Texas Workers’ Compensation System Is Improving

Texas stands alone among the 50 states in not requiring most employers to carry workers’ compensation insurance for their employees, and for years the system was in dire straits. Fortunately, in the years since 2003, the system has been improving.

Workers’ comp is an insurance program that provides medical, rehabilitation, and income benefits for workplace-related injuries and illnesses. Employees benefit from workers’ comp by knowing that if they are injured on the job, they will have basic coverage without having to go through a lawsuit. Employers benefit because employees who are covered by workers’ comp generally cannot sue their employers for their injuries.

The Texas workers’ compensation law enacted in 1913 allowed private employers to completely opt out of participation in the workers’ comp system, or “nonsubscribe.”  Employers who opt out lose the protection of statutory limits on liability and may be sued for negligence by injured employees. For many years, according to the Insurance Journal, Texas medical costs per claim were high compared to other states, return-to-work rates were dismal, and satisfaction with care was low. Workers’ comp insurance costs were high and insurance was hard to find, so many employees were not insured.

How Texas Workers’ Comp Is Improving

Major changes occurred in 2005, when the Texas Legislature approved House Bill 7, which transformed the state’s workers’ comp system from one of the weakest in the U.S. to one of the healthiest. Reforms included abolishing the Texas Workers’ Compensation Commission and replacing it with the Division of Worker’s Compensation under the Texas Department of Insurance (TDI). Under the TDI, a Workers’ Compensation Research and Evaluation Group (REG) was created, which reports on the availability and affordability of workers’ comp insurance.

In its most recent report, Setting the Standard, An Analysis of the Impact of the 2005 Legislative Reforms on the Texas Workers’ Compensation System, the REG examined data from 2005 through 2019 to create a picture of the changes that have occurred in the system. The report shows that there are now 312 insurers writing policies, with the top 10 insurance groups writing 76% of the market. The largest insurer, Texas Mutual Insurance Co., has a market share of 42% and $1.07 billion in premiums in 2019. Texas Mutual is the workers’ comp insurer of last resort to write voluntary business and compete in the marketplace.

The Top Workers’ Comp Insurers in Texas

Oversight of the Workers’ Comp System in Texas that Protects the Rights of Injured Workers

The Division of Workers’ Compensation (DWC) oversees the administration and operation of the Texas workers’ compensation system to ensure compliance with the Texas Workers’ Compensation Act, Texas Labor Code, and other regulations. According to Texas Labor Code section 402.021, the goals of DWC are to ensure that:

• Each employee is treated with dignity and respect when injured on the job;
• Each injured employee has access to a fair and accessible dispute resolution process;
• Each injured employee has access to prompt, high-quality medical care; and
• Each injured employee receives services to facilitate their return to work as soon as it is considered safe and appropriate by their health care provider.

Other Improvements in Texas Workers’ Comp

While the workers’ comp market for the last 10 years has been profitable overall, according to the TDI report, rates for premiums have decreased, benefiting the public. In addition, according to the report:

• TDI certified 30 networks covering 254 Texas counties to provide workers’ comp health care.
• While in 2001, Texas was among the highest nationally in terms of medical costs per claim, the current cost is about 24 percent less than the median cost of the 18 states in the analysis.
• Overall, TDI has received relatively few complaints about certified health care networks, with 80% of injured workers saying the “medical care for their work-related injury was as good or better than their routine medical care.”
• The waiting period to receive non-emergency medical care has been cut in half since 2011.

When Employers are Non-Subscribers

Some employers choose not to participate in workers’ comp. Many participate in alternative injury benefit programs for their injured workers, but some have no insurance at all and take the chance that they may be open to a lawsuit if employees get injured.

While the number of employers in the private sector not subscribing to workers’ comp remained essentially flat from 2018 to 2020, subscription rates since 2016 are at the highest rates since 1993. In 2020, an estimated 19% of private-sector employees did not have workers’ comp coverage, down from an estimated 24% in 2004. Employer non-subscription rates are highest for the smallest companies and also the largest companies.

How the Texas Workers’ Comp System Helps Workers During COVID

Workers’ comp has stepped in to help workers during the COVID crisis. For virus-related claims reported to workers’ comp insurers through June 30, 2020, there were more than 25,000 COVID-19 claims and 103 fatalities, with the majority of the claims and fatalities involving first-responders and correctional officers/prison workers.

When You Need to Turn to a Workers’ Comp Attorney for Help

Unlike a personal injury lawsuit, where you must prove that another party was negligent and at fault for your injuries in order to get compensation, worker’s comp is a no-fault program. If you qualify for, file for, and accept workers’ compensation, you are generally not allowed to sue your employer, even if their negligence caused the accident.

However, if your employer does not subscribe to workers’ comp or if certain conditions exist, such as if your injury was caused by a third party (such as an outside contractor who ran you over with a vehicle), you may be able to go beyond workers’ comp and file a personal injury lawsuit.

While workers’ compensation can provide benefits for your medical care and lost wages, a personal injury lawsuit can provide additional benefits. In a successful Texas lawsuit, our attorneys can win an award, called damages, for both compensatory damages for your economic and noneconomic losses such as pain and suffering; and, in some rare cases, punitive damages may be awarded as well.

Whether or not workers’ comp is involved, if you or a loved one has been injured and can’t work, you should get legal advice as soon as possible. Insurers and employers whose costs go up when claims are paid often try to deny or underpay valid claims. The experienced work injury lawyers at the accident and injury law firm of Terry Bryant can keep you from making costly mistakes and help you get the benefits you are entitled to.

If you are covered under worker’ comp, our work injury lawyers in Houston can ensure that everything is filed correctly and that you receive the benefits you deserve and can appeal your case if denied. If your employer does not provide workers’ comp, we will pursue maximum compensation for you in a personal injury lawsuit.

We provide a free, no-obligation consultation to examine the facts of your individual situation and show you how we can help. Call our team today at (713) 973-8888 or toll-free 1 (800) 444-5000.