Workers compensation in Texas is a state-mandated insurance scheme that compensates workers who become ill or injured at work for missed wages and pays their medical expenses. Payments for lost wages are made when workers lose all or part of their income due to a work-related illness or injury for more than seven days.
Workers compensation is a legally required program that provides compensation to workers who become ill or injured on the job. It is form of worker's disability insurance, giving workers who become ill or hurt due to their jobs financial compensation, healthcare benefits, or both.
This article examines key aspects of Texas workers' compensation, including benefits, eligibility, disputes, and reforms.
Related: Workers Compensation in Florida
Workers Compensation in Texas; What it Covers
Injuries and illnesses are frequently compensated if they arise from work-related activities. Although it often doesn't involve conventional commutes, this can include travel for work.
Workers' compensation may cover PTSD, depression, and other mental diseases. These claims, however, can be complicated. Whether a claim is recognized will depend on state law.
Another difficult claim category is communicable diseases. Since it can be challenging to establish whether contracting a communicable disease results from one's job, historically, such claims have not frequently qualified for workers' compensation. However, many states established presumptions for coverage if a worker catches COVID during the COVID-19 pandemic; some of these regulations may also apply to similar situations.
Related: Workers' Compensation in California
Workers Compensation in Texas; Benefits Available
Workers' compensation benefits, sometimes known as workers compensation, are often given when an employee becomes ill or injured while doing their job duties.
The financial effects of the accident, such as lost wages and immediate and long-term medical care for the damage, are all covered by workers' compensation benefits. Dependents of an employee who passes away may be eligible for death benefits. Included under worker's compensation coverage are;
1. Medical Costs
Workers' compensation coverage provides financial protection for both employers and employees in the event of work-related injuries or illnesses. This insurance policy specifically focuses on covering medical costs associated with claims made by injured workers. Some of the expenses covered by insurance include the cost of an emergency room visit, necessary surgeries, and medication prescriptions. For instance, an employee hurt after slipping and falling would be covered. Medical benefits may also cover longer-term costs like physical therapy or rehabilitation.
Most business owners cannot pay workers who are wounded and unable to work while they recover. If one of your employees cannot work due to an injury or illness, Texas workers' compensation income benefits will restore most of their lost wages. For instance, if a construction worker fractured their arm and could not work for eight weeks, the insurance would provide benefits to compensate for the missed wages.
An injury may occasionally result in temporary or more severe impairment. Worker's compensation enters into the picture to assist with the cost of ongoing medical expenses. It might even make up some of the lost wages due to the disability. The employee can receive compensation (an impairment rating) for the permanent disability caused by, e.g. the loss of the finger and some temporary disability benefits while they recover.
Unexpected occupational exposures can occur in certain types of work situations. For instance, a chemical mixing procedure may expose workers to chemical irritants, resulting in adverse reactions that make them ill. A sickness contracted while working would be treated at no cost under a worker's compensation program.
5. Funeral Expenses
Each year, there are close to 50,000 workplace fatalities. These are widespread in the trucking and construction sectors. A workers' compensation policy is made to pay for these funerals and give the employee's family death benefits. Frequently, state regulations dictate the dollar amount of coverage.
Workers' compensation insurance is a no-fault scheme created to stop expensive employee lawsuits resulting from workplace accidents. Numerous state statutes have exclusive remedy clauses that shield covered businesses from these claims in return for supplying their employees with workers' compensation insurance. Within 30 days, claims must be reported to a supervisor. Additionally, employers must notify their insurance provider of any claims or mishaps within 30 days of becoming aware of them.
Worker's Compensation in Texas; Reporting an Injury and Filing a Claim
The workers compensation system is a no-fault system, meaning that an illness or injury will often be covered regardless of who is at blame. However, injuries brought on by the employee's willful misbehaviour or egregious negligence might not be reimbursed. If a worker sustains an injury directly from their intoxication, the harm might not be covered by the state's work comp laws. In Texas, injuries resulting from horseplay, intentional criminal behavior, self-harm, intoxication from drugs or alcohol, voluntary engagement in extracurricular activities, acts of God, and third-party criminal acts committed against the employee for personal reasons are not covered by workers' compensation benefits.
The worker's compensation system is primarily used to handle workplace injuries. This implies that injured workers might be unable to file a lawsuit against their employers. According to the specifics of the circumstance and the state's laws, there might be a few exceptions.
Employees must inform their employers of any work-related illnesses or injuries, and the employer must tell the insurance. Timely completion of this is required.
In Texas, within 30 days following the incident, wounded workers are expected to file injury reports. The initial impairment rating may be challenged within 90 days of the date of issuance by the employee. A workers' compensation claim must be officially filed within a year following the injury. Workers might not always be aware that a sickness or injury is related to their job.
To start your official claim, it is required that you submit a DWC Form 041: Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease to the DWC. The form can be submitted in person, by mail, or online using the DWC's filing platform.
The claim form requests details regarding your identity, injury, employment status, and employer. You may find more specific instructions on responding to each question at the bottom of the form. Contact the Office of Injured Employee Counsel, a different state office that aids employees with their workers' compensation claims, if you require assistance.
You have one year to file the form after your accident or when you first became aware of your occupational disease related to your job. If you miss the deadline, you risk losing access to benefits unless you fall under one of the few exceptions.
The DWC will inform your employer and insurance company when it receives your claim. After reviewing your claim, the insurance provider will determine whether to accept or reject it.
Worker's Compensation in Texas; Common Disputes
In any workers' compensation system, disputes between parties are unavoidable. Conflicts frequently revolve around the attempts to reduce the income compensation or medical care that injured workers get following a compensable injury.
The two most frequent disagreements that will impact an injured worker, although there are many different types of disputes in workers' compensation cases, are medical and claim disputes (also known as indemnity disputes).
1. Medical Disputes – In these disagreements, medical facts and opinions regarding the injured worker's care are at issue. The ability of the doctor to advocate for the wounded worker's care nearly always determines the outcome of the dispute, even if the presence of attorneys can be highly beneficial in expediting and resolving medical disputes. An illustration of a medical dispute is:
- Refusing surgery
- Refusing therapy
- Refusing services such as home health care or other assisted living arrangements
- Refusing medical supplies or products such as braces, TENS units, and other devices
A knowledgeable workers' compensation attorney should be contacted soon if you have a medical disagreement. Your questions can be answered, and you can learn more about your alternatives in medical disputes with the assistance of an experienced compensation attorney.
2. Claim Disputes - these are matters where a lawyer can be most useful. The following are some instances of claim disputes:
- Compensability - whether or not your injury or illness qualifies for coverage by Texas Workers' Compensation Insurance
- Disability – whether or not you have lost money due to an illness or injury at work. Disability disputes may also concern the start and termination dates of the condition.
- Average Weekly Wage Disputes – debates over how much money you should receive while receiving workers' compensation.
- The extent of Injury Disputes - whether or not your work-related injury extends to other body parts or health systems (for instance, if a worker slips and hurts her back and shoulder, the insurance company may only agree to cover the back injury).
- Access to Supplemental Income Benefits (SIBs) - For injured workers who receive an Impairment Rating of 15% or higher, the insurance company may contest the employee's eligibility for benefits if it disputes that the employee made a good faith effort to find work during the qualifying period.
- Countless more arguments could surface throughout a typical claim.
Worker's Compensation in Texas; Fatal Occupational Injuries
Although fatal occupational injuries have decreased significantly since the 1970s, even one death at work is still too many.
In 2018, there were 488 fatal occupational injuries in Texas. 5,250 American workers died nationwide in 2018 due to deadly workplace injuries. Accordingly, Texas accounted for 9.29% of all fatalities. Unfortunately, Texas has long struggled with this issue.
What mishaps are responsible for these tragedies? Among the incidents or exposures that led to fatal injuries in Texas in 2018 were:
- Violence and other harm committed by people or creatures: 71
- Transportation-related mishaps: 223
- Explosions and fires: 20
- Trips, slips, and falls: 71
- Exposure to hazardous elements or substances: 43
- Contact with tools and objects: 58
Among workers, waged and salaried workers made up the great majority of the total fatal injuries (402). Among independent contractors, there were only 86 fatalities.
Who dies at work in Texas is better depicted by other demographics:
- Men made up 455 of the total 488 occupational fatalities.
- Just 33 fatal workplace accidents included women.
- Additionally, there was a very similar distribution of ages between 25 and 64. The following age groups saw the most fatalities in 2018:
- Ages under 16: 0
- 16-17 years - 0
- 18-19 years - 5
- 20-24 years - 32
- 25-34 years - 99
- 35-44 years - 98
- 45-54 years - 115
- 55-64 years - 89
- 65 or older and under 50
The breakdown by race and ethnicity included:
- White non-Hispanics: 219
- 56 Non-Hispanic Black or African American
- Hispanic or Latino: 198
- 0 Non-Hispanic American Indian or Alaska Native
- 12 non-Hispanic Asians
Worker's Compensation in Texas; Texas Recordable Injury Rates up to 2020
Texas has experienced a decline in nonfatal occupational injury and sickness rates during the past 20 years, similar to most of the United States. However, the figures have tended to stabilize in recent years.
In the United States, 2.8 million nonfatal occupational accidents and illnesses were reported in 2018. In Texas, there were 177,977 recordable nonfatal instances in 2018, according to the Survey of Occupational Injuries and Illnesses (SOII).
Worker's Compensation in Texas; Returning to Work in Texas
The cost of workers compensation claims is reduced when employees return to work more quickly, which eventually results in lower premiums. The least amount of time off work is taken by injured workers who return to work within six months. Employers can design programs to ensure workers receive the care and assistance they need to return to work.
Injured workers made a 78% return to work within six months in 2007. In 2017, the percentage increased by five points to 83%. Within six months of returning to work, most people reach their pre-injury salary level, which usually takes two years. Additionally, nine out of ten employees are back on the job in some capacity within a year. And 95% come back within three years.
Worker's Compensation in Texas; Where are Texas' weaknesses?
Employees 60 and older who are wounded miss work for ten more days than injured workers in the 16 to 29 age group. Mining, utilities, construction, and agricultural workers experience the largest average and median number of days off.
Worker's Compensation in Texas; Recent Reforms
Texas passed its first workers' compensation regulations in 1913 to provide companies with a choice over coverage for accidents at work. Before costs increased quickly in the 1980s, the system stayed substantially unaltered. The Texas legislature established the Texas Workers' Compensation Act in 1989. The Texas Workers' Compensation Commission was established to oversee the reforms, which included improved benefits and dispute resolution, developed medical charge rules to limit expenses, and improved workplace safety initiatives.
However, medical expenses kept rising in the 1990s, which prompted more reforms in the early 2000s. It also involved closing TWCC and handing over management to the Division of Workers' Compensation, establishing the Office of Injured Employee Counsel to support workers who aren't represented, and streamlining the dispute resolution procedures.
Based on Sunset Commission recommendations, the legislature implemented additional reforms in 2005, including measures to boost return-to-work rates, strengthen healthcare delivery networks, and streamline administrative processes. Through the networks, the reforms sought to lower costs while preserving benefits. Data on the 2005 reforms' implications on costs, benefits, and outcomes for injured workers is still in the early stages of development.
In conclusion, Texas's workers' compensation system plays a crucial role in providing support for sick and injured workers. However, achieving a delicate balance between the needs of companies, employees, and taxpayers remains challenging. While significant reforms have been implemented to address systemic issues, pressing concerns still need attention.
One ongoing challenge is the escalating medical treatment costs, which can strain the resources of employers and insurers. Additionally, ensuring access to high-quality healthcare for injured workers remains an important objective. Furthermore, improving the rates of successful return to work and enhancing the adequacy of benefits for seriously injured workers are critical areas that require further attention.