if a worker is injured, and the employer has opted out of providing workers’ comp coverage, then the employee is at the mercy of whatever alternative plans the employer has come up with (this is, of course, barring the potential for a third-party injury claim against a negligent party). A stunning 40 percent of all Texas businesses, large and small, no longer carry workers’ comp insurance. These companies are known as workers’ comp nonsubscribers.

Because workers’ comp nonsubscribers are allowed to come up with their own alternative workers’ comp plans, employees often run into problems. Employer-created plans tend to cover fewer injuries, cut off benefit payments sooner, dictate which doctors employees are allowed to visit and sometimes impose mandatory settlements that do not fully cover the injured workers’ costs, such as medical bills and lost wages. Because of these problems, victims of workplace accidents who are not covered under workers’ comp face serious financial and medical uncertainty.

A Deep Dive into the Issue

An investigation by the nonprofit ProPublica and NPR found that many independent insurance plans in Texas only cover care for an average of two years. This is in direct contrast to workers’ compensation insurance, which lasts as long as a worker needs it to.

Furthermore, employer-created plans sometimes will not pay for things like wheelchair vans or for complications due to occupational diseases caused by exposure to dust, mold and even asbestos. Worse still, appeals are often controlled by the employers, and payments for catastrophic injury and wrongful death are can be strictly limited.

For the reasons listed above, whenever you suffer an injury at work, the best course of action is to discuss your case in a free consultation with a workers’ comp attorney.

Without the assistance of a qualified personal injury/workers comp attorney, it can be extremely confusing and complicated to seek fair reimbursement for things such as medical expenses, wages lost while unable to work, and any other financial losses related to your accident.

Workers Comp

Workers compensation, also known as workers’ comp, is a form of insurance that provides medical benefits and wage replacement to employees who suffer work-related injuries or illnesses. It is designed to protect both employees and employers by providing financial support and ensuring that injured workers receive proper medical care.

Here are some key points to understand about workers’ compensation:

Coverage: Workers’ compensation laws vary by country and region, but in general, most employers are required to carry workers’ compensation insurance. The coverage typically applies to all employees, including full-time, part-time, and seasonal workers.
Benefits: Workers’ compensation benefits aim to cover medical expenses related to the work-related injury or illness. This includes doctor visits, hospitalization, medication, physical therapy, and rehabilitation. In addition, workers may receive wage replacement, typically a portion of their regular wages, during the period they are unable to work due to their injury or illness.
No-Fault System: Workers’ compensation operates on a no-fault basis, meaning that employees are entitled to benefits regardless of who caused the injury or illness. Even if the employee’s own actions contributed to the accident, they are still generally eligible for benefits, with some exceptions for cases involving intoxication or intentional self-harm.
Exclusions: While workers’ compensation covers most work-related injuries and illnesses, there are some exceptions. Injuries resulting from employee misconduct, such as fighting or willful negligence, may not be covered. Similarly, self-inflicted injuries and injuries occurring while the employee is not on the job are typically not eligible for benefits.
Filing a Claim: To receive workers’ compensation benefits, an employee must report the injury or illness to their employer within a specified timeframe. The employer then assists in filing the necessary paperwork with the workers’ compensation insurance provider. The claim is evaluated by the insurer, which determines the eligibility for benefits based on the circumstances of the case.
Legal Support: In cases where a workers’ compensation claim is denied or disputed, employees have the right to seek legal representation to appeal the decision or to navigate the legal process. Workers’ compensation laws can be complex, and having legal assistance can ensure that employees receive the benefits they are entitled to.

It’s important to note that workers’ compensation laws can differ significantly between countries, states, and provinces. If you have specific questions or need detailed information about workers’ compensation in a particular jurisdiction, it’s advisable to consult with a legal professional or the appropriate government agency responsible for overseeing workers’ compensation.