Take a look at this link from Houston’s ABC affiliate, KTRK’s investigative report. A police officer shot in the line of duty and years later he cannot get medical care. It is sensational because it is a police officer who is fighting to get medical care approved but his experience is no different than workers in any other field. The Texas Workers Compensation system was passed by a legislature that promised lifetime medical care but as anyone who has ever dealt with workers compensation in Texas knows, lifetime medical care is a farce. The Insurance industry is simply not set up to provide lifetime medical care to claimants.

courtesy of KTRK TV

Continue Reading Lifetime Medical Coverage is a Sham

I got drug tested after I got hurt and tested positive. What do I do now?

If you test positive for drugs or alcohol after getting hurt at work, the insurance company does not have to pay you any worker’s compensation benefits. You have to prove that you were sober at the time of your injury. You have to prove that you had, in legal terms, the normal use of your mental and physical faculties at the time that you got hurt.

One way you do it is by getting witness statements. You’ll have to get coworkers to write statements or they will agree to appear for you at a hearing and testify you were sober at the time you were injured. You’ll have to have some type of a drug or alcohol expert testify as whether or not that was a legitimate drug test and whether or not the numbers truly reflected whether or not you were impaired at the time of the injury. Those types of cases are cases that are highly specialized. You do not want to handle one of those types of cases alone.

You need to talk to a lawyer immediately if you get a letter from the insurance company saying they’ve denied your claim because you tested positive for any type of illegal substance.

How does workers comp affect my health insurance?

When you’re injured on the job and your employer provides health insurance, oftentimes people are worried what happens if I lose my job, how’s that going to affect my health insurance? If you’re injured on the job and your employer provides health insurance and you’re worried about losing your job, your employer has to continue paying for your health insurance premiums.

If your employer decides to quit paying your health insurance, then your employer has to give you notice of that. They have to increase the amount of worker’s comp benefits they pay you, such that you then are allowed to pay your health insurance premiums privately out of the increase of worker’s comp benefits that you get. One of the things that happens though is, no one tells you that they’ve cut off your health insurance.

That’s why it’s important to have a lawyer because one of the things that we do is we audit that and we make sure that you do get every single last dime you’re entitled to, so that way you can pay those health insurance premiums if they cut off your health insurance.

I was in a car wreck while on the job. Is it better to have a workers comp lawyer handle everything?

When someone’s in a car wreck, that happens while they’re also working on the job, one of the things they’re concerned about is, do I need to get two lawyers? One lawyer to handle the car wreck and one lawyer to handle the worker’s comp part of the case. When you have a lawyer who knows how to do both car wrecks and workers comp, then that lawyer has the skills in both areas in order to handle the case properly, and that’s important because those cases will overlap.

There are important legal concepts with workers comp that can affect the outcome of that personal injury case, and they’re important concepts with a personal injury case that can affect the workers comp case. If you have a case that involves some outside third party, and it’s always important to get a lawyer who is knowledgeable and experienced and skilled in both areas.

We have done a large amount of cases that involve both this third-party type, as well as workers compensation, so I’m one of those people who is knowledgeable and skilled in both areas.

What happens if I find a new job while on workers comp?

In the state of Texas, they put a very, very high premium on people getting back to work as soon as possible. We have seen that when people return back to work as soon as possible, they actually have increased outcomes on workers comp and in our office, we certainly want you to have the best outcome possible and we want you to return to work as soon as possible. If your employer that you were working for when you’re injured no longer has a job for you, you’re free to go out and get another job.

However, you want to make sure that that job is one that is consistent with your restrictions that you might be on. You want to make sure that, that job is one that you can do, but if you do get offered a job that is within your restrictions and it’s one that you can do certainly you want to take advantage of that opportunity but when you do, you also need to let your attorney know and you also want to make sure that the insurance company knows about it. But certainly you want to go out and find a job if you can, you want to work that helps you get actually a better outcome on your workers’ comp when you return to workers as soon as you can.

Do I have to go to court to get workers comp?

Most people are afraid to follower workers comp claim because I think that if they do they’re going to have to go to court and fight in court to get workers comp. Very few cases actually end up in court on a worker’s comp case. Whenever you get injured on the job, you follow your claim for compensation, then the insurance company will process the claim, oftentimes they will accept certain parts of the claim, deny certain parts of the claim, but we don’t have to fight those things by going to court, we go in front of what’s called an Administrative tribunal. And you sit there in front of the judge and you just tell the judge what’s happened.

It’s a very informal process but it’s nothing to be uptight about and nothing to worry about. Most the times it’s just you, your lawyer, the insurance company’s lawyer and the judge. It does have important legal consequences for you if you don’t do things correctly. That’s why it’s always important that you have a lawyer if you’re going to be involved in any type of legal lawsuit.

Why is it so hard to get my surgery approved?

One of the biggest problems people have with workers compensation is getting their surgeries approved. It’s a continual problem because, in Texas, the insurance company uses a one size fits all approach to medical care. They use a book called The Occupational Disability Guidelines. Your doctor has to go by the treatment protocols that are in that book. It means that your medical care is more expensive. It means that it takes a lot longer for you to get treatment.

Your doctor will have to send in justification to the insurance company saying that the ODG has been followed and you’ve been sent out for the appropriate treatment prior to doing the more expensive option, which is always surgery. It does have important legal ramifications for you if don’t do things correctly. That’s why it’s always important that you have a lawyer if you going to be involved in any type of legal proceeding.

Can I get reimbursed for my travel expenses to see the doctor?

In addition to your health care that the insurance company has to pay for, they also have to pay for your travel expenses for that health care. If you have to travel out of town to go see a specialist or for surgery and the Insurance company has to pay for your travel expenses. If you live in a remote part of Texas, for instance, and you have to drive two hours to go see the doctor, you don’t have to bear that expense.

You collect your receipt, you make a log of your travel expenses, and the insurance company has to pay for that. That’s one of the services that our office provides, is we make sure that all your travel expenses do get reimbursed anytime you have to travel or incur expenses out of pocket to get medical care.

What is considered a work related injury?

A work-related injury is any injury that occurs in the course and scope of employment. The easy way to describe it is if you are doing something in the furtherance of the affairs of your employer’s business, then you’re engaged in the course and scope of employment. If your boss says, “Hey, why don’t you go across the street and make a deposit at the bank?” and while you’re walking across the street, you slip and fall, that’s in the course and scope of employment. Anything that you’re doing where you’re furthering the affairs of your employer, you’re not doing something for personal business but you’re doing something for work business, that’s in the course and scope of employment. If you get injured doing those things, you need to talk to a lawyer.

How long does workers comp last in Texas?

Workers’ comp in Texas lasts the entire lifetime for the claimant when it pertains to the medical care that the claimant receives. In other words, for your entire life, the workers’ compensation insurance company is supposed to pay for all your medical pay that you need for your injury. It’s different when it comes to the income benefits that you receive. Your income benefits only last up until the time that you return back to work, and then once you return back to work, you get something called an impairment rating, and you get paid three weeks’ pay for every 1% for the impairment, and even that is kept. So most people with workers’ comp claims will get paid their benefits somewhere around one to two year, but then they do get medical care for the rest of their life. But we all know insurance companies want to wrap claims up, and they don’t want to be paying on something for the rest of your life. So the insurance company is going to be doing everything they can to try and get your benefits cut off, which is why you need to see an attorney to make sure that you get the maximum amount of benefits that you are entitled to.