Eligibility for workers' compensation coverage under Texas law

March 20, 2013

Eligibility for workers' compensation coverage under Texas law

Article provided by Charles L. Scruggs, Attorney at Law
Visit us at http://www.workerscompelpaso.com/

A work-related injury can be life changing. That is why it is so important to understand who is covered by workers' compensation insurance, what types of injuries are covered and any applicable time limits based on type of injury.

Not all employees are covered under Texas law

Texas does not require all employers to provide workers' compensation benefits. A 1996 study by the Texas Research and Oversight Council on Workers' Compensation reported that approximately two-fifths of employers in the state do not carry coverage.

However, some employers are required to provide coverage, including:
-Building contractors
-Motor vehicle and motorbus carriers
-Public employers

Public employers include anyone who works for counties, cities, state agencies and state university systems. Additionally, employers who deal in liquid propane gas or natural gas must provide coverage.

Certain types of employees are not covered. For example, an employee who works on an offshore drilling rig or ship is not eligible. Domestic and household workers as well as family members employed on a family farm or ranch are also excluded from coverage. However, Texas is one of only a few states that provide coverage to non-U.S. citizens.

Injuries that occur within the scope of employment are covered

Work-related injuries commonly occur on workplace property, but injuries that occur off property may also be covered. The common element both types of injuries share is that an employee suffered a work-related injury while performing an activity for an employer as part of his or her employment.

For instance, an employee may be covered if an injury occurs in a company-owned vehicle or at a separate company location, if the employee is performing work related to his or her employment.

An employee who sustains an injury while intoxicated is not usually covered, even if the activity is employment-related, like taking out-of-town clients out for dinner. However, if the alcohol was provided by the company for a company-sponsored event, coverage is generally available.

It is important to note that physical injuries are not the only types of injuries covered by worker's compensation insurance. Mental injuries such as anxiety and depression are also covered if an employee can show they were caused by the employment. Finally, some pre-existing conditions that are aggravated due to employment-related activities may be covered.

Maximum medical improvement date determines available benefits

An injured employee who receives necessary medical care through workers' compensation coverage may eventually reach what is known as maximum medical improvement, or MMI. MMI is the date at which a qualified doctor determines that no further medical treatment is necessary and the condition is not expected to improve.

MMI is automatically considered reached 104 weeks after an employee begins receiving workers' compensation benefits. Once MMI is reached, insurance carriers adjust the type and amount of available benefits. The MMI date can be extended if the employee undergoes spinal surgery within 12 weeks of the 104-week cutoff.

Employers providing coverage are required to provide information about available doctors and medical treatment options immediately after an injury. However, the workers' compensation process is complicated and often involves long wait times for treatment. Insurance companies also frequently dispute claims, adding to delays.

In a legal battle over workers' compensation?

If you were injured on the job and are having difficulties obtaining proper medical treatment, you need a knowledgeable workers' compensation attorney to move the process forward as quickly and efficiently as possible.