Older Texas Workers Compensation Claims Have Been Undercompensated

I have been pursuing issues arising out of older claims lately. Many of these are from the 1990’s, but it is clear that the injured worker was undercompensated. There are a couple of issues that I am looking at in particular. If you think any of these might apply to a case like yours, then we can discuss your situation privately.

Insurance Recoupment of Overpaid Benefits

Until 2002, the Division allowed insurance companies to recoup overpaid benefits from future benefits. This means that if for some reason a claimant received too much money for temporary income benefits, the insurance company could reduce impairment income benefits to get its money back. It was a matter of fairness. Insurance companies routinely performed this recoupment at will, even up to the present day.

But that is not how those rules are interpreted today. The rule is interpreted today to mean that the law must specifically allow an insurance carrier the right to a recoupment before it can take money away from a claimant. It is in very rare circumstances that this is allowed, and then only at a certain percentage reduction of benefits. Therefore, if a Texas workers’ compensation insurance company ever reduced your benefits to get back a perceived overpayment of benefits from you, that money could be yours today with interest from whenever the recoupment occurred. I signed an agreement yesterday where an insurance carrier agreed to pay this money back to the claimant with 12 years worth of interest.

Spinal Impairments Underrated

Another issue from way back when concerns impairment ratings for lumbar, thoracic, and cervical spine injuries. Before October of 2001, Texas used the 3rd Edition of the AMA Guides To The Evaluation of Permanent Impairment to assign impairment ratings. The majority of spinal impairment ratings were done incorrectly during that time period. If you have a spinal injury from back then with an impairment rating that has never been litigated or finalized by an agreement with the insurance carrier, then you might be eligible to have your impairment rating increased. This means you would be owed more benefits, even today. It only takes a second to review one of these impairment ratings, and it could be done via fax or email.

Denial of Lifetime Medical Benefits

A third issue is the ongoing denial of lifetime medical benefits. If you had a serious Texas workers’ compensation injury even as far back as the 1990’s, you are entitled to lifetime medical benefits. Most of the time the insurance company attempts to stop providing these benefits after awhile. If you are being denied medical treatment that is related to your workers’ compensation injuries, then we can help you determine how to get those benefits reinstated, and we can determine whether or not the insurance company has acted in bad faith towards you, which could result in a monetary award above and beyond the cost of health care.

It’s never too late to make sure you were paid everything you were entitled to receive under the law.

Have a Work Injury Case?