Injured workers will find that the insurance industry has "reformed" the workers compensation system in Texas so that legitimate claims are routinely denied and delayed.
Martin, 45, has undergone 11 surgeries to repair his various injuries. He was away from work for two years. Such treatment is built in progressive stages, many of which—like his helicopter evacuation—were initially denied by the insurer and only later approved.
The chain of repeated denials of treatment not only kept him from recovering sooner but also left him with deep, nerve-enveloping scars that today cause sharp tingles he says feel like ants constantly biting his hand.
As a law enforcement officer, Martin knows it’s best to have backup. But he never had a lawyer to help him through the adversarial, multilevel administrative maze that is the Texas Department of Insurance’s Division of Workers’ Compensation. He never had an administrative hearing. His case played out in an endless stream of letters and phone calls between his doctor, an insurance adjuster and various division officials.
Martin was, however, assigned a case-manager nurse, who was at his side on most of his doctor visits and who helped him with paperwork. He later learned that she worked for the claims management company that was denying his medical treatment, and impeding his recovery and rehabilitation.
http://www.abajournal.com/magazine/article/insult_to_injury_texas_workers_comp_system_denies_delays_medical_help/
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