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20. Does the QCARE designation require a particular duration or dollar amount of injury benefits and related insurance?

No.  However, such specificity is required by the Employee Retirement Income Security Act (ERISA) and all insurance companies writing insurance for Texas injury benefit programs.

First, remember that employers with no workers’ compensation insurance give up the “exclusive remedy” protection of workers’ compensation.  As a result, injured Texas workers have two avenues of recovery: (1) the employer’s injury benefits program, and (2) settlements and awards for any employer negligence that caused the injury.  This employer negligence liability exposure is not found in any state workers’ compensation system.

Over the past three decades, employers and insurers have developed market standards within this context of employee care and incentives for workplace safety.  With regard to employee care, ERISA requires any actual payment of injured employee medical and disability benefits to be specifically defined and communicated through a formal injury benefit plan.  Most employers are highly motivated to voluntarily establish such a plan to support healing and return to work for injured employees.  This helps protect their hiring and training investments, employee morale and productivity, which is the key to company profitability.  

With regard to workplace safety, ALL Texas employers that do not provide workers’ compensation insurance can be sued for any employer negligence that causes or contributes to an employee injury.  As stated in the detail on QCARE requirement #1 found here, the employer and its insurers cannot defend against negligence liability claims based on common law defenses of assumption of risk, contributory (or comparative) negligence, or negligence of a fellow employee.  This means employer liability for ANY failure to train, provide safe equipment to perform the job or maintain a safe work environment.  As discussed in Part 3 of the ARAWC Innovation Series, negligence liability exposure is real and a powerful force for good, supporting more robust job training and safety programs.  Employers and their insurance companies further reduce this liability exposure by paying – on a no-fault basis, as required by QCARE – all medical, wage replacement and related bodily injury damage and expenses under the injury benefit plan.  Where appropriate, payments can also be made under the terms of a supplemental benefit plan, court or arbitrator award, or settlement agreement.  

This combination of incentives for employee care and workplace safety have functioned within a competitive marketplace for over 30 years, successfully addressing the needs of over one million injured workers and their families.  More information on this system structure and recent benefit improvements can be found here.

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