Problems With Insurance Plans Offered by Non-Subscriber Employers

Texas law allows employers to choose whether or not they want to subscribe to workers' compensation. While employers are free to opt out of government-sponsored benefits, not all non-subscribers offer zero compensation to workers who suffer an on-the-job injury. Many non-subscriber employers offer an alternative insurance plan to cover the costs of work-related accidents.

How Employer-Funded Injury Benefits Differ From Workers’ Comp

Although workers' compensation and non-subscriber insurance both offer payment for workplace injuries, they are very different benefit systems. Workers’ compensation provides coverage for medical expenses and lost wages that can last indefinitely, issues payment regardless of fault, and offers protection from workplace retaliation.

On the other hand, coverage offered by a non-subscriber employer can vary from company to company. In general, plans cover fewer injuries and allow employers to stop benefit payments at any time—and policies are not required to provide job protection to injured employees.

Some of the problems with benefits offered by Texas non-subscribers include:

  • Inadequate coverage. Employer injury benefits may be subject to maximum dollar amounts that are often exceeded before the injury has healed. Companies may also offer a small amount of payment for certain treatments that only cover a few hundred dollars of care.
  • Exceptions. Employers are able to pick and choose which injuries are covered, as well as which conditions are specifically exempt from compensation. For example, a company that is likely to see large numbers of carpal tunnel syndrome may exclude cumulative trauma injuries from coverage in order to save the company money.
  • Time limits. Employers are free to end benefits paid to an injured worker at any time, regardless of whether the injury is healed or the employee is able to work. In contrast, workers' compensation benefits may continue indefinitely.
  • Lump-sum payments. Injuries that are likely to have high costs may only be covered under a one-time payout. In many cases, death benefits may be paid in a lump sum for an amount that is less than half what the claim would be worth under workers’ compensation.
  • Lack of medical privacy. Employers can dictate which doctors an employee must see, how many appointments will be paid for each year and may also require that someone from the company accompany the injured worker to a doctor's appointment.
  • Small reporting windows. Companies can write their own rules regarding the reporting of injuries, and may deny all benefits if an accident is not reported within 24 hours or even before the employee’s shift is over.
  • Unfair appeal process. As employers have complete control over the benefits system, the injured worker’s complaints are addressed by the same company that is paying for the benefits, creating a significant conflict of interest.

Filing a Lawsuit Against a Non-Subscriber Employer With Company Benefit Plan

While employees covered under workers’ compensation are barred from suing their employers, employees may file injury claims against a non-subscriber employer even if they were provided benefits under an alternative compensation plan. You may be able to pursue a case against an employer if:

  • Your employer did not have a workplace safety program in place
  • Your non-subscriber injury plan did not cover your occupational injury, aggravated injury, or other work-related trauma
  • Your employer did not adequately communicate the difference between the non-subscriber program and workers’ compensation
  • An employee was killed on the job
  • You have strong medical evidence that your injury will not improve
  • Your employer actively tried to discourage your claim or retaliate against you
  • Your employer did not comply with state or federal workplace regulations
  • Your employer was somehow at fault for causing your injury

If your work injury prevents you from earning a living, we can help. Our attorneys can take up the fight on your behalf, getting you the payments you need for medical treatment, disability, and lost wages. Contact the Packard Law Firm today to set up your free, confidential consultation to find out how much your non-subscriber claim could be worth.