As a Texas Work Injury lawyer, these are the Top 3 Coverage Circumstances we see!
- Workers’ Compensation: Your work injury is covered by Texas Workers’ Compensation Insurance!
- Texas Non-subscribers: Your work injuries are covered by an ERISA benefit plan and your employer is a Workers’ Compensation non-subscriber!
- Self-Insured: Your employer is self-insured.
Arguably, there is a fourth situation that you could find yourself in and that’s when a work injury occurs and the employer does not have any coverage at all and is not financially stable enough to pay any work injury claims brought by injured Texas workers. These are very unfortunate circumstances.
Read also: Why Don’t Employers Emphasize the Coverage Available for Injured Workers in Texas?
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Non-Subscriber claims in Houston, Dallas, Austin, Corpus Christi, San Antonio and The Rio Grande Valley.
Which One Best Describes Your Work Injury Situation or Experience?
Texas Workers’ Compensation
Injured workers covered by Texas Workers’ compensation are not able to pursue any claims outside of the workers’ compensation program. If an injured worker can verify that the employer has workers’ compensation coverage, then they will need to navigate the rules of the Texas workers’ compensation program. You do not have a right to sue your employer for employer negligence in this program. Injured workers cannot make personal injury claims for physical and mental suffering, disfigurement, and other claims. They will need to do everything they can to fight for the rights that the program makes available to them. Sandoval Law Firm does not handle traditional workers’ compensation claims.
Injured workers are able to receive medical and wage benefits pursuant to an ERISA employer benefit plan. On paper, the PLAN sets out to provide these benefits to employees that are injured on the job. It is our experience that the PLAN also prioritized saving money for the employer. That said, many times doctors are unable to provide the treatment that they believe would best help the injured worker recover faster. The doctors are often instructed to return employees to work with restrictions but, that they should not pull an employee completely off of work thereby, preventing the PLAN from having to pay the injured work for being at home and recovering from an injury. In a sense, the medical and wage treatment is limited and often leads to an Adverse Benefit Determination which is just a fancy way of saying that the claim has been denied. If the claim has been denied, you do have a right to file a lawsuit against your employer if you can prove your injury was caused by the negligence of your employer. Many employees opt to file a lawsuit against their employers after a claim denial because they never fully recovered from their injuries and feel that the injury would not have happened if the employer had just provided a safe place to work. Sandoval Law Firm handles Texas non-subscriber claims.
Self-Insured Companies (Railroad FELA Claims)
There are some large companies like railroads that do not pay an insurance company to administer or pay work injury claims made against them. They typically have sufficient revenue to set aside a fund to pay injured workers every year. Essentially, these employers can also be seen as non-subscribers because they do not carry workers’ compensation but, they also do not have a ERISA plan. Again, in this situation you can file a lawsuit against a self-inured employer if you can show that your injury resulted from employer negligence. Sandoval Law Firm handles FELA claims. Read also: Why Some Large Companies in Texas Choose Not to Pay an Insurance Company to Administer Work Injury Claims Made Against Them?
Why Is Getting Help After a Texas Work Injury So Complicated?
Explaining the coverage available for injured workers is not something that employers emphasize. The primary responsibility for taking care of you injuries following a work incident is going to fall on you, the injured worker. After suffering a work injury, you have to do your research and find out which coverage your employer has, if any. Starting with coverage will give you an idea of what you can expect. Learn more about Why Is Getting Help After a Texas Work Injury So Complicated?
At Sandoval Law Firm, PLLC, as your attorney, we believe that an attorney-client relationship is built on trust and confidence, and I take this very seriously. If you’ve been injured at work working for a non-subscriber or a self-insured company, do your research!
Read also: Not Your Typical Texas Workers’ Compensation Case
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