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.

Can a car accident be a workers’ compensation case?

Sometimes in certain situations, when you’re driving to and from work, if you’re involved in a car wreck, that is a workers’ compensation claim. For instance, people who have places of business that are frequently changing, the common example is a plumber or an air conditioner repair man, those types of things. People that drive for work but they’ve got their company truck, they keep it at home, and they just drive from their house, those could be an on the job injury, if you’re involved in a car wreck, driving to and from different customer locations. It’s important that you talk to a worker’s compensation lawyer to look at, investigate what exactly happened, so that that way, if it is a workers’ compensation claim, you can make that claim.

What happens to my workers compensation if I test positive for drugs or alcohol?

Often times, someone gets injured on the job and they’re forced to do a urinalysis or a blood test and it tests positive for some type of an illegal substance. When that happens, their claim is denied. So the question arises, what do I do now? Well, it’s important that you talk to a lawyer if you’ve tested positive for any kind of illegal substance, because just because you’ve tested positive, doesn’t mean that your claim is barred. But what that does is is it shifts the burden of proof on a worker’s comp case so, that the injured worker has to not only prove their claim, but the injured worker also has to prove that they had the normal use of their physical abilities and their mental abilities at the time the injury occurred. There can be some very important things with respect to your case, so it’s very important that you talk to a lawyer if your claim is denied for testing positive for any kind of illegal substance.

What is the difference between a workers’ compensation claim and a non-compensation claim?

Texas is one of the few states where you don’t have to carry workers’ compensation insurance. There are employers in Texas that don’t have workers’ compensation insurance. it gets confusing because the employer may carry insurance and they may tell their employees that it’s workers’ compensation insurance but it’s what we call an occupational benefit fund. It’s a form of the insurance but it doesn’t have the same protections that workers’ comp has and it’s not regulated by the state of Texas. In those situations, an employer can very well retaliate against an employee. The employer can do anything basically what they want to you. They just can’t fire you for certain federal and protected things such as race discrimination, sex discrimination, those kinds of things but they can go and retaliate against someone if it is a non-Texas workers’ compensation fund. If it’s one of these occupational benefit plan type of situations. That’s why it’s important to talk to a lawyer so the lawyer can look at things and see just what kind of a case is this.