When Does Workers' Comp Start Paying in Texas?
Texas workers' comp income benefits begin after a one-week waiting period. Under Labor Code Section 408.082, weekly benefits accrue from the eighth day of disability, and the first week is paid too once the disability lasts two weeks. Medical benefits start on the day of the injury. This guide explains how much benefits pay, how long they last, the deadlines, and employers without coverage.
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The seven-day waiting period
Texas Labor Code Section 408.082 says income benefits may not be paid for an injury that does not cause disability for at least one week. If the disability continues past one week, weekly income benefits begin to accrue on the eighth day after the injury, or after the disability begins if it starts later. If the disability lasts two weeks or more, benefits are computed from the first day, so the waiting week is paid back.
Medical care is different: under Section 408.021, medical benefits start on the day of the compensable injury. The insurance carrier, not the employer, pays. Under Section 409.021, within 15 days after receiving written notice of the injury, the carrier must begin paying or tell the worker and the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) in writing that it refuses. It has 60 days to contest whether the injury is covered at all.
How much workers' comp pays
Temporary income benefits, the weekly checks paid while a worker cannot earn the pre-injury wage, are set by Section 408.103. The rate is 70 percent of the difference between the worker's average weekly wage and what the worker earns after the injury. A worker who earns nothing while off work receives 70 percent of the average weekly wage.
Lower-wage workers get a higher rate for a time: an employee earning less than 10 dollars an hour receives 75 percent for the first 26 weeks. Every rate is capped. Under Section 408.061, the weekly maximum for temporary benefits is 100 percent of the state average weekly wage, and the Division computes the dollar figure for each state fiscal year, so it changes over time.
How long workers' comp lasts
Sections 408.101 and 408.102 pay temporary income benefits while the worker has a disability and continue them until the worker reaches maximum medical improvement. The Labor Code defines that point as the earliest date after which further material recovery can no longer reasonably be expected, or 104 weeks after income benefits begin to accrue, whichever comes first.
Section 408.083 sets an outer limit: eligibility for temporary, impairment and supplemental income benefits ends 401 weeks after the date of injury. Medical benefits are not tied to that clock in the same way. Section 408.005 bars a settlement from limiting or ending the worker's right to medical benefits for the compensable injury.
Impairment ratings instead of a body-part chart
Some states pay injuries from a schedule listing body parts. The Texas sections that set impairment benefits work from a single number instead: an impairment rating, which Section 401.011 defines as the percentage of permanent impairment of the whole body. Under Section 408.124 the rating comes from the American Medical Association Guides to the Evaluation of Permanent Impairment, in the edition the Division uses.
Under Section 408.121, impairment income benefits start the day after maximum medical improvement and run three weeks for each percentage point, so a 10 percent rating means 30 weeks. Section 408.126 sets the rate at 70 percent of the average weekly wage, up to a lower cap. A worker rated 15 percent or more may qualify afterward for supplemental income benefits under Section 408.142 if earnings and work-search conditions are met.
Disputes and the designated doctor
When the carrier and worker disagree about maximum medical improvement, the impairment rating, the extent of the injury or the ability to return to work, either one may ask the Division for a designated doctor examination under Section 408.0041. A designated doctor is appointed by agreement of the parties or by the Division to recommend a resolution.
That report carries real weight. The statute says it has presumptive weight unless the preponderance of the evidence is to the contrary. In practice, a worker who disagrees with the designated doctor needs medical evidence strong enough to outweigh the report, not just a different opinion.
Two deadlines that can end a claim
Section 409.001 requires the worker, or someone acting for the worker, to notify the employer of the injury no later than the 30th day after it happens. For an occupational disease, the 30 days run from when the worker knew or should have known the condition may be related to the job. Under Section 409.002, missing that deadline releases the employer and carrier unless they already knew, the Division finds good cause, or they do not contest the claim.
Section 409.003 adds a second deadline: a claim for compensation must be filed with the Division within one year of the injury. Section 409.004 again excuses a late filing only for good cause or if the employer or carrier does not contest. On a construction site, where several companies may be involved, early written notice helps keep every option open.
Is workers' comp required in Texas?
For most private employers, no. Section 406.002 makes coverage elective, except for public employers and where another law requires it. Employers that go without it are often called nonsubscribers. Section 406.005 requires every employer to tell new hires and post notice of whether it carries coverage, and to tell employees within 15 days when coverage changes.
An injured worker can sue a nonsubscriber in negligence, and Section 406.033 takes away three defenses: contributory negligence, assumption of the risk and a fellow employee's negligence. The worker must still prove the employer's negligence, the elements of negligence, and the employer may still argue intoxication or an intentional injury. A waiver signed before the injury is void.
Exclusive remedy and claims against others
When the employer does carry coverage, Section 408.001 makes workers' comp benefits the worker's exclusive remedy against that employer and its employees. One exception: after a death caused by the employer's intentional act or omission or its gross negligence, the surviving spouse or children may seek exemplary damages, which can matter in a wrongful death case.
The exclusive remedy protects the employer, not everyone else. Section 417.001 lets an injured worker claim workers' comp and also sue a third party who caused the injury, such as a negligent driver, an equipment maker or another contractor on the site. The carrier is subrogated to that claim and is reimbursed first from any recovery, with the rest going to the worker. A personal injury claim of this kind is measured by ordinary negligence damages rather than the benefit formulas above.
Summary
In Texas, income benefits accrue from the eighth day of disability, and the first week is paid once the disability lasts two weeks, while medical care is covered from the day of injury. Temporary income benefits replace 70 percent of lost wages, subject to a state maximum, until maximum medical improvement, which arrives no later than 104 weeks after benefits begin to accrue in most cases. Impairment benefits then follow at three weeks per percentage point of whole-body impairment. Workers must notify the employer within 30 days and file with the Division within one year, and coverage is optional for most private employers.
| Question | Texas rule | Source |
|---|---|---|
| When do income benefits accrue? | On the eighth day of disability; the first week is paid if disability lasts two weeks or more | Labor Code 408.082 |
| When do medical benefits start? | On the day of the compensable injury | 408.021 |
| When must the carrier act? | Pay or deny in writing within 15 days of written notice | 409.021 |
| How much are weekly temporary benefits? | 70 percent of lost wages (75 percent for 26 weeks if under 10 dollars an hour), up to a state maximum | 408.103, 408.061 |
| When do temporary benefits end? | At maximum medical improvement, generally no later than 104 weeks after accrual | 408.102, 401.011 |
| How long do impairment benefits run? | Three weeks per percentage point of impairment | 408.121 |
| What is the outer limit for income benefits? | 401 weeks from the date of injury | 408.083 |
| Deadline to tell the employer? | 30 days | 409.001 |
| Deadline to file with TDI-DWC? | One year | 409.003 |
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Frequently asked questions
Income benefits begin to accrue on the eighth day of disability under Labor Code Section 408.082. If the disability lasts two weeks or more, the first week is paid as well. The carrier has 15 days after written notice of the injury to start paying or deny the claim in writing. Medical benefits are not subject to the waiting period and start on the day of the injury.
Temporary income benefits last until maximum medical improvement, which the Labor Code sets no later than 104 weeks after income benefits begin to accrue, with a separate rule after spinal surgery. Impairment benefits then run three weeks per percentage point of impairment. All income benefits end 401 weeks after the date of injury. A settlement cannot end the right to medical benefits for the injury.
Temporary income benefits pay 70 percent of the difference between the average weekly wage and post-injury earnings, or 75 percent for the first 26 weeks for a worker earning under 10 dollars an hour. Impairment benefits pay 70 percent of the average weekly wage. Both are capped at maximums the Division sets each state fiscal year from the state average weekly wage.
Not for most private employers. Section 406.002 makes coverage elective except for public employers and where another law requires it. An employer must tell employees whether it has coverage. A worker hurt by a nonsubscriber's negligence can sue the employer directly, and the employer cannot blame the worker's own negligence, assumed risk or a coworker's negligence.
The Texas impairment benefit sections do not use a body-part chart. They use an impairment rating, the percentage of permanent impairment of the whole body under the AMA Guides, and pay three weeks of benefits per percentage point. A settlement that resolves impairment must use a rating under those guidelines, cannot be made before maximum medical improvement, and needs Division approval.
The Valentine Law Firm handles Texas personal injury cases. This guide is general information about Texas law, not legal advice.
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