Insurance Company Mistakes in Documentation Could Doom Your Workers Comp Claim

iStock_000022194672_LargeLast year, a Houston truck driver submitted his workers comp claim to Texas courts in order to receive benefits that have been denied to him for years. His company’s workers’ compensation insurance carrier is not denying him because he was not injured or it suspects fraud. Rather, he is being denied because his employers and their insurance company failed to document his injury correctly.

In 2012, the truck driver found he could not stand due to pain from his back to his lower leg. He told his employer someone would need to continue delivering the cargo so that he could go to an emergency room. A doctor diagnosed the truck driver with a strained and sprained back due to lifting at work. After two days, he returned to work and showed his employer his medical records so that his employer could refer him to a company doctor. That conversation went undocumented and the employer would later say it would not qualify as a “formal reporting” of the injury because it happened during lunch.

The truck driver worked through the pain, while seeing his own personal orthopedic specialist, until another incident occurred. A case of shelves landed on the truck driver’s head and his back was strained (again) from trying to lift a ramp. Later, he would be diagnosed with herniated disks, caused from multiple sprains to his spinal column. The insurance company refused to cover any medical costs beyond the sprain, which included multiple surgeries to correct the herniated disks. A document was released, saying “the document clearly states [the truck driver] was reporting a new accident but the insurance carrier did not file a First Report of Injury on his behalf.” That’s when the truck driver, who now walks with a limp and has been out of work recovering from his surgeries, submitted his case to Texas courts.

Earlier this month, he received a response: His insurance company should have recorded the injury correctly and the most the state of Texas can do is have the Division of Workers’ Compensation fine the insurance company… Which does not help the truck driver in the slightest.

What Can You Do to Ensure Your Claim is Documented Correctly?

The federal government estimates roughly 3 million on-the-job injuries every year. However, it admits that number is likely a fraction of cases, as most go unreported. Texas workers my crash their commercial vehicles, fall from unsafe scaffolding and be slowly poisoned from inhaling fumes. Yet, many employers do not document these injuries and many people do not receive the benefits they need to help them recover.

The best thing you can do if you sustained an on-the-job injury is to notify your employer, preferably through a written notice. Your employer has an obligation to report your injury to the employer’s insurance company. Texas law mandates that the insurance company must then create a written record of the incident straight away.

Due to the fact that the Texas workers’ comp system leaves plenty of room for error, it is best to consult with an attorney when you sustain a workplace injury. An attorney can tell you what your rights are in the situation, or help you with an appeal if your claim is denied.

The Law Offices of Aaron Allison is a personal injury firm that helps victims of workplace injuries in Austin.


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