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21. So, what injury benefit levels are commonly found in QCARE-eligible programs?

Insurance companies and agents that offer and support QCARE-eligible insurance policies vigorously compete on both the breadth of injury benefit and employers’ liability insurance coverages and pricing.  See information on the QCARE insurance requirement #9 found here.  Rather than provide ARAWC’s own detailed analysis of these Texas insurance products, ARAWC relies on insurers and insurance agents to provide their own marketing materials and coverage comparisons.  

Any comparison of benefit levels between a QCARE program and a workers’ compensation policy must consider the employer’s negligence liability exposure and related payments.  As described above and on the ARAWC website here, such negligence liability exposure is not found in workers’ compensation programs, but is unlimited for employers that do not provide workers’ compensation coverage.  With that in mind, and although specific plan levels vary, these are ranges found in most injury benefit plans:

  • 100% of medical expenses for up to 104 to 156 weeks.
  • 75% to 90% wage replacement beginning on the 1st day of disability, subject to a weekly maximum of $600 or higher (with many programs not specifying any weekly maximum).
  • Death or dismemberment benefits up to $100,000 to $250,000.
  • $250,000 maximum payable per employee
  • $250,000 to $500,000 maximum payable per occurrence

Due to the employer’s desire for employee care, as well as negligence liability exposure, additional medical, disability and other payments – beyond the above benefit limits – are made on almost every severe injury claim.  For more information and specific case studies, see Part 3 of the ARAWC “Innovation Series” on Active Engagement and Part 5 on Improved Benefits.

For additional information on insurance products available from ARAWC members, go to:  

Several other name-brand insurance companies, as well as the nation’s most-respected names in third party claims administration, support the QCARE insurance and claims marketplace.

Sample Texas injury benefit plans are readily available.  Every Texas employee covered by an injury benefit plan must receive a comprehensive summary of their rights and responsibilities under such a plan.  Sample copies of ERISA injury benefit plans and summary plan descriptions are also found at the links above or upon request from the insurance company, and elsewhere on the internet.  Not all injury benefit plans will meet QCARE’s 10 essential standards.

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Additional information on any item above is available by contacting info@arawc.org.