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What Are the Worker’s Compensation Rules in Texas?

Workers’ compensation programs greatly help employees who sustain diseases or injuries. In the US, each state has its own set of workers’...

Written by Niel Patel · 3 min read >
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Workers’ compensation programs greatly help employees who sustain diseases or injuries. In the US, each state has its own set of workers’ compensation laws, and Texas has its regulations. Contrary to most other states, Texas allows private companies to forgo membership in the regular workers’ compensation system in favor of creating their workplace accident benefit schemes. 

If businesses choose to use the system, they must abide by specific rules and requirements. This article will analyze the laws governing workers compensation rules in Texas and a summary of benefits, coverage, employee eligibility, and other related issues.

Texas’s Workers’ Compensation Laws

While Texas businesses can waive traditional workers’ compensation, those that do so must adhere to specific rules. The Texas Department of Insurance’s Division of Workers’ Compensation (DWC) manages workers’ compensation in the state.

Coverage Requirements

In Texas, employers offering workers’ compensation coverage must purchase insurance from a licensed insurance company or acquire self-insurance authorization. Unless expressly exempted, coverage shall be made available to all Eligible Employees, regardless of Immigration Status.

Employee Eligibility

An employee must fulfill these requirements to be eligible for workers’ compensation payments in Texas:

  • The person needs to be labeled as an employee instead of an independent contractor. Workers’ compensation benefits are not available to independent contractors. 
  • The illness or injury must have happened within the course and scope of employment.

Injury Notice

Employees who become ill or injured at work have 30 days to tell their employer. Give prompt notice to prevent benefit denial. Occupational diseases are an example of a circumstance where the injury or illness develops gradually.

Medical Treatment

In Texas, employers can choose the doctor initially treating an injured worker. This option is referred to as the “initial treating doctor.” However, wounded workers are permitted to switch doctors once during their claim. It is essential to adhere to the steps given by the DWC when receiving medical care.

The Benefits Involved

Injured workers in Texas are eligible for several benefits, including:

Medical Benefits

These pay for reasonable and essential medical costs associated with the illness or injury, such as hospital stays, doctor visits, prescription drugs, surgeries, and rehabilitation services.

Income Benefits

If a work-related injury prevents an employee from working for longer than seven days, they may be eligible for income benefits. These benefits helped compensate for some of the wages lost while the economy was recovering.

Vocational Rehabilitation

In situations where an employee’s capacity to return to their previous career is significantly hampered by an injury or sickness, vocational rehabilitation services may be able to help the person locate alternative employment.

Death Benefits

In the tragic case of work-related death, Texas workers’ compensation pays death payments to the surviving dependents, including money for funeral costs.

Dispute Resolution

Employers, employees, and insurance companies may develop disagreements regarding workers’ compensation claims. These issues are typically settled administratively in Texas under the DWC’s supervision. The process entails administrative hearings, arbitration, and mediation. In rare cases, parties may appeal judgments to the Texas state courts.

Non-Subscription Option

Employers in Texas have the option of choosing not to subscribe to the traditional workers’ compensation system. Employers can design benefit programs for workplace accidents not governed by state workers’ compensation rules with this approach. 

Non-subscribers, however, are subject to certain legal obligations, such as giving written notification to their employees and adhering to security regulations. Employers and employees must understand the consequences and variations between non-subscription programs and conventional workers’ compensation.

Occupational Diseases

While some incidents at work result in severe injury, others happen gradually over time. Occupational diseases are brought on by continuous or repeated workplace exposure, such as repetitive strain injuries or exposure to harmful substances. 

In Texas, workers’ compensation benefits may be available to those who contract occupational disorders. However, demonstrating the link between sickness and the work environment can occasionally be difficult and calls for appropriate medical proof.

Return-to-Work Programs

Employers and the workers’ compensation system focus on returning injured workers to work safely and on schedule. Texas supports implementing programs that help wounded workers find suitable employment and return to work. 

These initiatives seek to lessen the effect of accidents on workers’ long-term earning potential and enable a seamless transition back into the workforce. Employers who take the initiative to create modified duty programs can save money while assisting disabled workers in regaining their financial security and job satisfaction.

Fraud and Abuse

The integrity of the program is threatened by the vulnerability of workers’ compensation systems to fraud and abuse, which also drives up costs for employers and insurers. Texas has established procedures to identify and stop fraud, including harsh penalties for anyone who tries to game the system. 

Employees should be aware that lying or inflating injuries can have serious repercussions. To safeguard the credibility of the workers’ compensation system, businesses must continue to be alert in spotting and reporting fraudulent claims.

Independent Review Organizations (IROs)

To promote fair and impartial decision-making, some circumstances involving disputes between injured employees, employers, and insurance carriers may call for an independent review. The Texas workers’ compensation system depends on Independent Review Organizations (IROs).¬†

IROs are unbiased third-party organizations that offer expert opinions on disputed medical concerns, treatment regimens, and other topics. When parties cannot agree, their engagement provides a method for equitable settlement and assists in resolving conflicts.

Continuous Improvement and Updates

Over time, the workers compensation rules in Texas may be amended, and both employers and employees must stay up to date with these changes. 

The most recent laws and guidelines can be followed by frequently reviewing the official website of the Texas Department of Insurance, Division of Workers’ Compensation, and consulting legal experts with worker compensation experience.

In Conclusion

Texas permits companies to choose not to participate in traditional workers’ compensation; nevertheless, those who do so are subject to specific rules and regulations regarding coverage. As such, it behoves employees to know their obligations and rights about reporting injuries, obtaining medical care, and using benefits. 

That said, employers and employees can navigate the workers comp system successfully by abiding by the set workers compensation rules in Texas, ensuring the safety and protection of all parties involved.

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