ERISA (Employee Retirement Income and Security Act of 1974) is the federal law that allows Texas Employers to provide coverage to injured workers under a WELFARE PLAN. In a nutshell, instead of providing injured workers coverage for medical benefits and lost pay under Texas Workers’ Compensation Laws, Texas Employers that adopt ERISA Welfare Benefit Plans provide coverage to injured workers under ERISA and not Texas Worker’s Compensation programs. TEXAS EMPLOYERS THAT PROVIDED INJURY COVERAGE TO EMPLOYEES UNDER AN ERISA PLAN ARE KNOWN AS TEXAS NON-SUBSCRIBERS. If an injured worker is being provided benefits under an ERISA plan, they may be dealing with the following problems:
- Denied Benefits because the incident wasn’t reported within 24 hours or as the PLAN requires;
- Difficulty getting the Employer to file a report and get the claim process going;
- Denial of immediate medical care;
- Treatment and doctor’s visits that are not properly addressing the injury;
- Delay in issuing your 75% or 80% supplemental pay while out of work;
- Harassment by other employees and company managers or supervisors;
- Difficulty with communicating with insurance adjusters, and
- Several More!
Either when you first hire on with the non-subscriber company or, when the company first adopts an ERISA Plan, employees are generally provided a shorter version of the official Employment Benefit Plan. The “Plan” provides the details of coverage and the benefits provided to injured workers for the company. The short version of the Plan provided to employees is referred to as the Summary Plan Description (SPD). Although it is the intention that this SPD provide a true summary of coverage and the claim filing process, if there is a conflict in the explanation in the version provided to the employee and the official Plan that the employer has, the language and details in the Plan will trump any explanation found the Summary Plan Description provided to the employee. Moral of the story, as an injured employee working for a Texas Non-Subscriber, you can’t rely on the Summary Plan Description to determine what benefits you are entitled to. That’s why you need a Texas Non-subscriber work injury attorney!
If you are inured on the job working for an employer that provides coverage under an ERISA plan, it’s important that the first action you take is to report the incident to a supervisor! There are several reasons why you MUST REPORT YOUR INJURY IMMEDIATELY following a work injury but, one of the most important reasons is to buy you some time to find out the details of the coverage that your non-subscriber employer has under the ERISA plan.
As your work injury lawyer, my first step would be to find out the details of the coverage provided under your Employer’s ERISA Plan. As an injured worker, the first and most important step is to report the injury. There is no benefit for an injured worker at all when you delay reporting. Therefore, I cannot say it enough, no matter how minor you think your injury could be, report, Report, and REPORT THE IN INCIDENT IMMEDIATELY!
If you’ve been injured working for a Texas Non-Subscriber, you need to know what coverage is provided under the Employer’s ERISA EMPLOYMENT BENEFIT PLAN. The Plan itself tells you that you cannot rely on the Summary Plan Description! The longer you wait, the harder it will be on you and your family down the road as you face muddy waters created by your employer’s legal team.
When you are ready to discuss your work injury case, call Texas Work Injury Attorney Hector L. Sandoval at (346) 347-7777 or visit us on the web at https://sandovalpllc.com/. Call and put Sandoval to work for you!