How Is Texas Different
A constant theme is how Texas is different in both its terminology and laws. This is never more true than in the area of Workers’ Compensation where Texas is the only U.S. state that does not require employers to have coverage. The State’s reasoning is that this is sending money to insurance companies that would otherwise go to employees or better products.
However, that doesn’t mean that employers in the state will not acquire workers’ compensation insurance.
Types of Workers Compensation Benefits
This state website says the state allows for three types of benefits (see explanation below), but technically there are four types of benefits. All four types of benefits are defined and limited by state law. For links and explanations of all four, check this official state website page instead of the aforementioned website.
Medical Benefits: pay for injuries or illnesses incurred while on the job or traveling for the job. Unlike income benefits, see below, medical benefits are really just for the costs of medical care (“reasonable” amount of medical care) one may need because of the duties of the job.
Death Benefits: If an employee dies, the family may be eligible to receive money from the company depending on the nature of the workplace death.
Burial Benefits: Similar to the point above, burial benefits are money paid out to the family to handle the costs of burial which can be exorbitantly expensive.
Income Benefits: The most common type of income that’s given because of work-related injury or illness.
Let’s first look at Texas’ insurance laws from the standpoint of the employer. We’ll discuss why, if you’re an employer, you should have insurance even though you do not have to. Additionally, we’ll discuss who you have to call and what you’re required to do if you had insurance and choose to discontinue it.
Why You Should Have Insurance
If you do have workers’ compensation insurance then your liability for how much you might owe if a personal injury accident should occur is capped. Even better, these caps about how much you will have to pay our is set by the law and not by the insurance provider. This means that there is no way you will be required to pay more than the limit the law sets.
However, that’s not the only benefit of having workers’ comp insurance.
Protects against “Last Clear Chance”: Last Clear Chance is a principle in tort law that tries to determine which party had the last chance (hence the name) to prevent the accident in question. This principle states that even if the employee was initially negligent in placing themselves in a compromising position, the last person that could’ve stopped the accident from occurring is the one that is liable.
What is Benefits Stacking?
Benefits stacking is a maneuver available to employers where they can combine the benefits paid to the employee through the various benefits that they are owed. In other words, if an employee is injured on the job and eligible for benefits, the employer can combine paid leave benefits owed to the employee with the other benefits they are owed in order to guarantee that the latter receives a full paycheck while they are unable to work. See the Texas.gov page dealing with the limits on leave benefits for more information.
If Employer Insurance Is Discontinued
If you are an employer and you had worker’s compensation insurance and then discontinued it, then you have to take two steps immediately:
- Inform your employees that you no longer have workers’ compensation insurance.
- Notify the aptly named Workers’ Compensation Division of the Texas Department of Insurance using THIS form.
If you have questions, contact the Department of Insurance. We’ll try to keep the information updated and as accurate as possible but as of November 2021 their contact information is as follows:
7551 Metro Center Drive, Suite 100
Austin, Texas 78744-1645
Phone Number: (800) 252-7051
Fax Number: (512) 804-4146
Filing For Workers Comp In Texas
Now that we’ve discussed the issue from the worker’s side, we’re going to spend a little time on what to do if you’ve been injured and are looking to file for insurance. Obviously, the above section is relevant to you to because if your employer does not have insurance then things could get a bit awkward. Your employer, if they do not have insurance, is liable to be sued under state laws.
However, if they do have insurance, you need to begin the process of filing as soon as you are physically able to. The timetable you are working with is limited to initiating the request or at least being left without compensation for your time off in recovery.
What Isn’t Covered?
Before you file, you need to be confident that your injury occurred due to negligence from your employer (and you can show it). If your injury was due to messing around on the worksite then you can stop reading now because you do not qualify for worker’s compensation.
How Quickly Do You Have To File?
OK. Let’s say you’ve read everything above and believe that you qualify. Now you have to file the request within 30 days of the incident that lead to your injury. If your employer is covered, this process shouldn’t be too difficult to complete.
First Impairment Rating
Now you’ll be sent to a medical professional who will evaluate just how impaired you are from the injury and set the timetable for when you can return. It’s very important to note that if you disagree with your First Impairment Rating then you have every right to appeal their ruling. However, there is a catch.
In Texas, you only have 90 days from the time the medical professional submitted their ruling to appeal it. However, know that you can appeal their ruling.
What is Maximum Medical Improvement?
Maximum Medical Improvement is another aspect of Texas Law that is critical to understanding the laws of the state. The concept is an attempt to cap the time that workers are eligible for benefits. That time period is which of these two comes FIRST:
- 104 days have passed since the worker became eligible to receive benefits.
- The time the medical professional gave for the injury or illness to heal as much as it is expected to. This does not mean that you have to be fully healed before you stop receiving benefits. Obviously this is the more controversial note of the two and it is possible, though rare, for the medical provider to request an extension on your recovery.