The Morris Law Firm Blog

January 7, 2011

Insurance Commissioner Mike Geeslin Won’t Seek Reappointment

Filed under: Uncategorized — Tags: , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 3:15 am

Texas — Insurance Commissioner Mike Geeslin Won’t Seek Reappointment: CENTRAL [01/06/11] Texas Insurance Commissioner Mike Geeslin announced Wednesday that he doesn’t want to be reappointed to another term as head of the Department of Insurance.

In a letter to Gov. Rick Perry, who appoints the commissioner, Geeslin said that after eight years with the department — including five and a half as commissioner — he has decided to leave.

“This request is based on many considerations; the foremost being my family, and the other being the simple realization that it is time for someone else to lead,” the commissioner wrote.

Geeslin has not indicated what his future plans are. His term ends Feb. 1, and he said he will “serve in whatever capacity is necessary for a smooth transition.”

In his letter, Geeslin noted that the Texas insurance market has gone from $78 billion in 2005 to $102 billion now, “a sizeable force in both the United States and the world.”  The same period saw the merger of the state’s insurance and workers’ compensation agencies, several major hurricanes, a major economic downturn and other challenges, Geeslin said.  “My tenure at (the department) has proved to be the experience of a lifetime…Still, regardless of how much one enjoys the work, good agency management necessitates constant attention to developing leadership. Hence it is time to commence with change,” Geeslin wrote.

Mark Hanna, public relations and membership director for the Insurance Council of Texas, said Geeslin’s successor “will soon find out that holding the position of Texas insurance commissioner is one of the most difficult and demanding jobs in state government.”  Geeslin’s replacement will be chosen by Perry, and subject to confirmation by the Texas Senate.

Source: Texas Department of Insurance

December 21, 2010

Neck and Back Impairment Ratings

If you have a Texas Workers’ Comp claim for injuries to your neck or back, eventually you will be found at maximum medical improvement and receive an impairment rating.  To calculate impairment ratings, the Texas Division of Workers’ Compensation requires doctors to use the Fourth Edition of the AMA Guides To Permanent Impairments. 

Spinal impairments are rated per a Diagnosis-Related Estimates (DRE Model).  There are eight category levels of spinal impairments.  The greater the category of the DRE, the higher the percentage of the whole body impairment rating. 

     DRE CAT I: This category is used for injuries that only manifest as complaints or symptoms.  The level provides a 0% impairment rating.

     DRE CAT II: Clinical signs of an injury are present without radiculopathy or loss of motion segment integrity.  This level provides for a 5% impairment rating.

     DRC CAT III:  Evidence of radiculopathy is present. *  At this level a cervical impairment is 15%, while a lumbar or thoracic  impairment is a 10%.

     DRE CAT IV: Loss of motion segment integrity or multilevel neurologic compromise.  Cervical injuries provide at 25% impairment rating and lumbar/thoracic receive a 20% impairment rating.

The higher categories require greater levels of impairment.  You should always consult with your doctor and an attorney for your work related injury.  Spinal injuries have many pitfalls that should not be pursued without expert medical and legal advice.  At the Morris Law Firm (www.themorrifirm.net) , we’ve been handling work injuries since 1996.  Call our Dallas office at (214)357-1782. 

* The Texas Division of Workers’ Compensation has added the additional requirement of a loss arm or leg reflexes or atrophy of at least 2 cm above the knee or elbow on the affected side to establish radiculopathy.

November 19, 2010

Texas Work related Compensable Injury

Filed under: Accidents, Workers' Compensation — Tags: , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 10:10 pm

If you are injured at work in the state of Texas, how will you be taken care of? Your employer may carry workers’ compensation insurance, or they may be a non-subscriber to the workers’ compensation system. Deciding how the claim will be handled is like a course in journalism. You need to ask: who; what; when; where, why and how the injury occurred.  Hurt at work, work related injury, texas work injury, denied claim, work injury, work accident, hurt at work, Texas Department of Insurance, work injury, hurt at work

Who: For a person to be covered under the employer’s workers’ compensation policy, the person must be an employee, an independent contractor that is under the control of the employer, a borrowed servant or a have a relationship on the insurance that would include the injured worker.
What: What happened to the worker to cause injury? Injury means damage or harm to the physical structure of the body, or a disease or infection naturally resulting from the damage or harm. Pain in itself is not considered an injury. There must be some form of diagnosis indicating an injury. Some injuries are clear at the time of the accident (i.e. broken arm, hurt back or head injury). However, other forms of injury (i.e. RSD, a herniated disc, psychological conditions or neuropathy), may not become manifest for years after the injury.
When: Compensable injury means an injury that arises out of and in the course and scope of employment. To be considered in the course and scope of employment, an injured worker must show that the accident occurred while performing activities furthering the business of the employer. The activities can include such things as a company picnic, injuries while at break or injuries entering or leaving the employer’s property.
Where: An injured worker will have their injuries covered even if not on the clock when you are in an area controlled by your employer.
Why: The Texas Workers’ Compensation system does not look at fault or negligence. As long as the injury did not occur as a result of the workers’ willful attempt to injury themselves or another, while in a state of intoxication or while the worker was involved in horseplay.
How: There are specific event injuries, occupational diseases and repetitive motion injuries. Work related injuries can include aggravations of a pre-existing condition. Additionally, the employment need not be the sole cause of the injury. You must establish that the employment is a producing cause of the injury.
Bottom line is that if you are injured at work, talk to the Morris Law firm at our Dallas office. We can be reached at (214)357-1782, or by email at info@themorrisfirm.net. We can help you with the answers you need.

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October 25, 2010

Top 10 Ways To Avoid A Denied Claim

Filed under: Workers' Compensation — Tags: , , , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 3:58 am

The only thing worse than getting injured at work, is getting injured without the injury being covered by your insurance. The following list covers some of the major pitfalls people encounter after they file a Texas Workers’ Compensation claim.
1) Report the injury as soon as possible.
a) If a claim is denied, the sooner it was reported, the easier it will be to resolve.
b) Especially with occupational diseases (repetitive motion injuries), the date of injury and timely reporting generally become issues in the claim.

2) Get written statements from any co-workers that know relevant facts.
a) Co-workers are a lot more likely to write something down when there is no dispute and they are not concerned about retribution from the employer.
b) Just a one or two line hand written statement like “I saw John trip over a pallet” will suffice.

3) Make sure your employer creates a written report, even if it doesn’t appear to be serious.
a) Many supervisors are busy. If a report isn’t created they may forget.
b) Some companies have policies that the supervisor may be written up for not creating a report, creating the chance that the supervisor may lie to protect their job.
c) A written report creates a clear paper trail and may provide written notice to the insurance carrier.

4) Be as clear as you can when describing how the accident occurred.
a) If there are different versions as to how the accident happened, insurance carriers will use this to deny the claim
b) Always check how your employer, medical providers, insurance carriers and law firms describe the accident. Make sure they are being accurate.
c) Specifically in your recorded statement, do not let them confuse you.

5) Acknowledge any prior accidents.
a) The insurance company will run a record check to see what other work or auto injuries you have had.
b) Most of the time a prior accident will not affect any new injuries.

6) Have a medical exam with a doctor that is not the company doctor as soon as possible.
a) If a clinic states that they only need the most serious condition and will treat the other conditions later, do not trust them.
b) A medical provider that has the patients interest will list all the conditions, even if some require attention first

7) Maintain a calendar noting the dates of events.
a) A calendar will log the events of your injury, so you don’t have to guess after time has passed.

8) If you’re able to continue working, do so.
a) You will earn more from your salary than from disability.
b) Being active (as long as it doesn’t make the injury worse), usually speeds up recovery.

9) Follow through with your medical treatment.
a) The diagnostic tests and physical therapy from your medical provider are the clearest indication of an ongoing injury.
b) If you abandon your medical care, it will be assumed that you are at maximum medical improvement, which could end your disability benefits.

10) Get an attorney involved as soon as possible.
a) An attorney will help you avoid traps created by the insurance carrier.
b) Attorneys do receive a percentage of your benefit. But, most of something is always better than all of nothing.
c) Call (214)357-1782 for assistance. If your near the Dallas Fort Worth area make an appointment to see if we can help you.

October 7, 2010

Disputing Impairment Ratings

Filed under: Workers' Compensation — Tags: , , , , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 8:50 pm

Traditionally, a claimant could dispute their impairment rating by completing a DWC-32 form requesting a designated doctor for maximum medical improvement (MMI) and/or impairment rating (IR).  If the rating came from a designated doctor, the claimant had ninety (90) days (from the date of receipt) to fill out a DWC-45, stating that they wished to dispute the MMI and IR.  No evidence or even a hearing was required to stop the ninety (90) day window from expiring.

With the changes in Rule §141, disputing impairment ratings have become more complicated.  Claimant’s can still dispute rating by filling out a request for a designated doctor.  However, if the rating is from a designated doctor, the claimant must request a Benefit Review Conference (BRC) by providing a complete DWC-45 disputing the MMI and/or IR.  For the form to be considered complete there must be sufficient evidence to support the claimant’s position along with evidence of attempts to resolve the issue prior to requesting the hearing.

If the claimant does not submit a complete request, the ninety (90) day window could run thereby eliminating injured workers’ right to dispute the rating.  This could result in an injured worker being stuck with an inaccurate IR.  If the ninety (90) days has already run, ratings may only be disputed if there is compelling medical evidence meeting one of the statutory exceptions under Texas Labor Code §408.123(f).

To dispute MMI and IR, claimant’s legal counsel and treatment provider must coordinate quickly to prepare evidence to protect the claimant’s rights.  If you have any questions about disputing an impairment rating call our Dallas office at (214)357-1782.

October 1, 2010

Benefit Review Conference, The New Rules

Filed under: Workers' Compensation — Tags: , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 9:43 pm

Beginning October 1, 2010, The Division of Workers’ Compensation (DWC) will change how they grant Benefit Review Conferences (BRC).  Prior to the change, an injured worker could fill out a DWC-45 requesting a BRC along with some information as to their position, and one would be set.

Under Rule §141.1, the DWC will now review the DWC-45 for completeness.  If the form is found to be incomplete, the hearing will be denied.  In a workers’ compensation claim, there are many time sensitive issues.  If the DWC-45 is denied, the injured worker may lose the ability to have the issue addressed.

The injured worker must show documented evidence as to how they attempted to resolve the issue with the insurance company prior to requesting the hearing.  Additionally, the DWC’s position is that if the reviewer feels that the party did not make sufficient efforts to resolve the issue, the request will be denied.

The documentation that is relevant to the issue must be exchanged with the insurance carrier and the DWC prior to the BRC.  Once the BRC has been set, either party may request that the hearing be rescheduled within ten days of the receipt of the set notice.  After the tenth day, the party must show good cause for their continuance to be granted.

The DWC is clearly making it harder to get a hearing.  Do not attempt to go through the hearing process without an attorney that is experienced in the Texas Workers’ Compensation system.  At the Morris Law Firm, PLLC, we have been helping injured workers in the DFW area and all of North Texas,  for the last 15 years.  Call us at (214)357-1782 or contact us at info@themorrisfirm.net.

July 6, 2010

Overcoming an Intoxication Defense

Filed under: Uncategorized, Workers' Compensation — Tags: , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 9:55 pm

After an injury, many employers require their employees to have a drug screen performed the day of the injury. The testing is not to help the injured worker recover from his injuries. It is performed to allow the employer and insurance carrier to dispute the compensability of the injured worker’s claim. If an injured workers’ refuses to be tested, this does not mean that he is automatically considered intoxicated.  Might as well be fired for refusing the testing, than for a positive test.

If an injured worker is found to be intoxicated (does not have the full use of his physical and mental faculties) at the time of the accident, the insurance carrier is not liable for the workers’ compensation claim.  (See Tex. Labor Code §406.032(1)(A)).  It does not matter that the accident was not the fault of the claimant.  The intoxication serves as an absolute exception to liability, regardless of the cause of injury. See Texas Indemnity Insurance Company v. Dill, 42 S.W.2d 1059 (Tex. App.—Eastland 1931), aff’d 63 S.W.2d 1016 (Tex. Comm’n App. 1933).

You are not required to go to the company doctor.  The day of your injury, you should be seen by a doctor that will properly note all of your physical complaints from the accident.  A doctor providing treatment to someone who is injured should be more concerned about making their patient whole, then building a defense for an insurance company.

If the doctor you see tells you to only write down the most serious injuries and they will deal with the others later.  Be very weary of the loyalty of the doctor.  Do not allow the adjuster or your companies HR department to select your treating doctor.  Even if your employer is in a network, you have the ability to select your own doctor.  Call us, we can help you to find a doctor that has your interest at heart.

Intoxication is defined as the state of not having the normal use of mental or physical faculties resulting from the voluntary introduction into the body of an alcoholic beverage or controlled substance or controlled substance analogue.  This does not include medications taken by the injured worker, which were prescribed by a doctor to them.

The question of intoxication must be raised by the insurance company in a timely fashion.  If the insurance company fails to timely dispute the claim under the defense of intoxication timely, they are barred from doing so.

As the injured worker, you presumed to be sober at the time of the injury. Bender v. Federal Underwriters Exchange, 133 S.W.2d 214, (Tex.Civ.App.—Eastland, 1939, writ dism’d judgm’t correct).

However, if the injured worker tests positive for non-prescribed drugs or alcohol content, the burden shifts, as a matter of law, back upon the claimant to establish that he was not intoxicated at the time of the accident. If the insurance carrier presents “probative evidence” of intoxication to rebut the presumption of sobriety, then the claimant has the burden to prove that he was not intoxicated (had the total use of his physical and mental faculties) at the time of the injury. March v. Victoria Lloyds Insurance Co., 773 S.W.2d 785 (Tex. Civ. App.—Fort Worth 1989, writ denied).

If the injured worker refuses the testing, the burden does not shift as a matter of law.  See Appeals Panel Decision 033057.  However, the hearing officer may find that the  burden shifts through other evidence.

If the insurance carrier shifts the burden to the claimant in regards to intoxication, the claimant must prove by preponderance that he had the full use of his physical and mental faculties at the time of the accident.  Although, scientific or medical evidence is not required to establish sobriety, a one line statement that he was not intoxicated does not overcome the presumption.  See Appeal Panel Decision 062507-S.

The claimant may use the testimony of his co-workers, supervisors and other witnesses to establish sobriety.  Even witnesses that may e unwilling to testify as to sobriety may establish the same when they say that the claimant was allowed to operate dangerous machinery or equipment.  Testimony as to how long prior to the accident they had worked together that day, and claimant’s actions during that time period.

How long after the accident was the test administered?  If more than 24 hours has passed, most hearing officers will not consider the test.  If the testing was for alcohol, is the carrier trying to extrapolate the testing to shift the burden?  Many factors must be taken into consideration (ie weight, age, activity level, food intake…) to perform a proper extrapolation.

Who administered the testing?  If it was the employer, did they know how to properly administer the test?  How can they establish that it was not contaminated?  If it was for alcohol, was the machine calibrated properly?  It is not unusual that the employer does not have the proper expertise to administer testing after an accident.

Intoxication is a tricky area of a workers’ compensation claim.  Do not attempt to handle it yourself.  Contact an attorney to assist you.  You can call the Morris Law Firm to set up an appointment to go over your case at our Dallas location, (214)357-1782.

June 12, 2010

Work Injury 101 (What do you need to know and do after you’re injured)

Filed under: Uncategorized, Workers' Compensation — Tags: , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 4:01 pm

You’ve just been hurt at work. What happens now? How serious is your injury? Do you need medical attention? Are you going to miss time from work as a result of the injury? Does your employer have insurance to cover you? Who will pay your bills?
These are all important questions that you should ask yourself. When something happens, many of us try and down play what is going on. We’ve all had a pulled muscle that gets better over the weekend. We tell ourselves “by Monday I will be feeling fine and ready to go back to work.” But, what if this is not the case. You need to go through the proper steps to avoid complications.
The first thing to do is to report the incident to your supervisor. Even if you do not feel the need to seek medical attention, the sooner you report the injury, the fewer problems you will have in the future. Many companies will have you fill out an incident/accident report. If it wasn’t serious, no harm no foul. However, it turns out to be something that requires medical attention, you have it documented.
If you require medical attention, what type of insurance does your employer have? The State of Texas is the only state in the U.S. that does not require companies to be subscribers to workers’ compensation. If your company is a subscriber, your case will be handled through the Texas Department of Insurance (TDI), Division of Workers’ Compensation (DWC). If they are a non-subscriber, your company may have an Employee Retirement Income Security Act (ERISA), an Accident/injury policy or your employer may have no insurance at all. Each of the types of insurance has its own benefits and problems. You should always consult an attorney to get an understanding of how to handle your claim.
If your injuries require medical attention, finding the right doctor is one of the most important things you can do. Many employers will attempt to send their workers to a clinic select by the employer. Why do they do this? Whose interest will the company doctor have, yours or your employer’s? You need to select a doctor that will aggressively diagnose and treat you, to get you well and healthy as soon as possible. You do not need a doctor that will try and save money at the expense of your health. We can help you find a doctor in your area that will provide the proper medical treatment for you injuries.
If you need to miss time from work, the benefit plan will determine how you are to be compensated. If your company is a subscriber, the Texas Labor Code will determine what that rate will be. If your company is a non-subscriber, the policy may give a rate of compensation. If your company is a non-subscriber, you may have a cause of action against your employer for negligence.  In the Dallas or Fort Worth area, Contact the Morris Law Firm, PLLC to make sure you are receiving all the benefits to which you are entitled.

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