Requirements to Obtain Workers’ Compensation in Texas
Workers’ compensation in Texas provides benefits to employees who suffer work-related injuries or illnesses. However, Texas has unique rules compared to other states because not all employers are required to carry workers’ comp insurance. Understanding the eligibility requirements can help injured workers determine whether they qualify for benefits.
1. Employer Must Carry Workers’ Comp Insurance
Workers' compensation coverage is optional for private employers in Texas. This implies that an employee is only eligible for workers' compensation benefits if their employer maintains a workers' compensation insurance policy.
If an employer does not carry coverage (a “non-subscriber”), injured employees may instead pursue a personal injury claim against the employer, but they will not qualify for traditional workers’ comp benefits.
Employees should confirm whether their employer is covered by checking workplace postings or the Texas Department of Insurance.
2. The Injury Must Be Work-Related
To qualify, the injury or illness must have occurred while performing job-related duties. This includes:
- Injuries from workplace accidents
- Repetitive stress injuries (such as carpal tunnel syndrome)
- Occupational illnesses caused by workplace exposure
- Aggravation of a pre-existing condition due to job duties
Injuries that happen outside of work, during horseplay, or while committing misconduct may not be covered.
3. The Employee Must Report the Injury on Time
According to Texas law, injured employees are obligated to notify their employer of their injury within 30 days of the incident or the discovery of a work-related ailment. The loss of eligibility for benefits may occur if the report is not submitted by the deadline, unless there is a valid reason for the delay.
4. A Workers’ Comp Claim Must Be Filed Within One Year
The injured worker is required to submit a claim to the Texas Department of Insurance, Division of Workers' Compensation (DWC) within one year of the injury date, in addition to immediately notifying the employer. In order to activate benefits such as medical coverage and wage replacement, this formal filing is required.
5. The Employee Must Seek Approved Medical Treatment
In general, injured workers must adhere to the recommended treatment plans and seek treatment from approved workers' compensation healthcare providers in order to preserve their eligibility. Denial or reduction of benefits may result from failure to attend medical appointments or comply with treatment.
6. The Worker Must Be an Eligible Employee
The majority of employees are eligible; however, independent contractors, freelancers, and certain casual workers may not be covered unless the employer proactively provides insurance. Eligibility frequently hinges on employment status.
7. Benefits Available Under Texas Workers’ Comp
If eligible, workers may receive:
- Medical benefits for work-related treatment
- Income benefits for lost wages
- Impairment benefits for lasting injuries
- Death benefits for surviving family members
Conclusion
An injured worker in Texas must meet the following criteria to qualify for workers' compensation: work for a covered employer, sustain a job-related injury, disclose the incident promptly, file a claim within one year, and adhere to approved medical treatment. Legal alternatives may still be accessible in the event that coverage is declined.
