You may be surprised to find out that, in Texas, companies ARE NOT REQUIRED to carry insurance that covers injuries to their employees while on the job. Smaller companies often have insurance that covers any personal injury or property damage that they may cause while they are operating their business but, this type of insurance does not cover injuries to its own employees. Therefore, there is often confusion about whether injured workers are receiving the benefits they deserve.
If you are injured on the job, you may be facing one of a few possible scenarios:
Figuring out if you have benefits can be a difficult process and often times employers are not so willing to cooperate and help you figure it out. Therefore, if you are injured on the job, it is important you take the proper steps to make sure you haven’t affected your ability to claim your benefits.
If you have been injured on the job and you work for any of the NON-SUBSCRIBER employers listed below, call Sandoval & Waldman!
Stripes • Walmart • Kroger • Academy • Home Depot • Target • La Michoacana Meat Market
HEB • Whataburger • Dairy Queen • Tejas Tubular • Gretna Machine Shop • C & L Carriers
Exel • Cardinal Logistics • Igloo • Dillard’s • Bealls • Palais Royal
The Employee Retirement Income Security Act (ERISA) is a federal law that regulates and establishes oversight for private health insurance coverage by establishing rules and minimum standards that are meant to protect plan participants. Generally, under ERISA, employers are enabled to create employee benefit plans that provide coverage for injuries employee have on the job. These coverage plans are not created or subject to Texas Workers’ Compensation laws. Therefore, Texas employers who provide coverage under these ERISA plans are generally referred to as Texas Non-Subscribers.
Within the ERISA plan documents, Texas Non-Subscribers usually provide certain notice about the difference between coverage under a non-subscriber insurance plan and Texas Worker’s compensation. The following are some of the usual disclosures made:
The company will disclose that they do not have workers’ compensation insurance coverage
The employee is not entitled or eligible to receive workers’ compensation benefits under the Texas Worker’s Compensation Act;
The company may have benefits for the employee;
The employee should contact the company representatives to determine the availability of benefits for work-related injuries or occupational disease;
The employee could have rights under the common law of Texas should the employee have suffered a work-related injuries or occupational disease (Negligence claim);
The company is required to provide the employee with coverage information in writing when the employee is hired or, at any point that a company changes from coverage under the Texas Worker’s Compensation Act to a Non-subscriber policy
Any dispute related to a work-related injury is subject to arbitration;
Any dispute between the Summary Plan Description (SPD) and the Plan Document will be resolved in favor of what is found in the Plan Document.
Therefore, if you are injured on the job or suffer from occupational related disease, it becomes urgent that you notify your employer immediately. Many ERISA plans require that an injured employee notify their employer within 24 hours of the incident or, before the end of that work day. If the employee fails to notify the employer and REPORT the injury in writing, the employee’s benefits could potentially be denied by the ERISA plan administrator, who is another company that is responsible for managing the benefits under the ERISA plan.
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