Texas Workers' Comp Insurance for Home Health Care Agencies

Texas is the only state where workers' compensation coverage is optional for most private employers. A business that chooses not to carry it is called a non-subscriber, and there is no employee-count threshold that forces coverage for most private employers. The major exception is government building and construction contracts: a governmental entity's construction contract generally must require the contractor, and its subcontractors, to maintain workers' compensation coverage for the duration of the work. See the Texas Department of Insurance, Division of Workers' Compensation's employer guidance.

Common codes for this work include 8835 Home Health Care Services; 8810 Clerical Office Employees; 8842 Group Homes. Texas uses NCCI class codes, so the codes below are the ones carriers typically assign to this work in Texas.

Because coverage itself is optional, Texas doesn't have the same automatic-inclusion rules other states use for owners; a subscribing employer's sole proprietor, partner, LLC member, or corporate officer generally needs to be specifically included on the policy to be covered, similar to an employee election in other states, and coverage details should be confirmed with the carrier. Non-subscribing owners take on the same civil-liability exposure described below for any workplace injury, including their own employees' claims.

Because coverage is optional for most private employers, there's no direct penalty simply for choosing not to subscribe. Instead, a non-subscribing employer loses key common-law defenses (such as contributory negligence, assumption of risk, and the fellow-servant rule) in a lawsuit brought by an injured employee, which significantly increases the employer's exposure to an uncapped jury verdict rather than a scheduled workers' comp benefit. Non-subscribers must give written notice to new hires about their non-covered status, and non-subscribers with five or more non-exempt employees must report qualifying injuries, illnesses, and fatalities to the Division on DWC Form-007 by the seventh day of the following month; failing to file that report or provide required notices can itself bring penalties.

Price is driven by payroll in each class code, the Texas rates filed for those codes, your claims history (experience modification), and underwriting factors such as split between field caregiving staff and office-based scheduling and administrative staff; level of care provided, from companionship to hands-on nursing care; whether the agency also operates a group home or residential setting. We compare carriers so you can see what you qualify for.

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No — home, public, and traveling healthcare has its own classification built around care delivered outside a fixed facility, which reflects the different exposure of working alone in a client's home versus a controlled clinical setting.

It can — group-home operations are typically rated under a related residential-care classification separate from staff who make one-on-one home visits, since supervising a residential setting carries different exposure.

Most home health aides performing regular, supervised caregiving work are properly classified as employees; misclassifying them as independent contractors to avoid workers' comp is a common audit finding that can result in back premium and penalties.

No, not in most cases. Texas is the only state where coverage is optional for most private employers; a business that opts out is called a non-subscriber.

A non-subscribing employer loses several standard legal defenses and can be sued directly by an injured employee for an uncapped jury award, instead of paying a scheduled workers' comp benefit.