Austin, TX asked in Workers' Compensation for Texas

Q: I’m scheduled for ACL surgery tomorrow... how to proceed? Help...

I’m an Art Director who also organizes the company party’s & functions. It was the end of our holiday function, I was cleaning, an intoxicated coworker waiting on a sober ride who was wearing 3 inch heals took a tumble using me to stop her fall she pivoted us in a spin to the ground with her weight on top of me. My knee made a loud pop. I put a brace on it the next morning, came back to clean up. Monday it was worse so I tried to get an appt. Booked with the holidays... so I email my surgeon (my neighbor) that weekend and got him to squeeze me in. After the MRI I found out I have to have surgery. I was urged to make a claim after. When I went to ask my doctor’s office to send all my medical records & now they say they will have to process it another way and my insurance will have nothing to do with it and I have to pay out of pocket. Can I just proceed as planned and deal with this claim stuff after? The anxiety is too much.

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1 Lawyer Answer
Roy Lee Warren
Roy Lee Warren
Answered
  • Workers' Compensation Lawyer
  • San Marcos, TX
  • Licensed in Texas

A: There is an old (? before I was practicing law) Texas Supreme Court (TSC) Decision that ruled if one of two insurance carriers (health care insurance or workers comp carrier) owe benefits to a person they are to pay and basically figure out who owes between them. Making the injured party pay was bad faith. (I think the name of the case was either Aranda or Arnold).

However the TSC issued another decision just a couple of years back (named as Ruttlinger v. TMI) abolishing bad faith against wc carriers. So I recommend you file your claim with wc and with your health care provider. Be aware if your employer is in a "network" you MUST go to its medical providers or you could wind up owing for the medical care. I am sorry for your predicament. Also know that if your employer had actual knowledge of your injury then it has a duty at that point to file a notice of claim with the carrier and its failure to do so could have ramifications as for being able to dispute your claim. Good luck on getting it resolved

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