Texas Workers Compensation Process

Why is Texas workers compensation different?

Texas is the only state where private employers can opt out of the workers compensation system—a feature dating back to 1913. This creates two distinct categories of employers and fundamentally different rights for injured workers:

• Subscribers: Employers who purchase workers comp insurance or qualify as self-insured; employees of subscribers receive benefits through the Texas Department of Insurance Division of Workers' Compensation (TDI-DWC) system and cannot sue their employer for workplace injuries (exclusive remedy rule applies)
• Non-subscribers: Employers who opt out of workers comp; employees of non-subscribers can sue their employer in civil court for workplace injuries, and employers lose common-law liability defenses (contributory negligence, assumption of risk, fellow-servant rule)
• Required coverage: Government entities and construction contractors working on government projects must subscribe to workers comp; all other private employers may choose

According to the Texas Department of Insurance 2024 Biennial Report (accessed August 22, 2026), 76% of Texas employers subscribe to workers compensation, covering 87% of Texas employees. The remaining 13% of employees work for non-subscribers. Non-subscription rates have declined to decade lows as of 2024.

What are the advantages and disadvantages of the Texas system?

For employees of subscribers:

• Advantages: No-fault system (don't need to prove employer negligence), guaranteed medical coverage and income benefits if eligible, relatively quick benefit delivery in most cases
• Disadvantages: Benefit caps limit recovery, cannot sue employer for negligence or pain and suffering, impairment rating system may undervalue certain injuries

For employees of non-subscribers:

• Advantages: Can sue employer in civil court, potential for higher damages including pain and suffering and punitive damages, employer cannot use common-law defenses
• Disadvantages: Must prove employer negligence caused injury, no guaranteed medical coverage or income benefits, litigation can take years, employer may have no assets or insurance to pay judgment

When must I report my injury in Texas?

Important: You must file a workers compensation claim within 1 year of the injury date or from when you knew or should have known the injury is work-related (Tex. Labor Code § 409.003). File Form DWC-041 (Employee's Claim for Compensation, available at TDI forms page) to formally initiate your claim.

How do I get medical treatment?

For subscribers (employers with workers comp):

• Employee selects initial treating doctor: You choose your first treating doctor; prior approval is NOT required for your initial selection
• Changing doctors: If you want to change treating doctors after your initial selection, submit Form DWC-053 (Employee Request to Change Treating Doctor, available at TDI forms page) to TDI-DWC for approval
• Health Care Networks (HCN): If your employer participates in a certified HCN, you must select doctors within the network (except emergency care)
• Emergency care anywhere: Emergency treatment at any facility is permitted regardless of network or doctor restrictions
• After reaching MMI: You may switch to any qualified provider without restriction once you reach maximum medical improvement

Historical note: The Approved Doctor List (ADL) was discontinued on August 31, 2007 per Texas Labor Code § 408.023(k). Doctors are not required to be on an approved list or pass DWC training to treat injured workers.

What should my return-to-work note include?

Texas return-to-work documentation (DWC-073 or equivalent) should include:

1. Provider name, license number, signature, and date
2. Work status classification
3. Specific physical restrictions and limitations
4. Duration of restrictions
5. Date of next evaluation or treatment
6. ICD-10 diagnosis codes

What work status will my doctor assign?

What income benefits can I receive?

Texas workers compensation provides four types of income benefits, each with specific eligibility criteria and payment structures:

How do I qualify for Temporary Income Benefits?

TIBs compensate lost wages when you cannot work at all during recovery. Key requirements:

• Seven-day waiting period: First 7 days of disability are not compensated unless disability extends beyond 14 days (then first 7 days are paid retroactively)
• Medical documentation: Must have physician certification that you cannot work (Status 3 work status)
• Wage basis: Benefits calculated as 70% of your average weekly wage for the 13 weeks before injury
• Maximum benefit: Subject to state maximum weekly benefit (for injuries Oct 1, 2025 - Sept 30, 2026, the maximum is $1,271.00 per TDI)

Example: If your AWW is $800, your TIBs would be $560/week (70% × $800). According to the TDI maximum benefit table (accessed August 22, 2026), for injuries occurring between October 1, 2025, and September 30, 2026, the maximum weekly TIBs is $1,271.00. If your AWW is $2,000, you're capped at the $1,271 maximum.

What are Impairment Income Benefits?

After you reach MMI, your doctor assigns a permanent impairment rating (if you have lasting limitations). IIBs are paid based on this rating:

• Duration formula: 3 weeks of benefits per 1% impairment. Example: 15% impairment = 45 weeks of IIBs (15 × 3)
• Payment rate: 70% of your average weekly wage (subject to state maximum)
• Lump-sum option: In some cases, you can request to commute (convert) IIBs to a lump-sum payment
• Dispute resolution: If you disagree with the impairment rating, you can request a designated doctor examination

The impairment rating is based on the AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition (1993) as currently adopted by Texas. Per the TDI April 2026 AMA Guides Study, Texas doctors use the Fourth Edition. Ratings can range from 0% (no permanent impairment) to 100% (total impairment).

How do Supplemental Income Benefits work?

SIBs provide ongoing benefits after IIBs end if you still cannot earn your pre-injury wages. To qualify:

• Impairment threshold: Must have at least 15% permanent impairment
• Wage-loss requirement: Currently earning less than 80% of pre-injury average weekly wage
• Work-search requirement: Must document active job-search efforts (unless total inability to work is certified)
• Good-faith participation: Must participate in vocational rehabilitation if offered
• Duration: SIBs are paid in 13-week quarters; you must re-qualify each quarter

SIBs pay 80% of the difference between 80% of your pre-injury AWW and your current wages, subject to the state maximum. Per Texas Labor Code § 408.144(b) and 28 TAC § 130.102(g): "the amount of a supplemental income benefit for a week is equal to 80 percent of the amount computed by subtracting the weekly wage the employee earned during the reporting period...from 80 percent of the employee's average weekly wage."

Example: Pre-injury AWW $1,000, current earnings $400:

• 80% of AWW: $1,000 × 0.80 = $800
• Subtract current wages: $800 − $400 = $400
• SIBs rate: $400 × 0.80 = $320/week
• Monthly payment: $320 × 4.34821 = $1,391.43

What medical expenses are covered?

Texas workers compensation covers all reasonable and necessary medical care related to your work injury:

• Hospital and emergency room treatment
• Doctor visits and specialist consultations
• Diagnostic tests and imaging
• Surgery and rehabilitation
• Physical therapy and chiropractic care (subject to guidelines)
• Prescription medications
• Durable medical equipment
• Mileage reimbursement: For treatment more than 30 miles one-way from your home, reimbursed at the state employee travel rate: 72.5¢/mile (Jan-June 2026) or 76¢/mile (July-Dec 2026), per 28 TAC § 134.110

Texas uses evidence-based medical treatment guidelines that specify appropriate care for different types of injuries. If your doctor recommends treatment outside the guidelines, preauthorization from the insurance carrier may be required.

When have I reached maximum medical improvement?

In Texas workers comp:

• Doctor determines when you've reached MMI
• Permanent impairment rating assigned (if applicable)
• Transition from temporary to impairment income benefits
• Can request designated doctor exam if you disagree with MMI determination

What happens if my doctor says I can do light duty?

For Texas subscribers:

• Employer should offer light duty within restrictions if available
• Employee must accept suitable light duty or risk benefit reduction
• Light duty must comply with doctor's restrictions
• Employer can require updated work status reports
• Failure to return when medically cleared may affect benefits

What if my employer doesn't have workers comp insurance?

If your employer doesn't have workers comp insurance:

• You may be able to sue employer for workplace injury
• Employer cannot use common law defenses (contributory negligence, etc.)
• Must prove employer negligence caused injury
• No TDI-DWC dispute resolution process available
• Consult personal injury attorney immediately

What is a designated doctor examination?

When disputes arise, TDI-DWC may order designated doctor exam for:

• Determination of MMI date
• Impairment rating disputes
• Extent of injury questions
• Return-to-work ability disputes

Designated doctor opinions carry presumptive weight unless contrary evidence exists.

Should I hire a workers compensation attorney?

Consider legal representation if:

• Claim is denied or benefits are terminated
• Employer is a non-subscriber and you were injured
• You disagree with MMI or impairment rating
• Medical treatment is denied or inadequate
• You're terminated or retaliated against for filing claim
• Settlement offer is made (review before accepting)
• Permanent disability results from injury

Verify attorney licenses at texasbar.com/findalawyer (State Bar of Texas). Workers comp attorneys often work on contingency (fee is percentage of recovery).

How do I resolve disputes with my employer or insurer?

Texas provides multiple dispute resolution options:

1. Benefit Review Conference (BRC): Informal dispute resolution
2. Contested Case Hearing (CCH): Formal hearing before administrative law judge
3. Appeals: Can appeal CCH decision through appeals panel and courts

Where can I find official forms and resources?

• Texas Department of Insurance, Division of Workers' Compensation: tdi.texas.gov/wc (official forms including DWC-041)
• State Bar of Texas Lawyer Search: texasbar.com/findalawyer (verify licenses)
• Office of Injured Employee Counsel (OIEC): Free information and assistance
• Legal aid organizations: May provide free assistance if you qualify