What is Workers’ Compensation?
The “Workers’ Compensation” system was created with the intent to provide injured employees with the help they need to recover from injuries sustained on the job.
Managed by the state, this system was meant to be mutually beneficial, providing injured workers with medical care and a percentage of their lost wages while simultaneously protecting employers from personal injury lawsuits by injured employees.
However, the regulations for workers’ compensation vary state by state, and over the years legislative efforts in Texas as well as nationwide have complicated the system so that it is more difficult for injured people to obtain the compensation they are entitled to.
Workers’ Compensation in Texas – Subscriber vs. Non-Subscriber
In Texas, employers have the right to choose whether they subscribe to workers’ compensation insurance coverage for their employees.
If an employer carries workers’ compensation insurance, the employer is referred to as a “subscriber”.
If an employer does not carry workers’ compensation insurance, the employer is referred to as a “non-subscriber”.
If an employer carries workers’ compensation insurance (“subscriber”) and an employee is injured on the job, that employee must make his/her claim for benefits – medical care and loss of earnings – through the workers’ compensation system.
And although a claim is made, adequate medical care is not guaranteed. In fact, because of governmental changes spanning the last three decades, obtaining workers’ compensation benefits is a complicated process fraught with obstacles.
If a Texas employer does not carry workers’ compensation insurance (“non-subscriber”) and an employee is injured on the job, the injured employee must prove the employer’s negligence caused the injury in order to force the employer to pay for medical care, lost wages and other damages.
According to a recent Houston Chronicle article, 28% of companies in the state of Texas do not carry formal workers’ compensation insurance for their employees.
The remainder of this blog discusses claims made where the employer is a “subscriber”, meaning the employer did have formal workers’ compensation insurance coverage in place at the time of the employee’s injury.
Fewer Lawyers, Fewer Doctors
The number of doctors who are willing to treat injured workers under the current workers’ compensation system has been steadily dwindling. This is in part was due to legislative changes pushed by the insurance industry that happened in the 1990s.
As a result of the new laws, there is an abundance of hoops that treating doctors must jump through to treat workers’ compensation patients. According to Dr. Adam Bruggeman, an orthopedic surgeon out of San Antonio, dealing with the paperwork, technical stipulations, and general protocol with workers’ compensation patients is more complicated than that of a non-workers’ compensation patient.
It’s so cumbersome that many doctors avoid taking them on to avoid the hassle–in 2018, a mere 35% of doctors were taking on workers’ compensation patients, as opposed to 50% in 2005.
In addition, laws were passed that significantly limited the fees that lawyers representing injured people could be paid in cases involving workers’ compensation insurance, which disincentivized most lawyers to pursue workers’ comp cases on behalf of injured workers.
In sum, a lawyer who represents an injured worker under the current workers’ compensation system is limited by law in the amount that he/she can be paid for representing that worker. And the fee amount is so small that most lawyers cannot accept the case, which leaves injured workers to represent themselves all too often.
How Insurance Companies Play A Part
However, those aren’t the only obstacles that injured workers face. In 2012, the Supreme Court ruled in favor of insurance carriers, furthering their immunity to worker’s compensation-related lawsuits.
Under this ruling, the only way for an injured worker to contest the insurance company’s verdict is to go through the dispute resolution process, which can prove to be extremely time-consuming.
In the meantime, these people are at the mercy of insurance companies, and if their claim is denied, they become ensnared in a vicious cycle of being refused treatment, having to contest the denial with the insurance company for long periods of time, and then either receiving delayed treatment or never getting the medical assistance they require to heal at all.
Because of this, state reports indicate that the number of workers’ compensations claims made have dropped 12 percent from 2012 to 2018. While the Texas Division of Insurance says that better technology and safety awareness are what caused the drop, they admit that underreporting is a possibility as well.
The issues people face are so complex that many injured workers choose not to make a workers’ compensation claim at all.
Insurance companies can choose to deny doctor-appointed treatment to injured people, thus forcing them to go through a lengthy appeals process and in the meantime, postpone their treatment.
The lack of adequate, prompt medical care can cause more issues in the long run, thus worsening the workers’ injuries and repeating the cycle.
What About Health Insurance?
Due to these obstacles, in recent years many people have chosen to forego filing a workers’ compensation claim when hurt, instead seeking help via their insurance plans.
This situation is not ideal either.
If an injured worker tries to obtain medical care for an on the job injury using their health insurance, the health insurance carrier will usually deny the claim for benefits saying that insurance benefits should be provided through the workers’ compensation system.
And in Texas, once someone is entered into the workers’ compensation system, all treatments related to the injury are to be applied for through the system.
This puts patients in a vulnerable position—if their request for medical care under the workers’ compensation system is denied or delayed, they cannot double back and try to use their health insurance to fund treatment.
If you or someone you love has been injured in a work-related accident – whether or not the employer carried workers’ compensation insurance at the time of the injury – call The Callahan Law Firm at 713-224-9000 today to speak to one of our trusted Workplace Injury attorneys and get a free evaluation of your case.