Why Injury Benefit Programs Encourage Better Employee Advocacy ARAWC Why Texas’ Model Encourages Better Employee Advocacy For over three decades, Texas has stood out as the only state in the nation where employers can choose whether or not to subscribe to the state’s workers’ compensation system. Texas’ approach creates a system where businesses have strong incentives to prioritize workplace safety, streamline benefits, and provide superior injury care—resulting in stronger employee advocacy. By removing the blanket protections of “exclusive remedy” found in traditional workers’ compensation models, Texas compels employers to take a more proactive and accountable approach. They must not only focus on preventing workplace injuries but also ensure injured employees receive high-quality care to minimize legal exposure. Research shows that this approach drives better medical outcomes, faster recovery times, and an overall improved experience for employees. 1. An Intellectually Honest Approach In the traditional workers’ compensation context, when an employee is injured on the job, employers generally enjoy “exclusive remedy” protections. This means employees typically cannot file negligence lawsuits if they accept workers’ compensation benefits. However, under the Texas non-subscription system, employers who opt out of workers’ compensation lose that exclusive remedy defense and may be sued if found liable. Why does this matter for employees? The possibility of negligence claims creates a powerful incentive for employers to enhance safety programs, communicate transparently, and promptly address injuries. Instead of denying or delaying care, these employers often adopt a proactive approach to avoid litigation and ensure workers heal quickly and effectively. On a recent episode of Forecasting Success, Bob Wilson, President of WorkCompCollege.com, commented on how Texas’ model can benefit injured workers. Wilson noted that the liability exposure in Texas’ model creates an incentive for employers to take proactive steps to protect workers, differentiating it from other models such as Oklahoma’s Employee Injury Benefit Act. He explained: “Texas doesn’t afford exclusive remedy protection to non-subscribing employers. That exposure gives a different emphasis to protecting your interests and your assets, so if you’re a non-subscriber, you’re probably doing a little better job than if perhaps you’re given exclusive remedy–like they had in Oklahoma—and don’t have to take those steps.” — Bob Wilson, Forecasting Success Podcast Research supports this conjecture. For example, research out of Stanford by Morantz, A.D. Rejecting the Grand Bargain: What Happens When Large Companies Opt Out of Workers’ Compensation? highlights that workplace safety initiatives under these programs have reduced severe and traumatic injuries by nearly 50%. This demonstrates how liability exposure can drive employers to adopt proactive measures that prioritize worker safety and health. 2. Competition Drives System Improvements The Texas system fosters competition between the state’s workers’ compensation plan and private injury benefit alternatives. On Forecasting Success, Wilson highlighted how this system acts as a competitive force in Texas, driving improvements across both traditional workers’ compensation and alternative models: “The presence or ability to non-subscribe is a competitive value to the workers’ comp system. The system has to be good enough that people want to come in. … And, for those who opt out, the liability exposure encourages them to do a better job.” By fostering accountability and innovation, the Texas model ensures that employee advocacy isn’t just an ideal—but a practical reality that benefits workers when they need it most. Research by Jinks et al. (2020) in Opting out of workers’ compensation: Non-subscription in Texas and its effects illustrates how this competition has led to faster recovery and reduced hospitalizations, ensuring injured workers receive timely and effective care. Improved Recovery Experience: Total medical payments dropped by 40%, while the system facilitated faster recovery through reduced hospitalizations. Faster Return to Work: Work-loss durations were reduced by 80%, helping employees regain their livelihoods sooner. This dual structure—where companies can select either the traditional state system or a private alternative—drives continuous innovation and employee-centered reforms. As employers move in and out of the system, state regulators and private insurance carriers feel the pressure to offer better benefits, more streamlined processes, and higher-quality care for injured workers. 3. Best Practices for Employee Advocacy Texas injury benefit programs often prioritize practices that lead to better medical outcomes and high employee satisfaction, as recognized through the Qualified Compensation Alternative for Recovering Employees (QCARE) designation. QCARE is a simple, no-cost, online designation that highlights employers with responsible injury benefit programs adhering to high industry standards. These standards include: Awareness of Negligence Liability Exposure: Employers have a greater incentive to ensure workplace safety and employee care, with manageable and insurable liability exposure encouraging proactive measures. Defined Injury Benefits: Programs include specific levels of medical, wage replacement, and death and dismemberment benefits. These benefits are clearly outlined in insurance policies and benefit plans, ensuring transparency and consistency. Fair, Well-Communicated Injury Reporting Standards: Employers implement clear reporting guidelines, communicated effectively to employees, with a good cause exception for delays. This ensures timely and fair handling of claims. Broadly Defined Covered Injuries: Programs cover accidents, occupational diseases, and cumulative trauma, offering comprehensive protection to workers. Benefits Paid Without Regard to Fault: Employees receive benefits regardless of whether the injury was caused by the employer, the employee, or a third party, removing adversarial barriers to recovery. Employer Pays 100% of Costs: Employees bear no costs for participation, as employers cover all expenses from the date of hire, eliminating financial burdens for workers. Compliance with Federal ERISA Laws: Programs align with widely-accepted federal employee benefit regulations, ensuring consistency in communication, fiduciary obligations, and claims payment. Broad Insurance Coverage: Comprehensive insurance protects benefits, employer liability, and related expenses, ensuring financial security for both employers and employees. Approved Claims Administration: Claims are managed by insurers, licensed third-party administrators, or approved adjusters, ensuring professionalism and adherence to best practices. 4. A Key Part of the Employee Advocacy Equation Employee advocacy is not just a buzzword. When an on-the-job injury threatens a worker’s family, finances, and future, the employer’s responsiveness can make all the difference. The Texas non-subscription option has driven: Better Training and Quality Control: Employers who manage their own programs often invest heavily in professional claims handling, fiduciary oversight, and strong communication channels. Faster Claim Resolution and Better Outcomes: Without bureaucratic hurdles, non-subscribers can expedite treatments and wage replacement. Continual Improvement: Competitive tension between traditional workers’ comp and non-subscription encourages upgrades, such as simplifying plan documents, incorporating “good cause” exceptions, and aligning programs with federal ERISA standards. 5. Looking Ahead Texas’ model underscores a crucial lesson: when businesses are directly responsible for workplace injuries—without the shield of exclusive remedy protections—they are more likely to prioritize safety, accountability, and quality care. This approach doesn’t just benefit employers looking to avoid litigation; it significantly improves the experience and well-being of employees by ensuring more efficient injury response, comprehensive benefits, and faster recovery. The Texas model continues to evolve, pushing both state regulators and private benefit providers to improve their offerings. By fostering competition and placing responsibility directly on employers, the system drives real change—ensuring that employees are not just numbers in a bureaucratic process but individuals whose health, financial security, and livelihoods are valued. Ultimately, this approach reflects a broader truth: when companies are required to do better, they often do—leading to a safer, more responsive, and employee-first workplace. Watch Bob Wilson on Forecasting Success:
Texas’ Model Offers Solutions for Growing Physician Access Challenges in Occupational Health ARAWC The challenge of ensuring injured workers have access to quality medical care is becoming increasingly complex across the United States. As populations grow and physician participation in workers’ compensation decreases, states are grappling with how to maintain high standards of care while improving access. Texas’s innovative approach to workers’ compensation offers valuable insights into potential solutions. Greg Gilbert, a senior executive at one of the nation’s largest occupational health providers, recently shared his perspective on these challenges in a recent conversation on the Forecasting Success Podcast: “The data shows from the AMA that there’s an access issue. They’re not graduating enough physicians. There’s not enough of them out there to treat,” Gilbert noted The President of the AMA recently sounded the alarm on this in a national address, and according to recent data from the Association of American Medical Colleges (AAMC), these shortages may be getting worse. According to the AAMC report, the U.S. faces a projected shortage of between 13,500 and 86,000 physicians within 12 years. This shortage may become particularly acute in workers’ compensation with the treatment of occupational injuries, where the system has traditionally been very physician-focused. The Texas Advantage Texas has proven particularly effective in addressing these challenges. Texas is unique in that it does not mandate employers to carry workers’ compensation insurance coverage. Instead, Texas employers have three options: Opt-in to Workers’ Compensation – Texas innovation and competition has created one of the best-performing workers’ compensation systems in America. Opt-in to QCARE – A responsible Texas injury benefit program that delivers better medical outcomes, improved benefits and cost savings, and meets 10 essential standards to earn the QCARE designation. Opt-Out – May not meet industry standards for the QCARE designation or provide any injury benefits. This freedom enables competitive innovation unique to Texas’ system, and has enabled it to become one of the most respected, high-performing programs in America. As Gilbert explains in his appearance on Forecasting Success, “We treat a ton of non-subscriber patients in Texas… We find our non-sub clients are really open to doing good things and allowing the doctor to practice medicine, but holding us accountable.” This balance of flexibility and accountability has enabled providers to maintain high standards, like those specified by the QCARE designation, while adapting to market realities. The Texas model offers several advantages in addressing these challenges: Treatment Flexibility: Injury benefit programs programs can adapt quickly to emerging solutions like telemedicine, particularly valuable for behavioral health services where access issues are acute. Market-Driven Innovation: Free market competition helps attract quality providers by removing unnecessary administrative burdens while maintaining high standards of care. Practical Solutions: The model allows for pragmatic approaches to using mid-level practitioners like nurse practitioners and physician assistants when appropriate, while ensuring physician oversight where needed. Gilbert notes that his company’s treatment model remains consistent whether treating patients covered under workers’ compensation or an injury benefit program, emphasizing that quality care is paramount in both systems. However the flexibility of Texas’ system can allow for more efficient delivery of that care. Looking Forward The solution to physician access challenges requires a multi-faceted approach. Texas’s model demonstrates how market-based solutions, regulatory flexibility, and innovative care delivery models can work together. As Gilbert notes, “Practically, what we’re seeing now in multiple states is that because of that, we’re getting delays in treatment… The discussion we had… was how do we open up our minds and thought process with the new world and the lack of access and our unique system in workers’ compensation?” Texas’s success in maintaining quality care while adapting to these challenges offers valuable lessons for other states. By allowing market competition based on reimbursement and removing unnecessary red tape, while maintaining appropriate oversight, Texas continues to lead the way in ensuring injured workers receive timely, quality care. As states continue to grapple with physician access challenges, Texas’s balanced approach offers a proven framework for maintaining quality while improving access to care. Through innovation, flexibility, and market-based solutions, Texas demonstrates that it’s possible to adapt to changing healthcare realities while ensuring injured workers receive the care they need.
Forecasting Success Podcast Episode 8: Greg Gilbert, Concentra Watch Now: Subscribe on the Following Platforms: Facebook Youtube Linkedin iTunes Spotify In this episode of Forecasting Success, host Ryan Brannan sits down with Greg Gilbert, Executive Vice President, Chief Reimbursement and Government Relations Officer with Concentra, a leader in occupational healthcare. Together, they discuss the complex world of healthcare operations, exploring Greg’s journey from health administration to overseeing reimbursement and contracting for over 500 centers across 43 states. Their conversation highlights the evolution of workers’ compensation systems, Texas’s unique framework, and the challenges of navigating multi-state regulations. Greg also shares insights into the role of AI in healthcare, particularly how Concentra uses predictive analytics to improve patient outcomes and operational efficiency. From navigating post-COVID advancements in machine learning to discussing the transition of Concentra into a standalone public entity, this episode is packed with valuable insights into the future of occupational healthcare. Latest episodes Episode 8: Transforming Healthcare with AI with Greg Gilbert, Concentra Watch Now » Episode 7: Recent SCOTUS Decisions & Texas Injury Benefit Programs: Unpacked w/ Richard Johnson, PartnerSource Watch Now » Episode 6: Brightening Futures for Children of Injured Workers with Hiawatha Franks, Kids’ Chance of Texas Watch Now » Episode 5: Transforming the TPA Industry: Insights from Michelle Villarreal Watch Now » Episode 4: Revolutionizing Workers’ Comp Education with Bob Wilson Watch Now » Episode 3: Navigating the Future of Non-Subscription Insurance with Joe Zopolsky Watch Now »
ERISA at 50: Revolutionizing Retirement Security and Texas Injury Benefit Programs ARAWC As the Employee Retirement Income Security Act of 1974 (ERISA) marks its 50th anniversary, the Association for Responsible Alternatives to Workers’ Compensation (ARAWC) celebrates this milestone by highlighting the act’s broad influence on both retirement security and injury benefit programs in Texas. Initially focused on improving retirement plan safeguards, ERISA now underpins a variety of benefit programs, including the innovative Texas injury benefit programs that provide a robust framework for protecting employees.Core Principles and the Evolution of Texas Injury Benefit ProgramsERISA was enacted to enhance transparency, ensure fiduciary responsibility, and uphold employer accountability across employee benefit plans. These principles have been crucial in guiding Texas injury benefit programs, which, while not falling under traditional workers’ compensation, benefit from the structured oversight that ERISA’s federal standards provide. These programs emphasize clear communication of benefits and responsibilities, ensuring that both employees and employers understand their rights and duties, akin to the disclosures required in retirement plans.Hybrid Regulation and the Role of QCARETexas injury benefit programs operate under a hybrid model that integrates state-specific laws with federal oversight, ensuring comprehensive protections that align with both local and national standards. The introduction of the QCARE (Qualified Compensation Alternative for Recovering Employees) designation enhances this framework. QCARE recognizes Texas employers who maintain high industry standards in their injury benefit programs, promoting transparency and care for employees. This designation not only boosts the credibility of employers, but also ensures that employee benefits are administered fairly and effectively under the umbrella of ERISA’s guidelines.Fiduciary Duties and Continuous ImprovementARAWC emphasizes the role of fiduciary duty in managing injury benefit programs, ensuring that administrators handle claims with diligence and transparency. This adherence to ERISA’s fiduciary rules has fostered trust and efficiency, crucial for the fair processing of injury claims. Enhancements in Texas injury benefit programs include improved fiduciary training and updated compliance measures with ERISA’s evolving standards, reflecting a commitment to continuous improvement and alignment with best practices.Forward-Looking: Innovation and Employee-Centric BenefitsAs ERISA continues to evolve, so too do the Texas injury benefit programs. Inspired by ERISA’s framework, these programs are progressively refining their practices to better serve both employers and employees. ARAWC’s dedication to leveraging ERISA principles aims to foster innovations that prioritize employee well-being and ensure that injury benefits remain effective and responsive to workers’ needs.Celebrating ERISA’s Legacy and Future ImpactCelebrating half a century of impact, ERISA remains a cornerstone of employee benefit protection, its principles shaping the landscape of both retirement and injury benefits. ARAWC remains committed to upholding these standards, ensuring that Texas injury benefit programs continue to offer robust protections that reflect the act’s enduring values of fairness, transparency, and accountability. Through designations like QCARE and the ongoing evolution of benefit structures, ERISA’s influence will undoubtedly continue to safeguard American workers’ rights and well-being in the years to come.
