Case Study: Injury on the Job, Out of the State

Texas injury benefit plan or workers’ comp: Which applies?

Consider this: A Texas-based retail employee is out of state on business when that person suffers an injury on the job. This person’s employer provides employees coverage under its Texas injury benefit plan. Is that employee covered while out of Texas on business? The answer is yes: The employer’s plan defines a covered employee as one who is employed with the employer principally located in Texas. So, even though the person was out of state, coverage still applies.

Now, the more challenging question: The employee wanted to know if instead of making a claim under the employer’s Texas injury benefit plan, could they instead opt to file a workers’ compensation claim in the state where they were injured? If an employee is injured while traveling through or working in another state, there is a good chance they will be eligible to make a claim for workers’ compensation benefits in that state.

Which option is best for the employee? The employer turned to PartnerSource for the answer.

First, it’s important to know the benefits and advantages offered to employees under their employer’s Texas injury benefit programs, including and most importantly, the availability of expert medical specialists in a timely manner (which studies have shown produces better medical outcomes).

PartnerSource also advises that claims administrators be ready with information about an injured employee’s options. The employee may not be familiar with the coverage offered under their employer's Texas injury benefit program, and might not understand all the benefits available to them. Also, as far as understanding their eligibility for workers’ comp benefits in other states, claims administrators can provide the employee with the Department of Labor’s website with a direct link to each state’s official workers’ comp website: https://www.dol.gov/agencies/owcp/wc. This helps employees avoid search results that are likely just websites for plaintiff attorneys practicing in that state, who are likely not informed on all of the employee’s options.

Should employers be concerned about a Texas employee potentially filing an out of state workers’ compensation claim? For insurance purposes, PartnerSource advises that employers discuss this scenario with their national broker to ensure there are no coverage gaps. Also, knowing which states your employees may travel through or to for work is critical when placing your coverage. If you have a workers’ compensation policy with standard formatting, consider reviewing section 3A and 3C with your broker: Section 3A will typically list the states where you have coverage and Section 3C will typically list the states where the policy benefits can apply if an employee is injured while traveling through or temporarily working in that state. 

Once presented with all of the options, the employee who sustained the injury out of state opted to keep their coverage under their employer’s Texas injury benefit plan, and received timely medical treatment for their injury.

Knowing the options available, and being ready for all scenarios, helps employers take the best care of their most valuable resource, their employees, in the unfortunate case of an injury while on the job. PartnerSource is ready to advise and consult with all employers with operations in Texas about the best options for their employees.