This same Texas Department of Insurance report says delayed initial care is correlated with higher total medical costs.  For example, Texas workers’ compensation claims with greater than seven days delay in initial medical care had on average 39 percent higher medical costs in the first 6 months after injury.

• Follow doctor’s orders.  Immediate access to quality medical providers (at no fee or cost whatsoever to the injured worker) comes with a reasonable expectation for the worker to follow doctors’ orders – or pursue reasonable second opinion procedures detailed in the benefit plan, as required by federal law.
• Return to work.  Unless there is an appeal or second opinion request from the injured worker, return to work is reasonably required when a physician releases the employee to full or modified duty.  Returning to work at an appropriate time is well-known to promote better medical outcomes.

For employers, active engagement means:

• Communication.  Don’t wait until the injury occurs!  Injured workers can’t be held accountable for rules they don’t know about or understand.  Common sense and applicable laws require simple, personal communications from Texas injury benefit programs that help employees know how to timely report claims, understand available benefits, and know where to obtain medical care.  This helps build employee morale and a culture of caring before an injury ever occurs.
• Well-Established Benefit Claim Procedures.  Federal laws require almost every employer-sponsored benefit plan (including 401k, group health and all Texas injury benefit programs) to establish reasonable procedures for administration of benefits in the best interests of covered employees and beneficiaries.  The U.S. Supreme Court has, for decades, said these rules (first developed in 1974) provide administrative safeguards for a full and fair review of benefit claims, including criteria for initial benefit determinations, appeals and access to state and federal courts.  Regulations also prohibit final, binding arbitration of benefit disputes. Employers failing to comply with these laws can face large monetary penalties and enforcement by the U.S. Department of Labor.

• Negligence Liability.  Every employer failing to provide safety and care for their workers eventually pays the price through reduced productivity, higher insurance premiums or other increased costs of doing business. They may also be held accountable by the U.S. Occupational Health and Safety Administration (OSHA).   But Texas employers with no workers’ compensation coverage are also exposed to negligence liability claims by injured workers. The “Exclusive Remedy” rule does not apply! They are exposed to lawsuits for:
  • Actual damages – including any unpaid medical expenses and the employee’s lost wages, loss of earning capacity, other mental or physical damage, and pain and suffering;
  • Punitive damages; and
  • Attorneys’ fees.  

The Texas Labor Code also strips these employers of defenses based on the worker’s assumption of risk, contributory (or comparative) negligence, or negligence of a fellow employee.  Such lawsuits have developed a deep body of case law and an experienced group of attorneys representing employers and injured workers.

This reality has been a powerful force for good, commonly resulting in increased employer investments in job training, safety and return-to-work programs.  It even leads some less conscientious employers to support “Employee Advocacy” and voluntarily commit in writing to pay quality injury benefits in the hopes of avoiding negligence liability lawsuits.