Here's something that surprises most people opening a chiropractic practice in Texas: the state doesn't actually require you to carry malpractice insurance or workers' compensation. You read that right. Unlike many other states with strict insurance mandates, Texas takes a more hands-off approach. But before you celebrate those potential savings, understand this—just because the state doesn't require it doesn't mean you can skip it. The reality is more complicated, and going without the right coverage could put your entire practice at risk.
Whether you're just getting licensed or you've been practicing for years, understanding Texas's insurance landscape is crucial. This guide breaks down what the state requires, what you actually need to operate your practice, and how to protect yourself without overpaying.
Texas Licensing Requirements for Chiropractors
Before you can even think about insurance, you need your license from the Texas Board of Chiropractic Examiners (TBCE). The requirements are straightforward but rigorous: you'll need at least 90 semester hours of college coursework outside your Doctor of Chiropractic program, graduation from an approved DC degree program, and passing scores on Parts I, II, III, IV, and the Physiotherapy exams administered by the National Board of Chiropractic Examiners.
Your license expires every two years on the first day of your birth month. To renew, you'll need 32 hours of continuing education—16 hours per year. Here's what the state requires: 2 hours of ethics, 1 hour of record keeping/documentation/coding, 1 hour of risk management, plus 2 additional live hours. You can complete up to 10 hours through approved online courses. And as of September 2020, everyone needs a Health and Human Services Commission-approved course in human trafficking awareness. This doesn't count toward your 32-hour requirement, but you can't renew without it.
Professional Liability Insurance: Not Required, But Essential
This is where things get interesting. The Texas Board of Chiropractic Examiners doesn't require you to carry professional liability insurance to maintain your license. You could theoretically practice without it. But here's what actually happens in the real world: you can't participate in most insurance networks without malpractice coverage. Hospitals and healthcare facilities won't credential you. Many commercial landlords require proof of coverage before leasing office space. If you want to accept insurance from patients or work with any managed care organization, you'll need it.
Most malpractice policies for chiropractors offer coverage written as $1,000,000/$3,000,000—meaning $1 million per claim and $3 million aggregate for all claims during the policy period. This level of coverage has become the industry standard, and for good reason. A single malpractice claim can run into hundreds of thousands of dollars. Without insurance, that comes straight out of your pocket, and it could bankrupt your practice.
When you're shopping for malpractice coverage, look for policies that cover adjustments, soft tissue work, physiotherapy, and any other modalities you use in your practice. Make sure you understand whether you're getting claims-made or occurrence coverage—this affects when incidents need to happen and when claims need to be filed for coverage to apply.
Workers' Compensation: Texas's Opt-Out System
Texas is one of the only states where workers' compensation insurance is optional. If you don't have employees, this doesn't matter to you. But if you employ chiropractic assistants, massage therapists, or office staff, you need to make a deliberate choice here.
If you choose not to carry workers' comp, you must file DWC Form-005 with the Division of Workers' Compensation every year between February 1 and April 30. This notifies the state that you're a non-subscriber. You'll also need to report all workplace injuries or illnesses. Here's the catch: without workers' comp, you lose what's called the "exclusive remedy" protection. Normally, workers' comp is an employee's only option for workplace injuries—they can't sue you. But as a non-subscriber, employees can sue you directly in civil court if they're injured on the job. That's a significant liability exposure.
Many practices opt for workers' comp coverage even though it's not required. It protects employees from repetitive strain injuries (common in chiropractic offices), accidents involving equipment, and other workplace hazards. More importantly, it protects you from potentially devastating lawsuits. The peace of mind alone is often worth the premium.
General Liability and Property Insurance
General liability insurance covers third-party injuries and property damage at your practice. Think about a patient slipping in your waiting room, or someone claiming your marketing materials damaged their reputation. These aren't professional liability issues—they're general business risks. Texas doesn't mandate general liability insurance, but your commercial landlord almost certainly will. Most lease agreements require proof of coverage before you can move in.
The average cost for chiropractors is about $37 per month, or $446 annually. Most policies offer $1 million per occurrence and $2 million aggregate limits, with a $500 deductible. For slightly more—around $59 per month—you can get a Business Owner's Policy (BOP) that bundles general liability with commercial property insurance. This is usually the smarter play.
Commercial property insurance protects your physical assets—your adjustment tables, X-ray machines, computers, and office furniture. If there's a fire, theft, or vandalism, property insurance covers the cost to replace your equipment. Specialized chiropractic equipment isn't cheap, and replacing it all at once could cripple your practice financially. A BOP gives you both general liability and property coverage in one package, often at a lower price than buying them separately.
Getting Credentialed with Insurance Networks
If you want to accept insurance from patients, you'll need to become credentialed with various insurance companies and managed care networks. This process requires proof of your malpractice insurance—company name, policy numbers, expiration dates, coverage amounts. Most networks use the CAQH system for credentialing, and you'll need to keep your insurance information current in that system.
Some Health Care Networks (HCNs) in Texas may not allow chiropractors to serve as treating doctors for workers' compensation cases, even though state law permits it. Per Texas Insurance Code Section 1305.103, HCNs can determine which specialties may serve as treating doctors. This varies by network, so check with each one individually if you want to treat workers' comp patients.
How to Get Started with Your Coverage
Start by getting quotes from insurance carriers that specialize in healthcare and chiropractic practices. Look for bundled policies that can save you money. At minimum, you'll want professional liability insurance and general liability coverage. If you have employees, seriously consider workers' compensation even though it's optional—the liability protection is worth it.
Review your coverage annually. As your practice grows, your insurance needs will change. You might add new services, hire more staff, or expand to a larger location. Make sure your coverage keeps pace with your growth. And don't forget about your continuing education requirement—that 1 hour of risk management might give you insights on reducing your insurance costs while maintaining proper protection.
Texas gives you flexibility when it comes to insurance requirements, but that freedom comes with responsibility. The state won't force you to buy coverage, but the market will. Protect your practice, protect your patients, and protect yourself with the right insurance package for your needs.
