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Texas Department of Insurance
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Snapshot: 2024 Biennial Report to the 89th Texas Legislature

This report presents system trends that allow the Division of Workers’ Compensation, policymakers, and system stakeholders to gauge the relative health of the Texas workers’ compensation system and consider whether additional legislative changes are necessary.

Read the full report

Published: November 2024 by the Division of Workers' Compensation.

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Workers’ compensation insurance has become increasingly more affordable. Since 2003, workers’ compensation insurance rates have dropped 81%.

In 2023, the projected accident year combined ratio for workers' compensation in Texas was 94%. This means that for every dollar an insurance company collects, it pays an estimated 94 cents to cover losses and expenses and keeps the remainder as profit (Figure 1). Insurance companies writing workers’ compensation in Texas averaged a 9.9% return on net worth over the last decade, similar to the national average of 9.7%.

Projected ultimate calendar year/accident year loss and combined ratios

Texas allows private-sector employers to forgo buying workers’ compensation insurance, making them “non-subscribers” to the state system. Non-subscribers lose the protection of statutory limits on liability and may be sued by their employees who are injured on the job.

In 2024, the percentage of employers that were non-subscribers was the lowest since 2016, at 24% (Figure 3). The percentage of Texas employees working for non-subscribers was the lowest in a decade at 13%.

Percentages of Texas private-sector employers that are non-subscribers and Texas employees that are employed by non-subscribers

The total number of physicians actively practicing in Texas increased at an annual rate of 2.6% between 2017 and 2022. The total number of workers’ compensation participating physicians remained relatively stable in 2022 (17,659), resulting in a decreasing participation rate. Generally, the workers’ compensation participating physician retention rate remains high and relatively stable at 79% in 2017 and 76% in 2022.

The timeliness of medical care for Texas workers’ compensation claims also maintained a stable rate. In 2022, 82% of claims received initial non-emergency care in seven days or less. The share of claims receiving same-day treatment decreased 3% from 2017 to 2022 (from 44% down to 41%), with a slight dip during the COVID-19 pandemic.

Total health care costs in the Texas workers’ compensation system are down 30%, dropping from $1.15 billion in 2012 to $812 million in 2022. A contributing factor in this was a decrease in the total number of claims by 20%, from 319,000 to 256,000.

Notably, the total cost of pharmacy services decreased significantly by 71% from 2012 to 2022, with the average cost per pharmacy claim decreasing 38%, from $908 in 2012 to $563 in 2022.

In addition to decreasing costs, there has also been a considerable decline in the number of prescriptions. The total number of prescriptions decreased 73% from 2009 to 2022, and the total number of opioid prescriptions during that period dramatically declined 86%, from 555,000 to 78,000.
Last updated: 11/22/2024