Texas Fights over State-Created Firm, Texas Mutual Insurance Company

              In 1991, Texas employers sought policy writers to create polices covering employees injured on the job. To fuel this need, the Texas legislature created the Texas Workers’ Compensation Insurance Fund, the largest writer of workers’ compensation insurance. In 2001, the state changed the fund's name to Texas Mutual Insurance Company (TMIC) but maintained the same goal: to stabilize the state’s workers’ compensation system. Since its creation, TMIC has accomplished just that, consuming 40% of Texas’s workers’ compensation insurance market. Today, TMIC insures over 60,000 employers and their 1.4 million employees. Despite its success, TMIC recently announced its desire to cut ties with the state. The purpose of this blog is to explain some of the pros and cons associated with converting the state fund into a private company.  

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TX DWC Announces September Workers' Compensation Violations

         On October 20, 2014, Texas's Division of Workers’ Compensation (DWC) announced final disciplinary actions against insurance carriers, health care providers, and employers for violating the state's workers' compensation laws. Division of Workers' Compensation Announces Recent Enforcement Action, Tex. Dep’t Ins. (Oct. 20, 2014), available at http://www.tdi.texas.gov/news/2014/dwc---10---20.html.

           Since January 1, 2014, administrative penalties for these violations total $1,774,345, including $1,658,245 against insurance carriers, $65,600 against health care providers, and $1,000 against employers.

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Texas Injury Statistics by Race Go Uncollected

Access the NY Times article here: http://www.nytimes.com/2014/10/10/us/injury-statistics-by-race-go-uncollected.html?_r=0

Calling all Frackcident Victims: The Economic Benefits of Fracking do not Justify your Injuries

                                          

               According to a recent study performed by Associated Press, traffic fatalities in drilling states, including Texas, have more than quadrupled since 2004. But wait . . . hasn’t the energy boom positively impacted our country? The increased production of oil and natural gas creates job, lifts local economies, and attracts manufacturers to the United States. However, our nation’s booming economy comes with a price—a spike in traffic facilities. Large trucks and heaving drilling equipment consume the streets of Texas drilling counties, increasing traffic fatalities by 18%. 

 

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$97 Million in Workers' Comp Fraud: 2012's Top Cases

               Workers’ compensation fraud occurs when individuals intentionally make false representations to obtain or to deny workers’ comp benefits, which reimburse employees injured on the job.

             Individuals committing workers’ comp fraud carry many faces—employees, employers, and healthcare providers all qualify as potential violators. Employees become violators when seeking benefits by misrepresenting their injuries, employment status, or treatment. Alternatively, employers commit workers comp fraud not to receive benefits, but to avoid responsibility. Employers often seek to avoid responsibility by underreporting employee payrolls and avoiding premiums. Last, health care providers, such as doctors, counselors, and pharmacists, become violators by duplicating bills, billing patients for improper services, and receiving payments from multiple insurance carriers for the same treatment.

2012’s Top 10 Cases

             In 2012, the top ten workers’ comp fraud cases cost America $97,446,500. Below is a short description of each case and its damages:

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Workers' Compensation: Are you Covered?

            Workers’ compensation is a state-regulated insurance program that pays medical expenses and lost wages of employees who are injured at work or suffer from work-related illnesses. Workers’ compensation cases are treated on a case-by-case basis, which means that employees are treated differently based on the nature and severity of their injuries.

              In Texas, the agency responsible for regulating the state’s workers’ compensation system is the Texas Department of Insurance (TDI). Within the TDI exists a smaller division, which carries the sole responsibility of processing and monitoring workers’ compensation claims, called the Division of Workers’ Compensation (DWC).

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Texas Court of Appeals Affirms Injured Employee's LIBS

             A work-related accident can result in a lifelong injury. It can also leave you drowning in medical bills, lost income, and uncertainty about your future. Injured employees facing this situation are not alone—workers’ compensation attorneys will answer your questions and fight to obtain the benefits you deserve.

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Texas Workers Killed on the Job at an Alarming Rate

 On average, a Texas worker is 12 percent more likely to be killed on the job than someone doing the same job elsewhere, according to a Dallas Morning News analysis of federal data. That translates to about 580 excess workplace deaths over a decade. Construction has contributed mightily to Texas’ booming economy. And the state’s construction sites are 22 percent deadlier than the national average. Government and industry here have invested relatively little in safety equipment, training and inspections, researchers say. And Texas is one of the toughest places to organize unions, which can promote safety. 

Fighting Back Against the Privatization of Justice

 President Obama has recently issued an executive order that is being hailed as "the most important workers' rights reform of the last 20 years." Additionally, it is a beginning step at curbing the abuses of arbitration clauses. We still have a long way to go in this country, but these steps create ripples...

Click the link below for more info:

goo.gl/B78Lmr

The Presumption of Intoxication, continued.

 In a previous post, I gave an overview of the problem with the state of the intoxication defense in workers' compensation law in Texas--that it prevents people from recovery, even when their injury had nothing to do with testing positive for drugs. Again, I want to stress that everyone wants to maintain a drug free workplace.  I have lost two family members in incidents caused by a drunk driver -- a cousin and an uncle -- in separate  events. So, I tend to take a hard view towards injuries caused by intoxication. But that doesn't mean I think insurance carriers should be excused from covering injuries that they have legally contracted to cover. 

Currently, the Division of Workers' Compensation takes the position that the rebuttable presumption shifts the burden of proof in a workers compensation case. This is contrary to the law of rebuttable presumptions found in virtually every other legal context. In fact, it is contrary to the law as set forth by the Texas Supreme Court.

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Filing Suit Against the DWC

I haven't been able to update my blog because I had been sent a cease and desist letter from the DWC informing me that I was in violation of Texas Labor Code Section 419.002(a) because I had used the words "Texas Workers' Comp" in this blog's URL.

Well, today my lawyer filed suit against the DWC in federal court. You can view my petition here:

 

Petition Against DWC

 

I'll keep people posted on the progress as the case develops. 

The Presumption of Intoxication

Recently, I won a workers compensation jury trial on whether or not my client was intoxicated at the time of his injury. Intoxication cases are extremely difficult to win due to both the definition of intoxication and the way that the Division of Workers Compensation decides intoxication cases. There is a strong public policy in favor of maintaining a drug free workplace. However, the Texas Constitution guarantees all persons the right to seek legal remedies for injuries that were not their fault. This is the first of a few posts I plan on making which point out that in our rush to crack down on drugs, the Division and even the courts of the State of Texas have failed to follow the law.

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Injuries While Traveling To and From Work

Well, this blog has gone neglected for quite a while. Not by choice, but due to my health. A few months ago, I was driving to a continuing education seminar roughly five hours away. I was running late and so I never stopped for a snack or a beverage. Shortly after I arrived at the seminar, I noticed I had developed a minor cough. In the following weeks, that cough turned more serious and culminated in my being hospitalized for a week in critical condition with blood clots that nearly killed me. I am still on blood thinners which affect my energy level, but its time to have enough energy to work on this blog. And what better subject that to discuss the compensability of injuries occurring while driving to and from someplace for work. Yesterday, the Texas Supreme Court addressed this very issue in the case of Leordeanu vs. American Protection Insurance Company, 2010 WL 4910133. 

 

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Tex Supreme Court Refuses to Overturn Stop Loss Ruling

For the attorneys that follow this blog, in a decision that should surprise no one, the Texas Supreme Court refused to review the decision in Texas Mutual Insurance Co. vs. Vista Community Medical Center, LLP. Practitioners will recall that this is the Austin Court of Appeals decision from 2008 that invalidated the stop-loss exception.

Hospitals that treat workers' compensation patients in Texas are reimbursed under the state's workers' compensation in-patient fee schedule.The 1997 fee schedule, which was repealed in 2008, included a stop-loss exception. Under the stop-loss exception, hospitals could be paid more than the fee schedule if they met certain criteria. The dispute between Texas Mutual and Vista centered on those criteria. Texas Mutual argued that the stop-loss exception should be applied to admissions involving charges of more than $40,000 and "unusually extensive services." Vista countered that the exception applied to all admissions for which they charged more than $40,000.

The stop-loss rule has since been repealed. However, many fee disputes remained outstanding under the old rule.

Illegal Immigration and Workers Compensation

With all the discussion over Arizona's tough stance on undocumented aliens, a renewed interest has been undertaken regarding Texas' stance on these aliens in a workers' compensation context.

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