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Changes in the Compensation Laws

Were you aware that on September 1, 2005, the Texas Legislature passed one of the most impacting and far reaching changes to the Texas Workers’ Compensation System. Not since the 1989 legislative changes has the workers’ compensation laws been so drastically changed. Under these changes, insurance carriers, along with the employer, will have the authority to create its own workers’ compensation healthcare network, hence deciding who you choose as a treating doctor. This change in the law can be navigated, call our Law Firm for details.

These new law changes effect:

  • Your ABILITY to chose your own doctor
  • Your ABILITY to file complaints and disputes with the insurance carrier
  • Your ABILITY to have your case heard before a Judge
  • Your ABILITY to dispute medical denials

In addition to the current ability to determine MMI and IR, a designated doctor will have the following NEW authority:

  • To determine the Extent of the injured workers’ compensable injury
  • To determine whether the injured worker’s DISABILITY is a direct result of the work-related injury
  • To determine the ability of the employee to return to work
  • To determine the employee’s ability to return to work after the second anniversary of entitlement to supplemental income benefits
  • There is a new legal standard in overcoming the opinion of a designated doctor.

As you may anticipate, the expansive role of a designated doctor will have a large impact on your case.

What Types of Doctors may Offer Opinions Regarding Your Claim?

Currently, only a handful of new rules have been promulgated to coordinate the affect and timing of these statutes. Also, there are several rules that conflict with the new law changes, which has created procedural and substantive problems to Texas Workers’ Compensation cases. It is our opinion that an injured worker must be apprised of these changes and have a thorough understanding before going forward to a hearing.

New rules and policies are being incorporated into the workers’ compensation system all the time and it is critical that an injured worker keep updated on these changes. At Carabin Shaw, we are able to continue to provide quality services in light of these changes.

Work injuries in the past have been the responsibility of the Texas Department of Workers’ Compensation Office, and now it has been abolished! A new State (i.e., Department of Insurance, Division of Workers’ Compensation) agency will be responsible for all Texas work injuries. This new agency will be able to make and enforce rules affecting workers’ compensation claims. Therefore, we can expect changes in how workers’ compensation claims are handled. Even simple things like using the correct form will become more complicated as you must track down the current version.

On the forefront of the changes of Texas Workers' Compensation is the creation of doctor networks. Unfortunately, it is the insurance who will create the networks and it is your employer that will subscribe to them. Significanlty, the insurance company will determine which doctors are in the network. No longer will you be able to go see your doctor of preference. As a result, knowing which doctors you can and cannot see may become a problem. In our opinion, this new change in the law gives the network doctors an incentive to send injured workers back to work prematurely, even if the injured worker is still badly injured.

Another big change in the law is that you are now limited to two (2) conferences that can be requested before attending a final hearing. In the past, it was common to meet with the State and the insurance representative at a conference to see which issues could be worked out. Sometimes there were various conferences to see if an issue could be resolved, and only if all parties were unable to work anything out would the matter be set for a final hearing. This new limitation means you must be prepared from the very beginning as though it will not be worked out at the conference and have everything ready for the final heairng. You therefore must be prepared to meet the many deadlines for exchanging documentation and preparing for the final hearing. Otherwise it is very likely you will lose before you even get to the hearing. Again, this is yet another reason why it is more important than ever to obtain an attorney, even before problems arise.

We expect many more changes throughout the upcoming years. And we do not expect the the insurance company to keep you informed of these changes. At Carabin Shaw, we will keep you updated with new rules and laws. We know the new law, we keep up with the changes, and we use our knowledge and experience to protect you so that you do not lose the valuable medical and money benefits you deserve under the law.

Call us for a FREE consultation at 210-222-2288 or 800-862-1260, even if it is just to ask a question over the phone. Thanks for calling us. We’re stand ready to help you with your workers' comp claims.

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