Texas Workers Denied Coverage Because of Insurance Company Errors

Michael S. Callahan | | Insurance Claim Disputes
juan boston humble

Insurance coverage that is meant to protect employees injured on the job in Texas is only as good as the insurance company behind it.

When you get hurt on the job in Texas and your employer has workers’ compensation insurance, there are certain actions you must take to make sure that your work injury is documented and a proper workers’ compensation claim is filed. Unfortunately, there are some cases where even if you do everything you are required to, the insurance company still refuses to pay for your claim, as the Texas Tribune reported about a Humble truck driver.

“Last October, Juan Boston received two letters at his Humble home — north of Houston — telling the out-of-work trucker something he already knew: After he injured his back in 2012, his insurance company should have recorded it properly.

Had New Hampshire Insurance Company documented his injury as state law requires, Boston might not have found himself on the losing end of a benefits dispute that pushed him to sell his pickup truck to pay for surgery. Perhaps his mother-in-law would not have needed to tap her retirement savings to help Boston pay the family mortgage.

The Texas Division of Workers Compensation is now promising to ‘take appropriate action on this matter’ against the insurance company for its mistake, it wrote to Boston.

But whatever the state does now — whether a warning, fine or anything else — won’t help the 40-year-old pay the bills that have piled up in the years since McLane Foodservice Inc. fired him once he was too hurt to work.

Though Texas law says workers’ comp providers are liable for reported injuries they fail to document, state regulators say their hands are tied in cases like Boston’s. They have no plans to order New Hampshire Insurance, an AIG affiliate, to compensate Boston for the herniated discs and other spinal damage that he attributes to hoisting 40-plus pound boxes at work.”

This worker did everything he was required to yet his workers’ compensation claim was denied because the insurance company did not do its job correctly. Even though the state found that the insurance company was wrong, the employee still won’t be compensated. Instead, the insurance company will be fined.

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This is just one example of worker’s compensation claims that are denied every year for reasons that make no sense to the hard working employees who are supposed to be protected by this type of insurance coverage. In the video above, you can see another. A school administrator, who was on the clock at the time of her car accident, was denied coverage because the insurance company claimed that the car accident fell into a “gray area”.

If you have made an insurance claim and the insurance company has wrongfully delayed paying the claim or denied the claim, contact us today for a free case evaluation.