Texas Workers' Compensation Rules

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Unlike many other states, Texas doesn’t require employers to carry workers' compensation insurance. Many employers choose to carry it, however, as a shield from liability in cases where a worker suffers an injury while at work or is stricken with a work-related illness. The Texas Department of Insurance provides workers’ compensation insurance to employers and administers benefits and medical care to all beneficiaries.

Employer Requirements

Although employers aren’t required to carry workers' compensation insurance, they’re required to report their decision to refuse coverage to the Texas Division of Insurance. Employers without insurance must also notify the division of all work-related injuries and illness regardless of their workers’ compensation coverage status. If an employer opts out of compensation programs, he must notify all workers of the lack of coverage. Employers who carry workers’ compensation policies must report all injuries and illnesses to their insurer. Employers who fail to adhere to these standards may face fines or other penalties.

Care Process

When an injured or ill worker makes his initial claim, he is allowed to choose from a list of doctors approved for workers' compensation claims. Workers are entitled to change doctors once without approval from the Texas Division of Insurance, and all physician changes thereafter must be approved by the division’s health network administrator. Physicians cannot bill patients covered by workers’ compensation for their work-related treatment or threaten to sue for medical expenses incurred during insured treatment.

Medical and Short-Term Disability Benefits

Insured workers who are injured on the job or fall ill with a work-related illness receive full medical benefits required to treat the illness with no upper claims limit if treatment was provided by a doctor pre-approved by the division. This includes immediate treatment, follow-up care and therapy. Short-term disability benefits are also provided for workers who cannot immediately return to work and are computed as 70 percent of the injured worker’s average weekly wage, and is capped at 70 percent of the Texas median wage. Doctors assess an impairment rating, and short-term disability payments are provided for three weeks for every percentage of impairment, so a worker deemed 15 percent impaired is eligible for benefits for 45 weeks.

Permanent Disability Benefits

Certain severe injuries entitle an insured worker to permanent disability payments. These injuries include suffering third-degree burns over 40 percent of the worker’s body or the majority of both hands and face, brain trauma leading to severe impairment, spinal injuries resulting in at least 50 percent paralysis and the loss of two hands at the wrist, two feet at the ankles, or a hand and a foot. Lifetime disability benefits equal 75 percent of the injured worker’s average weekly wage, and cap at 75 percent of the median Texas weekly wage. Disability benefits increase by 3 percent each year.

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