You may not know it, but in Texas, companies are not required to have insurance that protects their employees if they are injured at work. Some companies usually have insurance that covers any personal injury or property damage that may occur while they are operating their businesses. Unfortunately, this type of insurance, known as the General Commercial Liability Policy, excludes and does not cover personal injuries for workers (employees and equal contractors). This confuses whether the injured worker will receive benefits.
If you are injured at work, these are the possible scenarios in which you may find yourself:
- Your employer does NOT have insurance: Generally, this means that, if you are injured due to your employer’s negligence, you could only sue the owner or the company directly, and depending on how the company was bodily established with the state, you can recover the profits and property of the owner or the company.
- Your employer has a General Commercial Liability policy: This type of policy does not provide coverage for injuries to employees or contractors. This will be the same as not having insurance.
- Your employer is a Texas Workers ‘Compensation subscriber and has insurance to cover damages to employees (TEXAS WORKERS’ COMPENSATION). This means that you will receive benefits. But the compensation rules under the state program are extremely specific, and you may need help to make sure you are accepting the proper treatment and benefits before you return to work.
- Your employer is NOT a SUBSCRIBER of Workers Compensation of Texas. (NON-SUBSCRIBER) The company has its insurance plan (not the Texas workers’ compensation program) that provides benefits and covers injuries to employees while they work. These are employers who are not subscribed to the workers’ compensation program. Several companies have insurance plans that cover injuries to employees. Some examples are:
o Stripes
o Walmart
o Home Depot
o Target
o HEB
o The Michoacán
o Kroger
o Academy
The process of identifying if you have benefits can be complex, and many times, employers are not willing to cooperate and help discover your benefits. Therefore, if you are injured at work, you must take the appropriate steps to ensure that you have not affected your ability to claim your benefits.
The Income Security for Retired Employees Act (ERISA) is a federal law that regulates and establishes oversight for private health insurance coverage by establishing minimum standards and standards that are made to protect plan participants.
In general, under ERISA, employers can create a benefit plan for the employee that gives coverage for the injuries the employee suffers at work. These coverage plans are not created or are subject to the Texas Workers’ Compensation laws. Therefore, Texas employers who provide coverage under these ERISA plans are generally referred to as Non-Texas Workers’ Compensation subscribers (Texas Non-Subscribers).
Within ERISA plan documents, Texas Non-Subscribers typically give a notice about the difference between the coverage under the non-subscriber’s insurance plan and the Texas Worker’s compensation. The following are some of the disclosures that are made frequently:
- The company will disclose that they do not have worker’s compensation insurance coverage.
- The employee is not entitled to or is not eligible to receive workers ‘compensation benefits under the Texas Workers’ Compensation Act.
- The company can have benefits for the employee.
- The employee must contact the company representatives to determine the availability of benefits for work-related injuries or occupational disease.
- The employee may have rights following customary law of Texas if the employee has suffered an occupational injury or illness (Lawsuit by Negligence).
- The company is required to provide the employee when hiring written information about the coverage, or any time the company changes coverage under the Texas Worker’s Compensation act to the non-subscriber policy.
- Any conflict related to a work injury is subject to arbitration.
- Any conflict between the summary description of the plan (SPD) and the Plan Document will be resolved in favor of what is found in the Plan Document.
Therefore, if you are injured at work or suffer from an occupational disease, you must notify your employer immediately. Many ERISA plans require the injured employee to notify their employer within 24 hours of the incident or before the end of the workday. Suppose the employee fails to notify the employer and does not REPORT in writing about the injury. In that case, the employee’s benefits could be potentially denied by the ERISA plan administrator, another company responsible for managing the benefits under the ERISA plan.
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