A Lesson From The Texas Worker's Compensation System

This month’s issue of the ABA  (American Bar Association) Journal has an in-depth look at the Texas Worker’s Compensation System   (Insult to Injury:  Texas Worker’s Comp System Denies, Delays Medical Help).  The article discusses the reforms of the worker’s comp system, the insurance industry’s heavy hand in determining how the system plays out, and the insurance compny’s scheme to deny and delay legitimate claims. 

The article starts out talking about an injured Deputy in East Texas:

As Deputy Sheriff Ed Martin sat by his squad car in a fast-growing pool of his own blood, he called his wife and woke her at 3:30 a.m. He knew he might die from the point-blank shotgun blast that greeted him moments earlier when he knocked on a door for a 911 call in a tiny east Texas town called China.

“It’s pretty bad and I don’t know how it’s gonna turn out,” Martin told his wife as he awaited a helicopter medical evacuation. “Get the kids and meet me at the hospital.”

When they arrived, Martin was on a gurney and covered with a white sheet splotched red. His wife clutched their sleepy 2-year-old daughter to her chest as their sons, 6 and 10, stood at her side.

“I know it was tough for them,” Martin says, retelling the story of that night in June 2006 in the flat monotone of cop-speak. “But I wasn’t sure if I’d make it through surgery and I wanted to at least tell them ‘Hello’ and ‘I love you.’ ”

Doctors say Martin’s life was saved by his ballistic vest and the swift trip to the hospital in Beaumont, near the Gulf Coast and the Louisiana border. But the blast vaporized the skin of his inner arm down to bare muscle and tendons, and tore out the main artery.

A couple of weeks later, Martin got a phone call from an insurance adjuster handling his workers’ compensation claim. He was told the $7,300 helicopter ride was “not medically necessary” and likely would not be covered.

From representing a number of people who have been injured on the job, I can tell you that the experiences outlined in the article are spot on.  For example, I currently represent a worker injured in an on-the-job car wreck.  He went to a surgeon recommended by the insurance carrier, and the surgeon recommended that my client needed surgery.  The insurance carrier denied the claim, and asked the client to be reviewed by another doctor for a second opinion.  That doctor agreed that surgery was necessary as a result of the on-the-job injury.  But the worker’s comp insurance company still refuses to pay the claim, instead, sending the client to another doctor.

Unfortunately, I fear that the changes to the workers comp system are only a pre-cursor to how insurance companies and the legislature treat all injured Texans.  Every legislative session we see new proposed laws that seek to limit the rights of people injured by others, and it seems that every Friday brings a new Texas Supreme Court decision that does the same.

I only hope that people realize the pendulum is swinging too far in favor of insurance companies and that we continue to protect those without a voice.