If an employee is injured while on-the-job or suffers from an occupational illness in Texas there is a good chance they are not covered by Workers’ Compensation Insurance. Texas is the only state in the country that does not require employers to carry workers’ compensation insurance for their employees. Instead, employers in Texas are split into two groups – “subscribers,” are employers who have purchased worker’s compensation coverage, and “nonsubscribers,” are employers who have chosen not to obtain coverage. Employers are required to notify new employees of the existence or absence of workers’ compensation coverage at the time of hiring, and must post notice of coverage status in their place of business.
The Texas Workers’ Compensation Act, (“TWCA”) provides a strong incentive for employers to become subscribers. Subscribers receive almost total immunity from lawsuits by their employees for injuries and illnesses arising from their negligence. The exclusive remedy for injured workers is workers’ compensation benefits, which is processed by the Division of Workers’ Compensation. If benefits are approved, employees may receive compensation for their medical expenses and partially recovery of lost wages. If you work for a subscribing employer, you can read more about your rights here.
On the other hand, employers who are non-subscribers have no immunity from lawsuits and also lose legal defenses normally available to defendants in common law causes of action. Injured workers who successfully sue a non-subscribing employer may recover more than they would under workers’ compensation law, including damages for medical expenses, pain and suffering and the full amount of their future lost wages. As of 2012, approximately 33 percent of employers in Texas are non-subscribers.
As a safeguard, most non-subscribers have a private policy of insurance to cover their employees’ injuries, providing compensation for medical expenses and lost wages. These insurance benefits are usually part of an “Employee Injury Benefit Plan” or “Occupational Injury Benefit Plan” sponsored by the employer. It is important for employees covered by such a Plan to carefully read and understand their obligations and the rules they must follow in order to obtain benefits should they be injured. Almost all Plans have the following requirements that may result in termination of all future benefits under the Plan if the employee fails to follow these requirements:
- Report your injury to your supervisor immediately.
- Only use medical providers approved by the plan.
- Do not miss doctor appointments.
- Follow the instructions of your doctor.
- Keep your employer informed of your injury status.
It is essential that you follow all requirements of your employer’s Plan to remain eligible for benefits. If you do not have a copy of your employer’s injury benefit plan you should request one immediately so you can understand your benefits and responsibilities. Federal law provides that you have right to receive a copy of the injury benefit plan and the “summary plan description” from the plan administrator upon written request. It is important that you make your request in writing and send it certified mail return receipt requested to your employer and the plan administrator. The plan administrator has 30 days to comply with your written request or be subject to potential penalties of $110.00 for each day they delay in providing you the requested documents. 29 U.S.C. 1132 (c ).
If you have been injured on the job and your employer is a non-subscriber to Worker’s Compensation you should make sure you understand all of your rights. If you have questions about your rights following an on the job injury or your employer’s injury benefit plan feel free to call us for a free consultation.
Partner Laureen Bagley