## Workers' compensation in Texas Workers' compensation is a no-fault system providing medical care, lost wages, and disability benefits to workers injured on the job — in exchange for giving up the right to sue the employer for negligence. Every state except Texas mandates WC coverage for most employers. ### Texas workers' compensation - **Agency:** Texas Department of Insurance — Division of Workers' Compensation - **Statute of limitations:** 1 year for filing **Worth knowing about Texas:** Texas is the ONLY state where private employers can opt OUT of workers' comp altogether ("non-subscriber" employers). ## What WC covers **Medical benefits:** - Doctor visits - Hospital and surgical care - Physical therapy / rehabilitation - Prescription medications - Durable medical equipment - Mileage to medical appointments **Lost-wage benefits:** - **Temporary Total Disability (TTD)** — usually 2/3 of average weekly wage during recovery - **Temporary Partial Disability (TPD)** — for partial inability to work - **Permanent Partial Disability (PPD)** — for permanent impairment that allows some work - **Permanent Total Disability (PTD)** — for permanent inability to work - **Death benefits** — to surviving spouse and dependents **Vocational rehabilitation** in many states for workers unable to return to former job ## What's covered as a "work injury" Generally: - **Specific accidents** — falls, machinery, vehicle crashes during work - **Repetitive stress / overuse injuries** — carpal tunnel, back issues - **Occupational diseases** — asbestos, hearing loss, chemical exposure - **Mental-mental injuries** (in some states) — psychological injury without physical trigger - **Heart attacks / strokes** — only when work-stress was substantial cause - **Aggravation of pre-existing conditions** — in many states, full benefits if work made it worse ## What's typically NOT covered - **Self-inflicted injuries** - **Injuries from intoxication** (with state-specific causation tests) - **Injuries from horseplay** by the injured worker - **Commute injuries** ("going-and-coming rule") — with exceptions for travel during work - **Off-duty injuries** — even if on employer property - **Self-employed / independent contractors** (with state-specific tests) - **Domestic workers** (in many states) — limited or excluded - **Volunteers** (typically) — though some states extend ## How to file 1. **Notify employer** — most states require notice within 30-90 days of injury 2. **Get medical care** — many states require seeing employer-designated doctor first 3. **File claim** with state agency — within state SOL 4. **Complete medical evaluation** — Independent Medical Examination (IME) often required 5. **Receive benefits** OR **dispute denial** 6. **Resolve case** — settlement, lump-sum, or ongoing benefits ## The "exclusive remedy" rule Workers' comp is the **exclusive remedy** against the employer — meaning you generally can't sue your employer for negligence. EXCEPTIONS: - **Intentional torts** by employer - **Third-party defendants** — equipment manufacturer, contractor, vendor — can be sued separately - **"Dual capacity" exception** — when employer was acting in capacity other than employer - **Texas non-subscribers** — can be sued for negligence (no exclusive-remedy bar) Third-party claims often produce significantly larger recovery than WC alone — they're a major focus of injured-worker representation. ## Common disputes - **Compensability** — was the injury actually work-related? - **Average weekly wage calculation** — drives all benefit amounts - **Medical care disputes** — denied treatments, IME conflicts - **Return-to-work disputes** — light-duty offers, max medical improvement (MMI) - **Permanent impairment ratings** — drives PPD benefits - **Settlement / lump-sum approval** - **Vocational rehab eligibility** ## Settlement Most WC cases eventually settle. Two types: - **Stipulation / award with reservation** — defined benefits with rights to medical care continuing - **Compromise / clincher** — full lump-sum payment closing all rights including medical Always have an attorney review settlement terms — Medicare set-asides (for older workers), tax implications, and waiver language all matter enormously. ## Retaliation protection All states (except possibly TX non-subscribers) prohibit retaliation against workers for filing WC claims. Retaliation claims often have: - **Burden-shifting framework** similar to discrimination law - **Damages beyond WC** — back pay, front pay, emotional distress, sometimes punitive - **State-specific anti-retaliation statutes** ## What you should do If you've been hurt on the job in Texas: report it to your employer in writing immediately, get medical care (preferably from your employer's panel doctor first to satisfy state requirements), document everything, and consider hiring a workers' comp attorney early. Most Texas WC attorneys work on contingency (statutorily limited percentages, e.g., 15-25% of recovery) and offer free consultations. --- *This guide is general information about Texas law as of early 2026 and is not legal advice. WC law is highly procedural and varies significantly between states. Talk to a licensed Texas workers' compensation attorney about your specific case.*