Workman's Comp Insurance Can't Find a Doctor...

by Danny
(Sherman, TX USA)

I injured my right shoulder on the job. My company has private insurance instead of Texas workman's comp, but goes by the same rules if it's to their advantage. I've had 2 surgeries and my shoulder still isn't repaired.

I could not get to a specialist doctor as they would not accept the insurance. I was told by the insurance claims adjuster that all benefits ceased as of June 1, 2011. Now I'm having to use my own health insurance to get my shoulder repaired.

Can the insurance company be held responsible for these charges as I was hurt on the job and none of their referred doctors could fix my shoulder?

Visitor Question:
Disclaimer: Information provided in our response is NOT formal legal advice. It is generic legal information based on the very limited information provided. Under no circumstances should the information in our response, or anywhere else on this site be relied upon when deciding the proper course of a legal matter. Our response does NOT create an attorney-client relationship. Always get a formal case review from a licensed attorney in your area.

ANSWER for "Workman's Comp Insurance Can't Find a Doctor...":

Danny (Sherman, TX, USA):

That’s a complex question requiring a complex answer. If you were injured on the job and your company didn’t have workmans compensation insurance, but rather private health insurance, your injuries and the medical treatment necessary to treat them should have been provided in full.

You mentioned “(you) I could not get to a specialist doctor as they would not accept the insurance”. Is there a reason you didn’t ask your employer which specialists their insurance did cover?

Although you didn’t mention when the injury occurred, the insurance company has a right to decide when they will discontinue offering compensation for your medical treatment. If you don’t agree with their cut-off date and feel you were wronged, you can always file suit against your employer.

The most important thing to remember is the Statute of Limitations period. The Statute of Limitations is a legal term meaning the time period between the date of the injury and the final date the injured party has to either settle the case, or file a lawsuit.

Of course there isn't any legal prohibition against an employer continuing to voluntarily offer compensation for an employee’s injuries after the Statute of Limitation period expires.

But if the employer chooses not to voluntarily continue those payments then you will be bound by the Statutory time. In cases of employee injuries in the State of Texas, the Statute of Limitations if 2 years.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.

Best of luck,

Judge Calisi

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