August 23, 2017
To understand what a Texas Non-Subscriber employer really is, we must first discuss what it is not: an employer with TEXAS WORKERS’ COMPENSATION INSURANCE. Even though the employer, the insurance companies and even the treating physicians call “Worker’s Comp” and fill out the DWC forms, Texas Non-Subscriber insurance is not the same of Worker’s comp nor is it a replacement for it. In fact, the rights you have under each type of coverage vary significantly.
In Texas, employers ARE NOT REQUIRED to carry insurance that covers injuries to their employees. This means that not all companies have Texas Worker’s Compensation Insurance. Smaller companies often have commercial liability insurance that covers any personal injury or property damage that that company’s employees may cause to third parties while they are operating their business but, this type of insurance does not cover INJURIES TO THAT COMPANY’S OWN EMPLOYEES. For this reason, 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 the following scenarios:
Your Employer has NO INSURANCE at all! Generally, this means if you get injured because of your employer’s negligence, you could only sue him or the company directly and recover from what assets your employer or the company may have, depending on how the business is set up with the State;
Your Employer only has a General Commercial Liability Policy! This type of policy does not provide coverage for injuries to employees or contractors of that company;
Your Employer is a Texas Workers’ Compensation Subscriber and has insurance to cover injuries to employees. This means you will be covered but, the Workers’ Compensation rules are very specific and you may need help making sure you get the right treatment and benefits before you are send back to work;
Your Employer is a NON-SUBSCRIBER. The Company has chosen not to “subscribe” to the Texas Worker’s Compensation Program and has instead, elected an insurance plan that provides benefits and covers injuries to employee while on the job. These are Non-Subscriber Employers. It is estimated that there are about 114,000 Non-Subscriber employers in Texas. MANY are several “well-known” retail stores, restaurants, and other industrial companies. Generally, when an employee suffers an on-the-job injury while working for a Texas Non-Subscriber, the medical and wage benefits under the insurance PLANS are administered or managed by another company. Some Examples of these third-party administrators include: SEDGWICK, PROVIDENCE RISK MANAGEMENT, GREAT AMERICAN, CAPROCK CLAIMS, ANCHOR RISK, CLAIMS MANAGEMENT INC and HELMSMAN MANAGEMENT SERVICES. Essentially, these are the insurance companies providing the policy to the employer that covers worker injuries. Texas Employers love these policies because they are managed primarily with the company’s interests in mind; protecting the business, controlling costs, controlling claims and, “getting the employee back to work”! Maybe not so surprising, “getting the employee healthy” is not one of the insurance company’s primary concerns. That’s where we can help!
As an injured employee, figuring out what benefits you are entitled to is a difficult process and most of the time, if not always, employers are not going to help you figure it out. Therefore, if you been seriously injured while working for a Texas Non-Subscriber, and the company and/or the insurance administrator is:
giving you the runaround about your treatment,
failing to approve significant procedures (MRIs, Injections, surgeries);
declining benefits because they say you have old or un-related injuries;
sending you to a doctor who is supposedly giving you an independent medical examination (IME) but he never actually examines you;
telling you that you have to work even though the company doctors have you on restrictions; or
denying benefits because, even though there were witnesses to the incident, you didn’t report the incident within the time they require you to report it;
Unlike the insurance companies, my main focus as your lawyer would be to make sure you are getting the treatment you need to get healthy again and, to make sure that you are fairly compensated for the injuries you’ve suffered.