Texas Workers Compensation Insurance: What It Covers

What Texas Workers Compensation Insurance Covers

Texas workers compensation insurance pays for medical treatment and a portion of lost wages when an employee is injured or becomes ill because of their job. Unlike many states, Texas does not require most private employers to carry workers comp, so coverage depends on whether the employer has elected to participate. When coverage is in place, it provides specific benefits that replace a portion of the employee's income and pays for care related to the workplace injury or occupational illness.

Medical Benefits

Workers comp in Texas covers all reasonable and necessary medical care to treat the injury or illness caused by work. This includes emergency treatment, hospital stays, surgeries, doctor visits, physical therapy, prescription medications, and medical devices. There is generally no dollar limit on medical benefits, and the employer or their insurer selects the treating physician through an approved network.

Income Benefits

If the injury prevents the employee from working or reduces their earning capacity, Texas workers comp provides income benefits. These include temporary income benefits during the period of disability, impairment income benefits for lasting impairment rated by a doctor, and supplemental income benefits if the employee returns to work at a lower wage. Death benefits are also available to dependents when a workplace injury results in a fatality.

What Is Typically Excluded

Workers compensation in Texas generally does not cover injuries caused by the employee's own intoxication, willful self-injury, or injuries sustained while committing a crime. Pain and suffering are not compensated under workers comp, and the employee typically cannot sue the employer for additional damages in exchange for receiving these benefits.

Employer Coverage Rules in Texas

Texas is the only state where private employers can choose whether to carry workers compensation insurance. Government employers and employers holding state contracts usually must provide coverage. Employers who do not carry insurance lose the protection of the exclusive remedy rule, which can expose them to direct lawsuits from injured workers.

How to Confirm Coverage

Employees should ask their employer directly whether workers compensation insurance is in place and which insurance carrier provides the policy. The Texas Department of Insurance maintains a division that handles workers comp claims and can help verify coverage and file disputes when benefits are denied.