Are exclusions and limitations on benefits only found in Texas injury benefit programs?


  • The Texas workers’ compensation system relies on various exclusions and limitations on benefits, buried among hundreds of pages of statutes, rules, guidelines and court decisions.
  • One difference is that Texas injury benefit program exclusions and limitations are much more transparent and easy to find in Texas injury benefit program documents and summary descriptions. These documents are readily available to every covered employee.
  • Texas injury benefit programs use certain exclusions and limitations on benefits primarily as a means of confirming payment for work-related injury and in consideration of the employer’s unlimited negligence liability exposure in Texas. Those plan provisions should be continuously reviewed and refined for best practices, as employers and insurance carriers are doing in Texas. Many micro-limitations on benefits that have been criticized in recent years have been removed from almost all programs.