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How Does Having Insurance Differ from Being Covered by Workers’ Compensation in a Work Injury Case in Texas?

Just because your employer has "insurance" that doesn't mean that they have a worker's comp policy.

Texas is the only state in the country that doesn't require all companies within its borders to carry worker's compensation insurance for their employees. Consequently, injured workers may find themselves working for an employer who opts into the state's workers' comp program (which gives the injured worker one set of rights) or they may find that their employer opted out of workers' comp coverage (which gives the injured worker a completely different set of rights). The determining factor as to what rights the employee has is whether or not the employer buys workers' comp insurance.

In this article, we'll look at the difference between an employer carrying some type of occupational injury insurance for its employees versus an employer who opts into the Texas workers' compensation program.

Questions Answered on This Page:

  • Should I assume that my employer has workers' comp coverage?
  • Is my employer's injury insurance the same as workers' compensation?
  • How can I find out if my employer subscribes to Texas workers' comp coverage?

Is injury insurance the same as workers' comp?

The fact that your employer carrier some type of work injury insurance does not mean that your employer has workers' comp insurance. You see, workers' compensation coverage is indeed an insurance product (like car insurance, life insurance, etc.), but it is run like a welfare or benefit system (like unemployment or SSI disability). The point is that the insurance component of the workers' comp scheme is essentially meaningless. It's just where the money comes from.

The important part of the workers' comp scheme is that it is a no-fault system where all work injuries are covered, irrespective of the fault of the employer, and rather than lawsuits and courtrooms, comp claims all take place in a non-court environment. Further, rather than settlements and jury verdicts, injured workers are paid benefits. That is what makes workers' comp its own unique system of dealing with injured workers.

On the other side of the coin, some employers choose not to participate in this worker's comp system, yet they may still buy a generic "work injury insurance policy." While that may sound like the same thing, there's actually a huge difference. You see, when an employer has worker's comp coverage, your rights are very restricted. When they have a generic occupational injury policy, you have pretty broad rights to sue them for work-related injuries.

Some employers treat generic work injury insurance as a workers' comp plan, which cheats injured workers.

As we stated earlier, workers' comp cases are not handled in court, which means, by extension, that you cannot sue your employer if they subscribe to workers' compensation coverage. That's obviously a pretty nice benefit for the employer; no matter how badly they err, they are immune from lawsuits. Further, the employer gets the benefit of only having to pay the bare minimum to injured employers.

As disturbing as it is that Texas' comp laws protect employers to such an extreme extent, the even more disturbing trend that we see is when non-subscribing employers opt out of workers' comp coverage, yet they deceive their employees into thinking that just because the company has some type of insurance, that makes them equally impervious to lawsuits and they only have to pay the bear minimum. It doesn't work that way. If your employer is a non-subscriber, then the law empowers you to sue them for all that they've cost you, which can be substantial.

Now, it should be pointed out that if you want to let your employer pay you some lesser amount, there's no reason you can't do so. For instance, if your employer says they will only pay you 60% of your lost wages while you're hurt, but you love your job and plan to work there into the future, so long as you're comfortable with what they're offering you, then you can accept such compensation. But just don't let them convince you that they can legally make you take such an offer.

We see this a lot. Many employers try to offer the injured employee "benefits" as if they're covered by a workers' compensation policy. Some even go so far as to say that all the employee is allowed to recover by law is some low amount. This is not true if the employer is actually a non-subscriber. Their liability is essentially unlimited, and pretending that their only obligated to pay some preconceived benefits is an outright lie.

The only slight exception to this is that some employers are covered by an ERISA-compliant plan, meaning they have a non-subscriber insurance plan that falls under the umbrella of ERISA (Employment Retirement Income Security Act of 1974), which was originally a federal law that set minimum standards for pension plans in private industry. It is enforced by the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) and has branched out to "cover" non-subscriber injured workers as well. Under such a plan, you can still sue them since they are non-subscribers to Texas workers' compensation law, but the ERISA rules require them to provide you with medical benefits that sort of resembles the medical benefits portion of a workers' compensation claim, but that's where the similarities stop

Your employer may treat you fairly. Sometimes, injured workers contact our firm for advice, and we advise them not to sue their non-subscribing employer simply because the employer is voluntarily paying them a fair amount for their injuries. However, that is the exception. Most employers do the opposite. They are non-subscriber who stand to lose big if they get sued, so they try to manipulate or coerce injured workers into thinking that they can only get paltry benefits. In reality, those workers can usually sue for full compensation.

Why do I need an attorney?

ERISA coverage for injured workers is notoriously fraught with red tape, as are many of the other occupational injury insurance plans that non-subscriber employers buy into. Most are also woefully inadequate when it comes to compensating injured employees and making them "whole" again. Attorneys like those at Grossman Law Offices can keep these employers accountable to their injured employees and make them pay the employee the compensation he deserves. At Grossman Law Offices, we know the ins and outs of ERISA and other insurance coverage, and can counter an employer who is trying to avoid their financial responsibility to their employees.

These kinds of claims against employers are not as streamlined as workers' comp claims. Whereas a comp claim entitles you to prepackaged benefits, a claim against a non-subscriber (whether they have insurance or not) is a court case. These cases can take a significant amount of time and can be quite complex, just like any other personal injury case. The assistance of a competent, experienced lawyer is imperative. We here at Grossman Law Offices have more than 25 years experience litigating these kinds of cases with a long track record of success. We have the skill and resources to establish a solid case on our client's behalf and to pursue it to a successful conclusion, getting them the money they need for things like medical bills, lost wages and pain and suffering.

Call Grossman Law Offices Today:

We keep our clients apprised of developments in their cases every step of the way, and our Texas attorneys handle each case from beginning to end, never referring them out. Our clients make all major decisions in their cases, and attorneys are available day and night to answer any questions or concerns. We have the knowledge and resources to get you the money you need for your injuries. Our initial consultation is always free, so call us toll-free at (855) 326-0000 and put us to work for you.

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