Workers' Compensation

Published on: March 12, 2014

Texas Court of Appeals Rules That Third Party Hospital Can Sue Employer to Pay For Employee’s Medical Care

Recently, the Texas Court of Appeals overturned a trial court’s judgment against the medical center that provided care to an injured worker in Hand and Wrist Center of Houston v. Maintenance Supply Headquarters.

Daniel Contreras was an employee for Maintenance Supply when he injured his hand in June 2009. The assistant operations manager took him to one clinic for treatment before being directed to the Hand and Wrist Center. The assistant operations manager then signed a letter of guarantee, which stated that the employer agreed to pay the Center the “usual and customary fees” for medical care rendered to Contraras, and that payment would be made regardless of whether the injury occurred at work, or if the patient tested positive for drugs or alcohol at the time of injury.

Contraras had wrist surgery and the Hand and Wrist Center billed the employer $3,612.62 and $19,138.30 for his care. Soon after, Contraras received notice from his employer’s workers compensation insurance carrier that his claim had been denied due to the discovery that he had tested positive for drugs at the time of injury. The denial was later upheld by the Texas Department of Insurance Division of Workers Compensation.

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Published on: February 4, 2014

Texas Court of Appeals Rules Against Injured Worker For Failure to Exhaust Administrative Remedies in Holmes v. Zurich Insurance Company

By Carabin Shaw

One of the most difficult aspects of coping with a workplace injury can be dealing with the your employer’s insurance company. Most employers are required to carry workers compensation insurance so that ideally, when a worker is injured, he or she can receive payments until able to resume work. However, sometimes insurers will refuse to pay for injuries or procedures that they believe do not fall within their “scope,” which was the case with Holmes v. Zurich Insurance Company.

In Holmes, the case involved a tire lube technician, Aaron Holmes, who injured his back at work. After he applied for workers compensation, the company’s insurance carrier, Zurich, accepted that Holmes had a lower back sprain, but not any other injuries. In February 2008, Holmes and Zurich participated in a benefit review conference to resolve the dispute, but were unsuccessful. A benefit contested case hearing was then held so that it could be determined whether Zurich had to compensate for a two-millimeter disc protrusion and two other injuries. In May 2008, the Division of Workers Compensation hearing officer found that the disc protrusion was a compensable injury, but not the others.

Holmes then sought pre-authorization for spinal surgery pursuant to the Texas Workers’ Compensation Act. After being denied once and having it overturned by the Independent Review Organization, Holmes had the procedure done. However, when Zurich received the bill, it refused to pay on the grounds that the surgery repaired non-compensable injuries in addition to the disc protrusion.

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Published on: November 24, 2013

Workers’ Compensation Update Part 2: No Bad Faith in Workers’ Compensation Context – Hopper v. Argonaut Insurance Company

By Carabin Shaw

Two recent Texas court decisions, including the October 18, 2013, decision in Hopper v. Argonaut Insurance Company, Inc., have established that there is no common law bad faith in Texas regarding workers’ compensation claims. First, last year, in Texas Mut. Ins. Co. v. Ruttiger, the Texas Supreme Court, finding that the reforms to the Texas workers’ compensation statutes in the 1990’s provided for adequate safeguards, abolished the common-law duty of good faith and fair dealing.

In Ruttiger, Texas Mutual disputed plaintiff Timothy Ruttiger’s claims for a workplace injury because his employers reported that the injury occurred at a non work-related softball game. Though the insurance carrier eventually agreed to pay workers’ compensation benefits, Ruttiger filed suit alleging both common law and statutory bad faith causes of action because his claim was initially denied. Initially, the trial court found that Texas Mutual’s insurance adjuster acted in bad faith when it believed the employer instead of the employee, Ruttiger. However, the Texas Supreme Court disagreed and held that an injured employee could not assert a common-law claim for breach of duty of good faith and fair dealing against a workers’ compensation insurance carrier. Notably, at the time, the court did not go as far as to hold that the Texas Workers’ Compensation Act was the exclusive remedy for all work-related injuries, meaning that following that decision, workers could still bring a bad faith claim against a workers’ compensation insurer under the Texas Insurance Code Section 541.061 for a misrepresentation of the policy.

More recently, however, in Hopper v. Argonaut Insurance Company, a decision by the Court of Appeals of Texas all but eliminated a claimant’s ability to bring a bad-faith claim of any kind. In Hopper, Mr. Hopper sustained a wrist injury on the job and received workers’ compensation benefits. Several years later, he died of a drug overdose of the pain medication he was prescribed following his injury. After the deceased’s family sought workers’ compensation death benefits, the workers’ compensation insurer denied the claim for two years, challenging whether Mr. Hopper’s death was work-related and his family’s status to bring the claim.

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Published on: November 17, 2013

Texas Workers’ Compensation Law Update

By Carabin Shaw

An August 2013 court decision by a federal appeals court brings attention to the impacts of Texas being one of two states in the country that allows companies to opt out of the state’s workers’ compensation system. In the case, Mary A, Ernewayn v. Home Depot U.S.A., Inc., Mary A. Ernewayn, a Home Depot employee in Texas filed sued against Home Depot in Texas state court, alleging that the company was negligent. Ernewayn claimed she suffered neck and back injuries while operating a lumber cart in a Home Depot store. Home Depot sought to remove the case to federal court based on the fact that the company had opted out of the Texas workers’ compensation system.

In August 2013, however, a federal appeals court panel denied the company’s request to defend itself from a workers’ compensation claim in federal court. More specifically, the federal court affirmed the lower court’s finding that even though Home Depot did not subscribe to the Texas state workers’ compensation system, the state’s workers’ compensation law still limited the number of common law defenses the company could assert.

The Opt-Out System in Texas

Most states require employers to carry a workers’ compensation insurance policy to cover any costs such as lost income or medical bills should an employee become injured while at work. This means that, in most states, if someone is injured on the job, he/she can file a claim. If the claim is approved, the employee is entitled to payment of his/her medical bills and compensation to cover lost wages and disability.

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Published on: August 17, 2013

Texas A&M Construction Accident Highlights Dangers faced by Construction Workers in Texas

By Carabin Shaw

Construction projects can be dangerous and can be the result of faulty machinery, inexperience, lack of safety measures, and weather, among other factors. Notably, the construction industry in Texas not only employs nearly 600,000 Texans, but it also contributes $9.2 billion in wages. Unfortunately, construction workers face some of the most deadly working conditions in the country. According to the Bureau of Labor Statistics, 715 construction-related deaths were recorded in the U.S. in 2010, and 138 of these deaths occurred in Texas.

In June 2013, four workers were hurt, three critically, after a barn frame collapsed at a Texas A&M University equestrian complex that was under construction. According to a Texas A&M spokesman, the collapse took place on university property about a mile from the main campus. The National Weather Service reported that conditions at the time of the collapse were cloudy with temperatures in the mid-80s and winds gusting just above 10 mph, indicating that weather was likely not a factor.

This accident is just one of many accidents involving construction workers taking place across Texas. According to the Houston Chronicle, Texas leads the nation in the rate of construction worker fatalities. Although federal and state regulations provide some protections to construction workers and their families, there is still more that can be done. Even though workers injured on the job are supposed to recover lost income via workers’ compensation, in at least 60% of work-related fatalities in Texas, no benefits from workers’ compensation are paid. In fact, according to data from the Texas Department of Insurance, this number is even higher for construction workers. Additionally, Texas is currently the only state in the United States that does not require workers’ compensation for private employers.

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Published on: March 12, 2012

Widow Files Lawsuit After Worker Dies in Texas City Industrial Accident

By Carabin Shaw

The widow of a 26-year-old worker killed in an industrial accident last month has filed a lawsuit for herself and on behalf of the couple’s minor child against her husband’s employer. Virgel James Stoker died after he purportedly became entangled in machinery used to package company products at Dallas Group of America, Inc.’s Texas City facility. After her husband’s unexpected death, Fredreka Denise Hayes also obtained a temporary restraining order against the Dallas Group and Action Personnel Group, Inc. The restraining order prohibits the two companies from destroying or altering physical evidence within 50 yards of the location of Stoker’s death.

The Dallas Group primarily produces absorbent synthetic magnesium silicate products used by food manufacturers. It is also the only manufacturer of ammonium chloride in the nation. If ammonium chloride is ingested in significant amounts, it may cause tremors, confusion, drowsiness, and coma. Although the Department of Labor’s Occupational Safety and Health Administration (OSHA) is still investigating the accident, Hayes’ lawsuit alleges Stoker was overcome by a toxic substance such as ammonium chloride prior to falling into the machinery.

In her lawsuit, Hayes accuses the Dallas Group and Action Personnel of failure to supervise, failure to provide proper training to employees operating the packaging equipment, failure to properly maintain and inspect the equipment, failure to have adequate safety measures and protocols in place, failure to properly ventilate the working environment, and failure to provide workers with necessary safety equipment.

Although most workplace injuries in Texas are covered by workers’ compensation laws, important exceptions exist. For example, an employer in Texas may be directly sued where a worker died as a result of a workplace injury, left behind financial dependents, and it can be demonstrated the employer committed gross negligence. An employer may also be sued if the employer does not subscribe to, or fails to keep its workers’ compensation policy current.

In Texas, only a spouse, child, or the parents of someone killed due to an individual or company’s negligent act may file a wrongful death claim. If you recently lost a loved one due to someone else’s carelessness, a qualified wrongful death lawyer can explain your options.

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