Opening an optometry practice in Texas comes with a lot of decisions—where to locate, what equipment to buy, how to market your services. But before you hang your shingle, you need to understand the insurance requirements that keep your practice legal and protected. The good news? Texas has some unique rules that give you more flexibility than most states. The not-so-good news? That flexibility means you need to make smart choices, because the wrong coverage decision could leave you vulnerable.
Let's break down exactly what insurance you're required to have as a Texas optometrist, what's optional but highly recommended, and how much you can expect to pay.
The One Insurance You Absolutely Must Have: Professional Liability
In Texas, there's only one type of insurance that the state legally requires you to carry: professional liability insurance, also known as malpractice insurance. This isn't negotiable. The Texas Optometry Board mandates minimum coverage of $200,000 per claim, with a total limit of $600,000 for all claims in a year.
Here's what professional liability insurance actually does: it covers legal fees and damages if a patient sues you for negligence or harm caused by your treatment. Maybe you missed a diagnosis that another optometrist would have caught. Maybe a patient claims your contact lens prescription damaged their cornea. These situations happen, even to careful practitioners, and without malpractice insurance, you'd be paying out of pocket for lawyers and potential settlements.
The good news is that professional liability insurance for optometrists is relatively affordable compared to other medical specialties. Most Texas optometrists pay between $500 and $700 annually for coverage. That's less than $60 per month to protect yourself from potentially devastating lawsuits. The Texas Optometry Board tracks your malpractice insurance as part of your licensing primary source information, so maintaining continuous coverage is essential for license renewal.
The Workers' Compensation Question: Texas Is Different
If you're hiring staff for your optometry practice—receptionists, opticians, technicians—you need to understand Texas's unique approach to workers' compensation insurance. Texas is the only state in the country where private employers can choose whether or not to carry workers' comp coverage. That means you're not legally required to buy it for your employees.
But before you celebrate saving money, understand what you're giving up. Workers' compensation insurance covers medical expenses and lost wages for employees who get injured on the job. If your optical technician slips on a wet floor and breaks their wrist, workers' comp pays for their emergency room visit, follow-up care, and time off work. Without it, your employee can sue you directly for those costs—and unlike workers' comp claims, lawsuits can include pain and suffering damages.
If you decide to operate as a "nonsubscriber" (Texas's term for employers without workers' comp), you must follow specific rules. You have to file an annual notice with the Texas Department of Insurance by the end of April each year. You must give written notice to new employees when you hire them, informing them that you don't carry coverage. And you must post a Notice of No Coverage to Employees in a prominent location in your office. Failing to post these notices can result in administrative fines.
Here's the risk: if you're sued by an injured employee and you don't have workers' comp, you lose the legal defenses that normally protect employers. You can't argue that the employee's negligence caused the injury, that another employee was responsible, or that the injured employee knew about the danger. For most optometry practices, the cost of coverage—averaging around $638 annually, or $53 per month—is worth the protection. That's a small price to avoid a potentially six-figure lawsuit.
Important exception: If your optometry practice works on government contracts, workers' compensation becomes mandatory. Any employee working on a government project must be covered.
General Liability Insurance: Not Required, But Essential
General liability insurance isn't mandated by Texas law, but here's the thing: you probably can't operate without it anyway. Most commercial landlords require proof of general liability coverage before they'll rent you office space. And if you're seeking financing or business loans, lenders typically want to see you have this protection in place.
General liability covers bodily injury or property damage that occurs on your business premises. A patient trips over your waiting room rug and breaks their ankle. A delivery person damages their truck on your parking lot. A patient claims your advertisement contained false information. These scenarios aren't covered by professional liability insurance—they fall under general liability.
The coverage also includes claims of wrongful eviction, libel, slander, false arrest, and malicious prosecution. Optometrists pay an average of $42 per month, or about $500 annually, for general liability insurance. That's comparable to what you'd pay for professional liability, and for practices with patient foot traffic, it's money well spent.
Additional Coverage to Consider for Your Practice
Beyond the required professional liability and the strongly recommended workers' comp and general liability, several other insurance types make sense for optometry practices in Texas.
Property insurance protects your physical assets—the expensive diagnostic equipment, your inventory of frames and lenses, your furniture and computers. A fire, tornado, or theft could cost hundreds of thousands of dollars to recover from without coverage. If you're leasing equipment, your lease agreement probably requires you to insure it.
Cyber liability insurance has become increasingly important as optometry practices store patient records electronically and process credit card payments. A data breach exposing patient health information could trigger HIPAA violations, regulatory fines, and lawsuits. Cyber liability covers the costs of notifying affected patients, providing credit monitoring, legal defense, and regulatory penalties.
Business interruption insurance pays for lost income if you have to temporarily close your practice due to a covered event. If a fire damages your office and you need to close for two months while repairs are completed, this coverage replaces the income you would have earned during that time. It can also cover the cost of operating from a temporary location.
Staying Compliant with Texas Licensing Requirements
The Texas Optometry Board tracks your professional liability insurance as part of your licensing records. When you renew your license every two years, the Board verifies that you maintain continuous malpractice coverage. Your license expires on December 31 of your renewal year—approximately half of Texas optometry licenses expire in even years, and the other half in odd years.
Practicing with an expired license is considered the same as practicing without a license—a serious violation. Make sure you complete the required 32 hours of continuing education and maintain your insurance coverage to avoid any gaps. The Board maintains primary source information on all licensees, including specialty certifications, postgraduate training, residency completion, and your malpractice insurance status.
How to Get the Coverage You Need
Start by getting quotes for professional liability insurance from carriers that specialize in optometry coverage. Organizations like the American Optometric Association offer insurance programs designed specifically for optometrists, often at competitive group rates. Compare coverage limits, deductibles, and whether the policy is claims-made or occurrence-based.
If you have employees or plan to hire them, seriously consider workers' compensation insurance despite it being optional in Texas. The modest annual cost provides significant protection against employee lawsuits and demonstrates that you value your team's safety. Many carriers offer business owner's policies (BOPs) that bundle general liability, property insurance, and business interruption coverage at a discount compared to buying each separately.
Review your coverage annually. As your practice grows, you may need higher limits or additional types of protection. Keep copies of all insurance certificates and policy documents in a secure location, and provide proof of coverage to the Texas Optometry Board, your landlord, and any other parties who require it. Running an optometry practice in Texas gives you flexibility in how you structure your insurance, but that flexibility requires making informed decisions. Focus on the required professional liability coverage first, then build out the additional protections that make sense for your specific practice and risk tolerance.
