The idea that workers should be compensated for work-related injuries and that the government should administer programs to ensure compensation came into law in the US in the early 1900s. Texas enacted its first workers’ compensation laws in 1913 and today all 50 states (and the District of Columbia) have workers’ compensation requirements.
Workers’ comp, a state-regulated insurance program, pays medical bills and replaces some of the lost wages for employees who are injured at work or have work-related diseases or illnesses. It also protects employers that have workers compensation insurance in Texas from civil suits brought about by an injured worker. The Texas Workers’ Compensation Act states that recovery of workers’ comp benefits are a covered employee’s, or any legal beneficiary’s, right when there is a work-related injury or death sustained by the employee.
What to do when an injury occurs
When a patient goes to receive treatment at a doctor’s office, it is very important for the physician to first determine if the injury or illness is, in fact, work-related. The intake form and the physician’s history and physical of the injured party will help to verify this. If the patient’s injury or illness is work-related, the physician’s office should be aware whether or not the employer has workers’ comp coverage.
If there is coverage under the Texas Workers’ Compensation system, then the physician and his or her office must follow the statute, rules, and guidelines of the state of Texas. These rules mandate reporting requirements, pre-authorization of certain procedures and services, prescribed billing forms, and specific time frames for filing. Rules and regulations also define different roles for doctors, how the physician’s exam may impact the injured workers’ income benefits, and any expected reimbursement for health care services.
Public employers have the option to buy commercial coverage, self-insure (no certificate required), or join a workers’ compensation pool or fund composed of other public sector entities. Some groups that pool workers compensation insurance in Texas are the Texas Association of School Boards, Texas Municipal League, and Texas Association of Counties. Speak to an agent to determine what your best options are regarding workers comp coverage.