Injury Care Benefit Plans in Texas


While Texas has unique workers’ compensation laws, about 20% of Texas employers have injury benefit plans, regardless of their size. In this article, we will discuss the differences between Texas injury care benefit plans and non-subscriber plans, medical expense caps, and income benefits. For more information, please visit our injury care benefit plan guide. The Texas legislature will also provide further guidance on how to design an injury care benefit plan that meets your needs.

Non-subscriber injury care benefit plans

Texas employers can choose to participate in the state workers’ compensation system or offer an alternative injury care benefit plan. Nonsubscriber plans enable companies to control costs while providing great benefits and personalized services to their employees. Many top employers in the state have opted for alternative plans. By using an alternative plan, employers can improve worker safety and increase their ability to invest in their business. If you’re considering an alternative plan, here are a few benefits of each option.

First, make sure you understand what non-subscriber injury care benefit plans are and how they differ from workers’ compensation. Workers’ compensation is a form of governmental insurance that extends benefits to injured workers and assists in getting fair compensation for their pain and suffering. Non-subscriber injury care benefit plans in Texas are available to all businesses, regardless of the size. However, be sure to consult an attorney before signing up for a non-subscriber plan.

Pre-authorization requirements

Pre-authorization for injury care benefit plans in Texas are necessary for the provision of treatment for covered injuries. In the state, workers’ compensation carriers must use Utilization Review Agents (URAs) licensed by the Texas Department of Insurance. These individuals review and approve medical procedures prior to providing them. They may need additional documentation to support the requested procedure. If treatment is denied, the member has 30 days to appeal the decision.

Income benefits

The state of Texas offers income benefits for injured workers. These benefits are provided to injured workers who are unable to work for seven or more days because of an injury. These days need not be consecutive. Benefits are calculated based on the difference between pre and post-injury wages, and the maximum and minimum amount depend on the injury’s date and the start of the benefits. However, if a worker is able to return to work, he or she may still qualify for the full 70 percent of lost income.

To receive these income benefits, employees must meet the four requirements set out by the state. These requirements include: (1) a permanent injury, or (2) a disability that limits a person’s ability to return to work. Then, a physician will rate the injury and determine a temporary or permanent impairment. These factors will determine the amount of monetary benefits that a worker can receive for the rest of their life. Each percentage point of impairment equals three weeks of benefits, and the total amount is limited by state maximums.

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