In April of 2007 Charles Robison, a worker for Texas-based West Star Transportation, suffered a traumatic brain injury after falling headfirst off an unevenly loaded flatbed trailer. At the time of the accident, West Star had “opted-out” of the Texas workers’ compensation system and forfeited its protection against negligence law suits by its employees.
Mr. Robison filed a lawsuit in January of 2009 against his employer, and a jury found that West Star’s negligence caused Mr. Robison’s injuries. He was awarded $5.3 million dollars in damages.
The judgment included: “$3.7 million for Mr. Robison’s past and future medical care, $1 million for past and future physical pain and mental anguish and $400,000 for Ms. Robison’s past and future loss of consortium, as well as additional payments for Mr. Robison’s loss of earning capacity and physical impairment.”
On January 23, 2015 a three-judge panel in the Texas 7th Circuit Court of Appeals unanimously upheld the jury’s decision. Employers who want to be allowed to “opt-out” of workers’ compensation programs need to understand that one of the great benefits to the employer under workers’ compensation is the protection against civil law suits.
Original post by Sheena Harrison, writer for www.businessinsurance.com
Will Medicare cover my future medical expenses for my workers’ compensation injury if I settle my case? Yes, no, maybe…the answer to this question is always a tricky one. In fact, this is one of the most complex questions that will confront an injured worker at the time of settlement.
Most settlements are final. Once you agree, you may have created a binding contract that will have serious financial repercussions for you and your family. It’s best to be prepared ahead of time so you fully understand the potential impact of a settlement. Settlement agreements cannot be set aside except in very rare circumstances. Before settling your case, you should take a full accounting of your future medical expenses and your insurance coverage. In reviewing your medical needs, do not forget to account for over-the-counter medications. These costs add up quickly over time.
If you are already a Medicare beneficiary, it’s quite likely you will need to set aside a portion of your settlement for future medical expenses. Medicare may refuse to pay for medical coverage relating to your injuries unless you’ve allocated some of the settlement funds for future medicals. Determining how much to set-aside is another complicated question and usually an outside company is hired to help assist with this determination.
Furthermore, injured workers must also take into consideration the fact that there are certain medical expenses that Medicare may not cover. For example, when an injured worker needs someone to take care of them. Medicare will not pay for these services so the injured worker would be forced to pay if she failed to negotiate this amount prior to settlement. Also, even when Medicare does help foot the bill, the injured worker will still likely pay the coinsurance amount (typically 20%). In short, be careful and think about future medical expenses.