Data Shows Texas Employers Shift Costs of Workplace Injuries Onto Workers, the Public


A peer-reviewed article in the newest New Solutions journal highlights the extreme medical costs of severe work-related injuries that Texas employers have shifted onto workers, the public and other payers in Texas. The article unearths over $132 million in hospitalization costs for work-related injuries that were not covered by workers’ comp system. This is just the tip of the iceberg – an iceberg that economist Paul Leigh has estimated nationally to be $197.91 billion. While Texas uniquely allows employers to “opt-out” of the state’s workers’ compensation system, the article stresses, fear of retaliation is also a factor that contributes to workers not filing for workers’ compensation claims and the cost-shifting found in the report. 

The article, entitled “Uninsured have more severe hospitalizations: examining the Texas workers’ compensation system”, is a collaboration between NESRI’s Senior Research Strategist, Brittany Scott, Workers’ Defense Project researcher, Bethany Boggess, and University of Texas School of Public Health Professor, Lisa Pompeii. 


Texas’ unique elective system of workers’ compensation (WC) coverage is being discussed widely in the United States as a possible model to be adopted by other states. Texas is the only state that does not mandate that employers provide statecertified WC insurance. Oklahoma passed legislation for a similar system in 2013, but it was declared unconstitutional by the Oklahoma Supreme Court in 2016. This study examined 9523 work-related hospitalizations that occurred in Texas in 2012 using Texas Department of State Health Services data. We sought to examine workrelated injury characteristics by insurance source. An unexpected finding was that among those with WC, 44.6% of the hospitalizations were not recorded as work related by hospital staff. These unrecorded cases had 1.9 (1.6–2.2) times higher prevalence of a severe risk of mortality compared to WC cases that were recorded as work related. Uninsured and publicly insured workers also had a higher prevalence of severe mortality risk. The hospital charges for one year were $615.2 million, including at least $102.8 million paid by sources other than WC, and with $29.6 million that was paid for by injured workers or by taxpayers. There is an urgent need for more research to examine how the Texas WC system affects injured workers.

Additional Resources

Uninsured data on Texas workers comp