How Being an Opt-Out State Can Make Life Difficult for Workers

What is an “opt-out” state for workers’ compensation? Most states require employers to cover employees under a workers’ compensation policy to cover the costs of things like medical bills and lost wages for workers who are injured.

Texas is not one of those states. Here, there is no requirement for employers to carry workers’ comp insurance. Normally, when a worker is injured, that worker files a claim. If that claim is approved, then the worker receives benefits. But in Texas, if the employer has opted-out of workers’ comp, then the employee is at the mercy of whatever plan the company has come up with (barring the potential for a third-party injury claim).

There’s a problem, though. These employer-created plans often cover fewer injuries, cut of benefits payments sooner, dictate which doctors the employee is allowed to use and sometimes even impose mandatory settlements that are not enough to cover the injured worker’s bills and lost wages.

Investigating the Issue

An investigation by ProPublica and NPR found that many independent insurance plans in Texas only cover care for about two years, whereas workers’ comp lasts as long as a worker needs. These plans sometimes will not pay for things like wheelchair vans or for occupational diseases caused by exposure to dust, mold and even asbestos. Worse still, appeals are often controlled by the employers, and payments for catastrophic injury and wrongful death are often strictly limited.

For the reasons listed above, whenever you suffer an injury at work, the best course of action is to discuss your case in a free consultation with a workers’ comp attorney.



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