WFAA TV in Dallas reports that a Texas District Court judge has ruled that the state’s largest workers’ compensation insurance carrier committed fraud against an injured worker. It is interesting to note that this insurance company has lobbied extensively before the Texas Legislature for immunity from bad faith claims arising from the wrongful denial of benefits to injured workers. I guess now we know why this issue has been so important to them. Here are excerpts from the story:
Texas Mutual Insurance Company has already been accused of callously denying claims against injured workers, but allegations of falsifying records could be a first.
Questions about Texas Mutual’s business practices were first raised in a News 8 Investigation four years ago.
Injured workers complained that the insurance carrier was randomly denying their claims and robbing them of much needed medicine and benefits.
District Judge Martin Hoffman issued a ruling declaring "Texas Mutual Insurance Company committed fraud on this court" by "falsifying a critical medical record."
The record was a doctor’s report in which someone added letters that tend to support the insurance company’s position in the case.
"This fraudulent conduct was committed knowingly by agents and representatives of Texas Mutual Insurance Company," Judge Hoffman said.
The judge ordered Texas Mutual to pay $30,000 and publish the court’s ruling on their home page on the Internet.
State Workers Compensation officials said they are already reviewing the facts of the case. Texas Mutual officials have yet to respond.
Worker’s Comp is totally set up to victimize injured workers. It’s no wonder that the few doctors who do treat injured workers fail to report all the obvious injury; when their reports go before a peer review and if the industry and carrier friendly peers don’t match the doctors, the doctor is removed from the approved doctor list and no longer gets paid. Now. we know why ethical doctors want no part of Texas Worker’s Comp. In my case, the list of approved network doctors submitted to TDI was totally bogus. Many on the list have never accepted worker’s comp and none sccepted older cases. Bad faith and deceptive trade practices are SOP with the carrier and now Texas Supreme Court is expected to remove the only remedy injured workers have in dealing with a bought and paid for system.