Injuries that occur in the course and scope of your employment in Texas are generally covered under workers’ compensation insurance policies. Lifting a box and experiencing pain in your low back, getting run over by the forklift driver, falling off of a ladder, repetitive typing that results in carpal tunnel syndrome – these are all examples of work injuries that can be workers’ compensation claims. Sometimes injuries result from workplace accidents, other times they result from normal, everyday activities that you have done hundreds of times without injury. Whatever the situation, if an injury occurs at work, it can be a workers’ compensation claim.
Given the political climate in Texas, many workers’ comp injury claims are denied. Insurance companies will often deny claims in their entirety by saying your injuries did not happen at work, even though you know it did and have witnesses. Other times, insurance companies will cover your claim for a minor injury like a muscle sprain, but deny the full extent of your injury if it is more significant. When this happens, it is hard to get the right medical treatment and benefits to cover your lost wages without litigation. This is when you need the help of a good Texas workers’ comp attorney.
Knowledge. Experience. Integrity.
Based in Dallas, Texas, the workers’ comp attorneys at MLF Legal, PLLC represent injured workers throughout the State of Texas. We are well known and respected — a significant portion of our business comes from referrals from previous clients, doctors and other attorneys. We have the knowledge and experience needed to guide you through the Texas workers’ compensation system.
MLF Legal’s founding partners have over 40 years of combined experience handling workers’ compensation cases. Daniel Morris and Matt Lewis speak regularly at conferences on Texas workers’ compensation matters, appear on Radio shows, and have even written a book titled, “The Ultimate Survival Guide For Texas Injured Workers: Everything You Need To Know To Beat Insurance Companies At Their Games.” This book is available to all Texas injured workers in a FREE download. Get your free copy right now.
We Fight Employers & Insurance Companies
In Texas, workers’ compensation claims are generally made against insurance companies. Most employers have workers’ compensation insurance in Texas even though it is not required. When an employer has workers’ comp insurance, they are called a subscriber. These are the typical work injury claims where injured workers get traditional workers’ comp benefits of medical treatment and lost wages, as well as a little recovery for permanent impairment. Pain and suffering is not included, and there is no “settlement” at the end of the case like you would expect with a personal injury claim such as a car wreck.
If the employer does not have workers’ compensation insurance, they are called a nonsubscriber. These employers might have accident insurance of some kind, but they do not provide traditional workers’ compensation benefits. In a nonsubscriber work injury claim, you have to go after your employer for negligence in order to get a recovery. These types of cases are like personal injury claims and you can get a settlement or a judgement from a court at the end of the case.
MLF Legal, PLLC handles both subscriber and nonsubscriber cases. If you have been injured at work, you may ask for a free consultation to determine which type of case you have.
Insurance Companies Dominate The Texas Workers’ Comp System
If you have ever had any damage to your car or your home, then you have an idea about what insurance is supposed to be. You call the insurance company and tell them about the damage, then they send someone out to inspect the damage, and then they write a check to cover the repairs. In essence, the insurance company confirms what its responsibility is, and then takes care of it. If you talk to your insurance agent, they are usually very caring and can’t wait to help make things better.
Well, that is not how workers’ compensation works. In a workers’ compensation claim, the insurance company does everything it can to get out of paying for any of its responsibility. In order to make that easier, insurance companies have lobbied and contributed lots of money to Texas legislators to change the rules in its favor. Let’s examine these changes.
Before 1990, workers compensation claims were paid a lot like a car wreck. You would establish the cost of your medical bills and your lost wages, consider future medical care and impairments, and reach a settlement of the case. If it couldn’t be settled, then the case could go to court. That resulted in a pretty good outcome for most injured workers. So, they had to change it.
The first big change took effect in 1991. Texas adopted what is called the “new law” workers’ comp plan which took away your right to sue your employer for the injuries you sustained on the job. Insurance companies and legislators came up with a progression of benefits you could have for lost wages and impairment. They took away your ability to settle your future medical costs and your pain and suffering damages, taking a lot of money away from injured workers.
By 2005, insurance companies were complaining about the cost of healthcare. In order to fight your right to medical treatment, they adopted medical networks. These networks were mostly run by third parties who set up networks of doctors to treat patients with each insurance company, a lot like how if you have health insurance you have to treat with a doctor treats on that insurance plan. The spin with workers’ comp was that they tried to kick out all of the doctors who fought for patients to get all of the proper treatment to get them well. The plan was to limit treatment to doctors who would do what the insurance companies told them to do, which was often to limit treatment and send people back to work before they were really able to perform their jobs.
Through all of this time, the one major protection that injured workers had against insurance companies was the requirement for insurance companies to act in good faith when making decisions about injury claims and benefits. If an insurance company did something bad to an injured worker that resulted in damages, the injured worker could sue the insurance company. So, when insurance companies denied benefits that they rightfully owed, injured workers could sue. In 2012, this right was taken away and insurance companies were allowed to do anything they want to an injured worker without the risk of any repurcussions. Benefits were denied and lawsuits were thrown out of court. This essentially stacked the deck against injured workers because they had nowhere to turn for help. There were no checks and balances.
Now, in 2018, the medical network idea has been given extra muscle. The third parties are no longer in the middle to manage things. Insurance companies themselves are running the networks, refusing to allow doctors who actually try to help patients be involved. Your choice of doctor is severely limited. Most often, you are asked to treat with clinics that are set up for one time exams, not long term treatment.
How Can A Texas Workers’ Compensation Attorney Help?
At MLF Legal, we want every injured worker to get the best treatment they can get, to get benefits to cover their lost wages, to recover from their injuries and return to work, and then get a monetary recovery for any permanent impairment resulting from that work injury. Making this happen requires effort, planning and some expertise. That’s why we wrote the book, “The Ultimate Survival Guide For Texas Injured Workers: Everything You Need To Know To Beat Insurance Companies At Their Games.” We want everyone to have the gameplan. But we understand that not everyone can do it on their own. After all, insurance companies have worked hard to put every hurdle they can think of in your way.
That’s why we fight. By the time you figure out that you need to fight, a lot of your will to fight has been taken away. Sometimes your injuries weigh on you so much that you can’t fight for yourself. Other times, by the time you figure out that you are in a fight, it’s beyond your control. That’s why we fight.
We fight to get you the medical treatment you need. We know quite a few of the doctors in the system. We know who is on your side and who does what insurance tells them to do. We can help you get to the doctors who will stand by you and help you get well, and avoid the ones who don’t.
We fight to get you the monetary benefits that you have a right to receive. When you can’t work because of your injuries, we pursue benefits for these lost wages. Almost every day one of our attorneys is in a hearing to establish our client’s rights to these benefits.
We fight to establish the full extent of your injuries. When insurance companies try to limit their responsibility to just a bruise or a sprain, we go to court to prove the full extent of your injury. This means we pursue claims to spinal injuries like herniated discs and pinched nerves, or joint injuries like meniscus tears and rotator cuff tears. We also work to get you covered for pre-existing conditions that the work accident made worse.
We fight to prove your permanent impairments. Many insurance company doctors like to say that you have no impairment at all. We are often able to get other doctors to do a fair examination that will show all of the impairment that resulted from your on the job accident.
We fight to make your claim about you. You didn’t ask to get hurt, and in many cases your employer is the one who did something wrong that resulted in your injuries. You deserve everything the State of Texas allows you to have as a result of a workplace injury – not what an insurance company says.
What Does A Texas Workers’ Compensation Lawyer Do?
Texas workers’ compensation attorneys at MLF Legal pursue claims. We push cases forward. Our clients hire us to make sure they get the benefits the law provides. We help resolve claim denials over specific injuries and diagnoses, as well as all monetary benefits and permanent impairment.
What types of disputes do we resolve?
- Claim denials
- Access to medical care
- Change of Treating Doctor
- Extent of injury
- Disability / Lost Wages
- Bona Fide Offer of Employment
- Average weekly wage (AWW)
- Impairment rating
How do we resolve workers’ comp disputes?
As lawyers, we represent you. We speak on your behalf with years of expertise behind our words. We work directly for you. The workers’ comp lawyers at MLF Legal do not work for the Division of Workers’ Compensation, and do not work for an insurance company. We work for you.
The first step in our representation is to identify the problems that need to be solved. Then we gather evidence relevant to those issues. At that point, we attempt to negotiate a resolution with the insurance adjuster. If that fails, we get the case into litigation.
Sometimes the problems are solved by getting you to a new doctor who isn’t influenced by your employer or the insurance company. Other times, we just need to get the right piece of evidence to get the adjuster to do the right thing. But if necessary…we fight.
There are three steps to the Texas workers’ compensation litigation process. The first hearing is called a Benefit Review Conference. This is an administrative mediation. At a BRC, we meet with the insurance company representative and the Division’s mediator in an effort to find a way to settle the disputed issues. It usually lasts 30 to 45 minutes. There are three potential outcomes from a BRC: we could identify the need to have another BRC at a later time after more evidence is developed, we could sign an agreement resolving the dispute, or we can recognize that the issue cannot be resolved without asking a judge to hear the case and issue a ruling. If a judge is necessary, then we schedule a time to appear at a Contested Case Hearing while we are still at the BRC.
If the case proceeds to a Contested Case Hearing, then we are headed to an administrative trial. A Contested Case Hearing, or CCH, is similar to what you probably expect a court hearing to be like. You will likely have to testify and answer some questions about your injuries. We will have evidence to show the judge, such as your medical records. The lawyers at MLF handle all of this for you. We develop the strategies and offer the evidence. We show the judge why you should prevail and argue about how the law affects the question being litigated in your specific case.
What’s the difference between a Texas workers’ compensation lawyer and an ombudsman?
The short answer is that a lawyer represents you and only gets paid if you get paid. An ombudsman can only “assist” you – they are not allowed to represent you, and they work for the State of Texas.
An ombudsman is required to be an insurance adjuster and does not have to have any experience with workers’ compensation claims.
When you ask for an ombudsman, you have to use the one assigned to you on any given day. With lawyers, you can shop around and hire the one that makes the most sense for you.
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