Details of Employer Rights

In Texas, workers’ compensation coverage is optional for most employers. The law encourages employers to subscribe to workers’ compensation coverage by guaranteeing them certain rights and protection not afforded to non-subscribers.

The law protects subscribers from lawsuits resulting from an employee’s on-the-job injury. The value of this protection cannot be overestimated. Even with the tort reform laws, lawsuits can potentially cost employers hundreds of thousands or even millions of dollars. Only employers who subscribe to workers’ compensation coverage are protected from most lawsuits related to an employee’s on-the-job injury or illness.

Beyond this basic protection, subscribers have additional rights. If you subscribe to workers’ compensation, you have the following rights under law.

Your right to information
Upon receiving your written request, a Texas Mutual^® workers’ compensation specialist will provide you with information about how we plan to resolve a claim. Note, however, that the law stipulates that only your licensed workers’ compensation insurance carrier can determine how to resolve a claim.

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Your right to dispute resolution
When two parties cannot settle a claim dispute (such as compensability or the amount of benefits due) between themselves, they may take the matter to an administrative proceeding. You have the right to attend all administrative proceedings about your employees’ claims and to present relevant evidence.

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Your right to accident prevention services
The law requires us to maintain or provide accident prevention services that are adequate for your operation. To request these services, call a Texas Mutual^® loss prevention specialist.

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Your right to loss run reports
You have a right to receive loss run reports that show:

• the claims filed against your policy,
• claim payments, and
• reserves for each claim.

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Your right to reimbursement for voluntary payment of benefits

You have a right to reimbursement if you pay compensable expenses related to a workers’ compensation claim; however , if you pay directly, you may be overpaying. We can only reimburse you for the amount allowed by the Division’s fee guidelines. If you pay expenses for an injury that is not compensable, we cannot reimburse you.

To request reimbursement, you must file an Employer’s Report for Reimbursement of Voluntary Payment.

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Your right to assistance
You have a right to assistance in understanding your rights and responsibilities in the workers’ compensation system. Call Texas Mutual Insurance Company or the Division for more information.

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Your right to report fraud
You have the right to report suspected workers’ compensation fraud. Texas Mutual Insurance Company provides a toll-free number for you to call to make a report. You also may report fraud to the Division at (800) 372-7713. For more information on fraud, click here.

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Your right to contest compensability
Although Texas Mutual Insurance Company is responsible for deciding whether to deny or accept a claim, you have the right to contest a claim’s compensability, even if we have already accepted the claim.

To contest the compensability of a claim, you must file an Employer’s Contest of Compensability, with the Division.

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Texas Mutual^® is a registered service mark of Texas Mutual Insurance Company.