If you were hurt at work in Texas, you’re probably wondering what your employer’s workers’ comp policy covers and what it doesn’t. Medical bills? Time off work? Ongoing therapy? The answers aren’t always clear.
At The Zimmerman Law Firm, P.C., we help injured workers across central Texas, including Waco, Temple, Killeen, Round Rock, and Austin, get the answers they need. We have answers if you’re wondering: What does workers’ comp cover? How does it work in Texas? or What benefits am I entitled to?
What Is Workers’ Compensation?
Workers’ compensation insurance covers employees who are injured or become ill on the job. In most states, all employers must carry it, but Texas is different.
In Texas, most private employers are not legally required to carry workers’ comp. That means your employer may not be covered under the state system. You can check whether your employer has coverage on the Texas Department of Insurance website or by asking them directly.
If they do have workers’ comp insurance, you can file a claim through the state system. If they don’t, they are considered a non-subscriber, and you may have the right to file a personal injury lawsuit instead.
This post explains what workers’ compensation does cover when your employer carries workers’ comp in Texas.
Workers’ Comp, What Does It Cover in Texas?
In a valid Texas workers’ comp claim, injured workers can receive four main types of benefits: medical, income replacement, burial/death, and vocational rehab.
1. Medical Benefits
Workers’ comp covers all reasonable and necessary medical care related to your work injury, including:
- Doctor visits,
- Hospital treatment,
- Physical therapy,
- Prescription medications, and
- Medical devices (crutches, braces, etc.).
There are no co-pays or deductibles for approved treatment. However, you must see a doctor in the approved network for your care to be covered.
2. Income Benefits
If your injury keeps you from working, workers’ comp may pay part of your lost wages. The amount depends on the severity of your injury and how long you’re out of work.
There are four types of income benefits:
- Temporary Income Benefits (TIBs)—paid if you miss more than 7 days of work due to your injury;
- Impairment Income Benefits (IIBs)—paid if you have a lasting physical impairment;
- Supplemental Income Benefits (SIBs)—additional payments for workers with severe, long-term impairments who return to lower-paying jobs; and
- Lifetime Income Benefits (LIBs)—for catastrophic injuries, such as the loss of a limb or complete blindness.
These benefits are typically a percentage of your average weekly wages, up to a cap set by the state.
3. Burial and Death Benefits
If an employee dies because of a work-related accident, their family may qualify for:
- Burial benefits to help with funeral expenses; and
- Death benefits to help replace lost income for a surviving spouse, child, or dependent.
These benefits make a difficult time more manageable for families.
4. Vocational Rehabilitation
If your injury prevents you from returning to your previous job, you may qualify for help finding a new one. Workers’ comp may provide job retraining or placement assistance to help you transition into a new line of work.
What Does Workers’ Comp Not Cover in Texas?
Knowing what workers’ comp does not cover is just as important, so there are no surprises.
Here are a few key things workers’ comp typically does not cover in Texas:
- Pain and suffering,
- Emotional distress,
- Punitive damages,
- Injuries that happened while you were intoxicated,
- Injuries that occurred while you were breaking company policy or committing a crime, and
- Pre-existing conditions unrelated to your job.
Also, none of these benefits will apply if your employer doesn’t carry workers’ comp. In those cases, you may be able to sue your employer directly, but the process is different, and the rules change.
Workers’ Comp vs. Personal Injury Claim: What’s the Difference?
In a typical personal injury case, such as a car accident, you can recover compensation for pain and suffering, emotional trauma, and full lost wages. Workers’ comp, on the other hand, is more limited. It only covers medical costs and a portion of lost wages.
The trade-off is that you don’t have to prove fault with workers’ comp. You can usually get benefits even if the accident was partially your fault, as long as it happened while doing your job.
But if your employer doesn’t offer workers’ comp and you have to file a lawsuit instead, you will need to prove negligence, and your potential recovery may be higher if you succeed.
Do You Need a Lawyer for a Workers’ Comp Claim?
You’re not required to hire a lawyer, but the truth is, it helps. A good attorney can:
- Help you file your claim correctly,
- Make sure you’re getting all available benefits,
- Dispute low settlements or denied claims,
- Handle appeals or legal hearings, and
- Take action if your employer retaliates or refuses to cooperate.
At The Zimmerman Law Firm, we walk our clients through every step of the process and are honest about what workers’ comp covers and what it doesn’t.
Still Unsure What Workers’ Comp Covers? We’re Here to Help.
If you’re still wondering what workers’ comp can cover, or whether you are getting the full benefits you deserve, we’re ready to help you figure it out. Whether dealing with medical bills, time off work, or questions about your employer’s insurance, The Zimmerman Law Firm, P.C. is here to guide you.
We serve injured workers across central Texas, including Waco, Temple, Killeen, Round Rock, and Austin. We’re proud to give our clients honest answers and personal attention. Contact us today for a free consultation to discuss your injury and next steps. We’ll help you understand your rights and ensure you aren’t leaving money on the table.
Michael Zimmerman
Michael was born in Houston, Texas. His education at Baylor and Texas State Universities earned him a Bachelor of Science degree in 1987. His major was in Biology with a Minor in Chemistry. He finished his legal education at Texas Southern University in 1990, earning a Juris Doctorate from Thurgood Marshall School of Law. He was admitted to the State Bar of Texas in 1990.
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