Is My Employer a Non-Subscriber?
Texas employers that have chosen to go outside of Texas Workers’ Compensation and have adopted a work injury benefit program under ERISA are commonly referred to as Texas Non-Subscribers. There are several non-subscriber employers in Texas and, therefore, if you get injured on the job, a good starting point for you is to figure out whether your claim is a Workers’ Comp claim or a Non-Subscriber claim. You can easily find out if your employer has Worker’s Comp coverage by going to the Texas Department of Insurance-Division of Workers Compensation website. If your employer does not show up as having workers’ compensation coverage, it’s very possible that they are a non-subscriber. As a general rule of thumb, if you work for a major retailer or grocery store, there’s a good chance that your employer is a nonsubscriber.
In workers compensation claims, you cannot sue your employer for the negligence that caused your injuries. You exclusive remedy is to file your claim with the division of workers’ compensation and fight for your medical and wage benefits. Your employer is protected from being sued.
Reporting the Injury
In nonsubscriber cases, your employer has waived the protection against being sued by going outside of the worker’s compensation program. Although non-subscribers have work injury benefit program that seemingly provided medical and wage benefits, the claim process mirrors that of a litigation risk management program. Although you can now sue your employer in non-subscriber cases, you can only do so if you can establish that your injury was caused by some the negligence of your employer in failing to provide a safe workplace. Determining whether there is negligence in your case requires some very careful review. After an injury, non-subscriber employers typically refer the injured worker to the work injury insurance representatives. The employee calls in, reports the injury, and is asked to provide a statement before that employee is referred to a clinic or hospital for medical treatment. The statement is the insurance company’s first crack at determining if they could be on the hook for causing an injury.
Should I speak to the adjuster? They want my statement!
My recommendation is that you should only talk to the adjuster about the details of how you were injured when you are prepared to defend yourself against questions about what caused the injury. This may require that you speak with a work injury lawyer as soon as you can! Once the insurance company takes an injured worker’s statement, they can review the worker’s account of how the incident occurred and develop a strategy for how your claim will be disposed of. Although the statement is presented to the injured worker as necessary to receive benefits, it really has a bigger role in determining whether the company’s insurance really needs to pay anything on your claim. If, from the statement, the insurance company can conclude that the company did nothing wrong or wasn’t negligent, the injured worker could find themselves having their claim denied very early in the process. The denial will not state that the reason has anything to do with liability but, it certainly does! The denial is usually based on an opinion from one of company’s doctors!
If receiving benefits under the employers’ work injury plan had no connection to whether the company was negligent or not (Liability), then why do adjusters ask the following questions:
- Is there something that could have been differently to avoid your injury?
- Were you just doing your regular assigned duties when you were injured?
- What shoes were you wearing at the time?
- Do you feel like you were properly trained to do your job?
- Do you feel like working at this company is safe?
The nonsubscriber work injury program is all about saving money, managing risks and finding a way to complicate a good work injury case for an injured worker. Once you suffer an injury at work, no matter how nice anyone is, you have to be ready to battle your employer and their insurance because no one is going to watch out for your best interests but you!
If you’ve been injured at work accident (non-subscriber), do your research! We’re here to help injured Texans with their personal injury case. Call and speak directly with me, Texas Non-Subscriber Injury Attorney Hector L. Sandoval at (346) 347-7777 or visit us on the web at https://sandovalpllc.com/ to set up a free personal injury phone, virtual or in-person consultation!