April 11, 2018
No one wakes up and goes to work intending to get hurt. An injury or illness is an unfortunate event no matter when or where it occurs. Missing time from work, feeling sick or being in pain plays no part in the American dream. Moreover, sustaining an injury at work can be serious as well as frustrating.
For these reasons, laws were passed over a century ago intended to protect the injured worker. Certainly, frustration was not the outcome intended, nor should you have to deal with such as you go through your work injury claim. It is very important to report any on the job injury to your employer immediately. Regardless of embarrassment or circumstances, immediate reporting of all work accident claims is necessary. This applies whether you believe you might be wholly or in part responsible for the accident.
The term non-subscriber is important if you are working for a large employer in Texas.
Upon receiving a report of a work injury claim, your non-subscriber employer should offer any assistance needed for medical care. Your employer has arranged to provide the similar benefits for their injured workers than required by Workers’ Comp. Unless you have written notice already on file with your employer, non-emergency medical treatment for a work injury needs to go through a hospital or urgent care facility approved by them. Normally, your employer wants your initial medical treatment to be coordinated through a physician. If preferred, you may subsequently choose a different treating doctor or provider, please check your plan or ask your supervisor for the time frame and further information.
Severe accidents and medical emergencies are transported by ambulance or helicopter to the nearest facility capable of rendering appropriate care. Although each benefit plan may be different, generally, these cases do not require prior treatment coordination through the employer during the emergency phase.
When an injured worker has non-subscriber employers, such as Walmart, HEB, Whataburger – there is a written contract or plan given to every employee. If you cannot locate your copy, ask your employer for another copy. Your company’s headquarters very likely hired a third-party administrator (TPA) to make certain all benefits listed in that written plan are appropriately provided and given to the injured workers. There is no doubt though, that these non-subscribing companies hire TPAs as much for your protection as theirs. They do not want any misinterpretation taking place on the part of a local supervisor. Any treatment coordination or monitoring by a nurse case manager goes through that TPA with your approval and input. The TPA does need regular updates on your medical status. The TPA is required to maintain your confidentiality and privacy. Most importantly though, they want to control costs of having an employee injured on the job!
The non-subscriber employers Plan spells out all of your benefits. Work accident claims are not usually acrimonious occasions. You and your employer generally want the same result, your successful return to work once you are healthy and able to perform your job. However, the problems arise after the injured worker begins to realize that they are seriously injured and returning to work might not be so easy. That is when, you have to be sure that the medical benefits you are entitled to under the Plan are being lived up to. This doesn’t always happen.
Large companies typically have workers in many states, as well as being non-subscriber employers in Texas. Typically, they follow a protocol and take care of their injured workers under a standard that they’ve set for themselves, often putting profits before the health of their employees. If you feel this is happening for you, and contacting the TPA is impossible, you need to speak to a work injury attorney immediately. TPAs are hired to serve a special purpose of managing work injury claims and that doesn’t always result in the best of medical care. In the likely event that they are being unresponsive or unhelpful, you need to contact a work accident attorney. If you have any questions regarding a work injury claim.