Latest / Blue Grit Podcast: The Voice of Texas Law Enforcement / #017-"Workers Comp Was Not Written For You..."

Transcript

#017-"Workers Comp Was Not Written For You..." · Blue Grit Podcast: The Voice of Texas Law Enforcement

0:02
SPEAKER_00: As I say, if you forget everything I tell you today, remember workers' comp is broken.
0:07
SPEAKER_00: Workers comp was not written for you, it was written for the benefit of an insurance company.
0:14
SPEAKER_00: Only way that I can be paid in a workers' compensation case by law is through the benefit checks of the injured worker.
0:24
SPEAKER_02: All right, Blue Grip family, welcome back.
0:27
SPEAKER_02: You guys hit that subscribe button and uh hit the uh the download button on the podcast platforms.
0:33
SPEAKER_02: I'm Tyler Owen, your host.
0:35
SPEAKER_02: We've got some special guests, our Texas TMPA ledge team, John, the man, the myth, the legend, Wilkerson, one of our ledge lobbyist guys, the one that marches the halls of the Texas Capitol.
0:50
SPEAKER_02: Used to be a field rep, and you went on the dark side now.
0:54
SPEAKER_02: They're what is the address at the Capitol?
0:56
SPEAKER_01: You know, I'm still not sure.
0:58
SPEAKER_01: I know what our I know what our address is downtown at the at the little office, and then we walk a block down and a block uh west, and there I am.
1:05
SPEAKER_02: Well, I know that you're a busy man.
1:06
SPEAKER_02: You start your day.
1:07
SPEAKER_02: What we just got through talking about at what 5 a.m.
1:09
SPEAKER_02: You're pretty much at the Capitol, and it ends sometimes midnight, one o'clock.
1:13
SPEAKER_02: It depends on what committees are going.
1:15
SPEAKER_02: And if you're a lazy man, the session is not someone that uh you need to be involved with because you're a busy guy.
1:20
SPEAKER_01: Yeah, no, it's uh it's typically you're there at five o'clock in the morning.
1:24
SPEAKER_01: Uh, because you you know you gotta you gotta take that time and and go through emails and go through legislative drafts that are sent over to you, and then uh, you know, and then be ready to go in there and the doors when they open up at eight and meet with the offices and staff and get things going.
1:39
SPEAKER_02: Yep.
1:39
SPEAKER_02: So our for the viewer, listener, watcher, uh, for you guys that don't know, our our ledge team is consisted of John Wilkerson, uh Dallas Reed, Mitch Landry, and uh John Sarrega.
1:52
SPEAKER_02: Uh the main two that are at the Capitol every single day, every night is uh John Wilkerson in Dallas, and then uh Mitch when he can.
2:00
SPEAKER_02: Uh, we all know, and and those that know Mitch, uh you can't break him away from the Capitol.
2:05
SPEAKER_02: He loves being down there, but that's that's essentially our four uh our four amigos that are down there at the Capitol day in, day out, that are fighting for bills.
2:13
SPEAKER_02: But John is very much instrumental in the uh in the ledge team.
2:17
SPEAKER_02: So anyway, we got some important stuff to talk about today.
2:20
SPEAKER_01: Yeah, so uh, you know, what we we did a podcast before where we talked about some of our legislative priorities.
2:26
SPEAKER_02: Yes, sir.
2:26
SPEAKER_01: Uh one of those priorities is the workers' confidence compensation uh reform that we're that we're looking at doing.
2:32
SPEAKER_01: And uh, you know, there's and that's just one piece.
2:35
SPEAKER_01: Like you said, there's many of us on the team, uh, and we're all working on different things.
2:38
SPEAKER_01: Dallas is down there right now working on some important stuff that that he's he's working on on some of the other ledged priorities.
2:44
SPEAKER_01: Yep.
2:44
SPEAKER_01: Uh but part of that process is is we uh you know the workers' comp system is just highly complicated.
2:49
SPEAKER_01: I mean, you want to talk about a cure for insomnia and start trying to read you know workers' comp laws.
2:53
SPEAKER_01: I mean, it'll put you to bed pretty quick.
2:55
SPEAKER_01: Uh and and so part of that is is we we went out and we found a subject matter expert, which is a gentleman sitting here on my right, uh, Mr.
3:03
SPEAKER_01: Aaron Allison, who's a workers' comp attorney out of here in Austin, Texas.
3:07
SPEAKER_01: Welcome, Aaron.
3:08
SPEAKER_01: I appreciate you being here, man.
3:08
SPEAKER_01: I'm happy to be here.
3:09
SPEAKER_01: Yeah.
3:10
SPEAKER_01: Yeah.
3:10
SPEAKER_01: So uh, you know, we went to all we went to Aaron and and I said, look, I said, this nobody understands this thing, uh, but we know it's broken because we've got all these members calling in saying we're f, you know, we're tired of fighting with the workers' comp insurance carriers.
3:23
SPEAKER_01: Uh so I went to Aaron and I said, hey, let's not try to change the entire system in one legislative session, uh, but let's, you know, pick me a handful of things, just four or five things that that you feel would make the most impactful difference.
3:36
SPEAKER_01: Yeah.
3:37
SPEAKER_01: Uh and let's start with that.
3:38
SPEAKER_01: Let's let's focus on that.
3:40
SPEAKER_01: And so that's what led to the information found in House Bill 790, which has been filed by Representative Patterson.
3:47
SPEAKER_01: It was heard last week uh in the business and industry committee on the House side.
3:51
SPEAKER_01: Uh had a lot of great witnesses there testifying in support of the bill.
3:54
SPEAKER_02: Yeah, big shout out to those witnesses that came down and did that.
3:56
SPEAKER_01: Yeah, absolutely.
3:57
SPEAKER_01: And so what we wanted to do today is put a podcast out there and get some more information to our members that are, you know, uh either currently in the system of workers' compensation hell for lack of better terms.
4:12
SPEAKER_01: Right.
4:12
SPEAKER_01: Uh, or those who may find themselves there one day.
4:15
SPEAKER_02: Yeah.
4:15
SPEAKER_01: Uh so you know, just kind of wanted to talk about uh, you know, that that entire system and that process that that goes on with that.
4:23
SPEAKER_01: And uh we have a good subject matter expert here to help walk walk us through that.
4:28
SPEAKER_01: Um so Aaron, can you can you talk briefly about yourself and introduce yourself to or are they are the listeners or viewers or all right?
4:36
SPEAKER_02: So my co-host is out.
4:38
SPEAKER_02: He is uh he is in training, so he says he's in class.
4:43
SPEAKER_02: You know, there's excuses and me being me, and I'm not the most well-educated man.
4:48
SPEAKER_02: Clearly, I'm here hosting a podcast here at TMPA.
4:51
SPEAKER_02: Uh, I think my personality is probably what got me by throughout school.
4:55
SPEAKER_02: So I screwed up one day and said watchers instead of viewers.
4:59
SPEAKER_02: And so I've stuck with that.
5:00
SPEAKER_02: So I'm gonna stick with viewers instead of watchers.
5:04
SPEAKER_02: I've learned that over the podcast classes that I've been to, but listeners and viewers is the proper terminology, I guess, in the podcast and the television industry.
5:13
SPEAKER_02: Gotcha.
5:14
SPEAKER_01: Okay, so if you would uh Aaron, if you'll tell our watchers and listeners uh a little bit about yourself and sure.
5:23
SPEAKER_00: Um I'm Aaron Allison.
5:24
SPEAKER_00: Um I'm a personal injury trial lawyer and a workers' compensation injury trial law specialist.
5:29
SPEAKER_00: I've been practicing uh in about 20 years in Austin, um, exclusively in personal injury and workers' compensation for the injured worker exclusively.
5:40
SPEAKER_01: Good deal.
5:41
SPEAKER_01: So, Aaron, let's let's just walk through the process.
5:43
SPEAKER_01: Okay, I I've been through the workers' compensation system myself.
5:46
SPEAKER_01: Uh fighting a bad guy circa 2007-ish, something like that.
5:52
SPEAKER_01: Go down, bad guy comes down on top of me here, pop in my shoulder.
5:56
SPEAKER_01: Uh, go down, you know, pick myself up.
5:59
SPEAKER_01: Bad guy is in jail, he's in custody.
6:01
SPEAKER_01: Grab back at it, you know, jump back in my crown Vic, you know, the world, the best police car ever made ever made, yes.
6:07
SPEAKER_01: Uh so jump back in my crown Vic and I drive down to the emergency room and they take some x-rays and they say, Yeah, nothing's broken.
6:13
SPEAKER_01: You know, here you go.
6:14
SPEAKER_01: Just uh take it easy for a couple days and uh follow back up with your primary care uh specialist.
6:20
SPEAKER_01: Yeah.
6:21
SPEAKER_01: So I go to my doctor, and my doctor takes one look at it and says, Oh, worker's comp?
6:24
SPEAKER_01: Hell no.
6:25
SPEAKER_01: I don't want nothing to do with that.
6:27
SPEAKER_02: Yep.
6:27
SPEAKER_01: Uh so then I got to contact the insurance carrier, and they they put me in contact with a general medicine doctor, and he sends me off for two weeks of physical therapy.
6:37
SPEAKER_01: And on the last day of physical therapy, the doctor comes over, he puts his hand on my uh or the therapist puts his hand on my shoulder, he's feeling around, and he uh he calls another therapist over and he says, Hold on just a minute.
6:50
SPEAKER_01: The other therapist comes over and he messes around with it.
6:52
SPEAKER_01: And I looked at him and I said, You know, in my line of work, when we call our partner over, it's not good.
6:58
SPEAKER_01: Something's either really funny or something's really messed up.
7:00
SPEAKER_01: And I don't see either one of you guys laughing.
7:02
SPEAKER_02: No.
7:03
SPEAKER_01: Uh so go back down to the doctor, doctor puts his hand on my shoulder, rotates my arm twice, says, How's it feel?
7:07
SPEAKER_01: And I said, It hurts.
7:08
SPEAKER_01: I almost punched you for doing that.
7:10
SPEAKER_01: And he says, Well, let's do two more weeks of physical therapy.
7:13
SPEAKER_01: And um thinking, you know what, the first two weeks didn't fix anything.
7:16
SPEAKER_01: I don't know about the next two weeks.
7:17
SPEAKER_01: Uh so I threw a fit and contacted workers' comp and they sent me to an orthopedic specialist, put me in for an MRI, and sure enough, I had a my my labrum was torn, entire all the ligaments that keep your bone into the shoulder.
7:31
SPEAKER_01: So a week later, I'm on an operating bed, uh getting some hardware put in my shoulder and getting it fixed.
7:36
SPEAKER_01: Obviously, there were some issues there.
7:39
SPEAKER_01: Um and so, in that scenario, in in a in a typical workers' comp scenario scenario, Aaron, uh, if you would, can you kind of talk to our members and let them know kind of what to expect when they're injured at work?
7:53
SPEAKER_00: Yeah, the first thing that you need to do when you're injured at work is you know go to the emergency room and get checked out.
7:59
SPEAKER_00: Emergency room care is is designed to stabilize you and and and give basic care, but they're always going to tell you to follow up with your primary care physician.
8:09
SPEAKER_00: Um they'll x-ray to see if there's any broken bones, but a lot of the time they don't perform CT scans or MRIs because of the cost-prohibitive nature of those exams.
8:19
SPEAKER_00: And unless they have some real fear and belief that you're seriously injured, they're going to give you the basic emergency room care and send you on your way to follow up with the primary care physician.
8:29
SPEAKER_00: Um after that, it's very important that you make sure you notify your chain of command and you document that you've notified your chain of command, your sergeant, your lieutenant, your captain, whoever, up the chain of command and document that in writing.
8:45
SPEAKER_02: And the easiest way to do that, and and this is what's this is what's mind-boggling.
8:48
SPEAKER_02: Everybody asks, well, how can I do that?
8:50
SPEAKER_02: It's a simple email.
8:51
SPEAKER_02: Send them an email, send them a text.
8:53
SPEAKER_02: Yeah.
8:53
SPEAKER_02: Well, yeah, an email probably best because that way you can't delete, but an email.
8:57
SPEAKER_02: That's the best way on a department email.
8:59
SPEAKER_02: Hey, this is what's going on.
9:00
SPEAKER_02: Boom, you can always search that.
9:02
SPEAKER_02: Yeah.
9:02
SPEAKER_02: I just wanted to follow up with that.
9:03
SPEAKER_00: Well, yeah, and and and make sure you you communicate up the chain of command, you document it.
9:08
SPEAKER_00: Um, and make sure you get usually first responders, the first party they're sent to after an injury on the job and they've notified their chain of command is usually sent to someone who's in HR.
9:18
SPEAKER_00: Yeah.
9:18
SPEAKER_00: And the HR person is usually the person that interfaces with the insurance carrier, the workers' comp carrier.
9:24
SPEAKER_00: That would be your next communication, would be to them and say, I've notified up through the chain of command that I've sustained this injury on the job, and what is the status of the workers' comp claim being filed?
9:35
SPEAKER_00: Yep.
9:35
SPEAKER_00: And make sure you follow up with them on that, and they make proper notice to the workers' comp carrier.
9:40
SPEAKER_00: And then take direction from them because once the workers' comp insurance carrier is notified, they have 15 days to do an initial investigation.
9:48
SPEAKER_00: And that's where they talk to your chain of command, they act, ask for an incident report, they communicate directly with the injured uh worker, uh, first responder, do a recorded statement just for their file.
9:59
SPEAKER_00: And then what they do is facilitate you going out to your primary care physician under workers comp through the HR director or the HR department.
10:07
SPEAKER_00: That's where you get your follow-up orders.
10:09
SPEAKER_00: You need to go to XYZ Medical or the doc in the box place off the highway to go see a usually a general practitioner in medicine.
10:19
SPEAKER_00: And that's where that person, that first doctor you see under workers' comp will be identified as the primary care physician, also known as the PCP.
10:27
SPEAKER_02: And what gives your doctor the right to refuse that?
10:31
SPEAKER_00: Well, if you go to your own doctor, there are a lot of doctors in Texas who do not take workers' comp because the billing rates on workers comp are very low.
10:41
SPEAKER_00: They're right around Medicare rates, and a lot of doctors don't want to accept that payment for their services.
10:46
SPEAKER_00: But also, billing under workers' comp is extremely complicated.
10:51
SPEAKER_00: There's different billing codes, there's there's more bureaucracy, more paperwork involved.
10:57
SPEAKER_00: Those doctors who take workers' comp injury cases and treat them usually have a dedicated person on staff in their billing department who's dedicated specifically for workers' comp and workers' comp billing issues, approvals, things of that nature.
11:12
SPEAKER_00: So if you're a doctor and you're doing workers' comp, you have the added cost of headcount, and you're not getting paid insurance rates for your services.
11:23
SPEAKER_00: So there are a lot of doctors uh in the state of Texas who don't do workers' comp.
11:28
SPEAKER_00: Fortunately, there are some specialists, orthopedic specialists uh in in Texas who do, who are really highly regarded.
11:36
SPEAKER_00: And I've asked them, why do you do workers' comp?
11:38
SPEAKER_00: You make very low rates on workers' comp.
11:41
SPEAKER_00: And their response is, well, workers comp is an injured person.
11:46
SPEAKER_00: Um, I want to help the injured.
11:47
SPEAKER_00: I want to relieve suffering, provide health care.
11:50
SPEAKER_00: But we look at workers' comp as a volume business.
11:53
SPEAKER_00: Yeah.
11:54
SPEAKER_00: You know, it's a volume business to make a profit margin.
11:57
SPEAKER_01: Yeah, Tyler, a good friend of mine is a doctor up in the Abilene area, and when this whole workers comp thing kicked off, and I'm going to try to make this PG 13.
12:04
SPEAKER_01: Uh, but I'll send him a text and I said, hey bud, what can you tell me about workers comp?
12:08
SPEAKER_01: And his response to me was I'd rather take a gun, uh, I'd rather take a handgun, uh, a loaded semi-autom his words were a loaded semi-automatic, pointed at my groin and plate rushing roulette.
12:19
SPEAKER_01: And his next message was, and yes, I know how semi-automatic works.
12:23
SPEAKER_02: There you go.
12:23
SPEAKER_00: So that sums it up.
12:25
SPEAKER_00: Uh the first thing I tell every single client I've ever had workers comp, every single one, before I tell them about workers comp and go into their case with them, is I say, if you forget everything I tell you today, remember one thing.
12:37
SPEAKER_00: Workers comp is broken.
12:39
SPEAKER_00: Workers comp was not written for you.
12:41
SPEAKER_00: It was written for the benefit of an insurance company, not you.
12:45
SPEAKER_00: And so I'm gonna tell you a lot of things that are technical and bureaucratic, and you're probably it's like drinking from a fire hose and you're not gonna remember half of it, but just remember one thing.
12:54
SPEAKER_00: This was not written for you.
12:56
SPEAKER_00: This is not for your benefit.
12:58
unknown: Yeah.
12:59
SPEAKER_01: So that that's really a great segue to lead into, you know, we talked about our, you know, our members heard at work, you know, here's what they need to do, and here's what should happen.
13:09
SPEAKER_01: Uh now let's let's talk about a lot of times what actually happens.
13:13
SPEAKER_01: And uh, you know, taking these legal calls and talking to a lot of our members that were injured and fighting the system, you know, it's it's it's it's almost like a broken record.
13:22
SPEAKER_01: It's gotten to the point now where most of the time when somebody calls in and uh you know, one of the field reps is like, hey, maybe maybe our government affairs team can help you out.
13:30
SPEAKER_01: And I get on the phone with them.
13:32
SPEAKER_01: Uh it's a it's the same broken, broken song, and just it just seems to be on repeat.
13:36
SPEAKER_01: And typically what happens is they'll go down, they'll see that doctor, doctor will say, okay, it's a uh strain sprain.
13:44
SPEAKER_01: And uh that's what the workers comp insurance carrier uh accepts as the injury.
13:52
SPEAKER_02: Say that in the back so the people in the back can hear it.
13:54
SPEAKER_02: You said a sprain, strain, strain, sprain.
13:57
SPEAKER_02: Strain sprain.
13:58
SPEAKER_02: Okay.
13:59
SPEAKER_02: That's a medical terminology for but we don't know what the hell is going on.
14:02
SPEAKER_00: I mean it's a medical terminology for a baby injury that doesn't cost an insurance company very much money.
14:09
SPEAKER_02: I'm trying to figure out what okay, go ahead.
14:12
SPEAKER_02: Proceed.
14:13
SPEAKER_01: Yeah, so you know, they they go in and they they have this strain sprain.
14:18
SPEAKER_01: Uh, and and you know, so the workers comp insurance carrier, a lot of times what I'm finding out is is they'll send them down for a little bit of physical therapy, um, maybe, you know, kick your heels off for a week, you know, get some relaxation in.
14:31
SPEAKER_01: And uh, and then they try to send them down for a to see a designated doctor for a sprain strain.
14:40
SPEAKER_01: Yeah, for a strained sprain.
14:42
SPEAKER_01: And uh they'll tell that designated doctor, they'll say, hey, we need you to examine this patient and for the strain sprain and tell us what the maximum medical improvement is, meaning how you know, are they fully healed?
14:57
SPEAKER_01: Uh, and if there's an impairment rating for a strain sprain.
15:02
SPEAKER_02: Yeah.
15:03
SPEAKER_02: And you know what's crazy?
15:04
SPEAKER_02: This is this is the the truth about it.
15:09
SPEAKER_02: Whenever I was in my position at the SO, you you can't bring an employee back whenever they're on workmen's comp because they haven't been released.
15:17
SPEAKER_02: So you've got look, cops and firemen and public we are the worst, we eat our own, okay?
15:25
SPEAKER_02: So you've got this going on for the employee, and at the same token, you've got other coworkers that are eating these guys alive and starting or are starting shit, talking shit about this guy.
15:35
SPEAKER_02: So you've got the physical aspect of this.
15:39
SPEAKER_02: Then you've got probably a rock star that probably why he got physically hurt to begin with is because he was kicking ass, taking names, and being a proactive employee.
15:47
SPEAKER_02: Now you've got the mental anguish where this guy or female or you know, female officer wants to go back to work, but can't, because you've got this bureaucracy of BS with workman's comp that you've got to deal with.
16:00
SPEAKER_02: So you've got the mental anguish, now the mental anguish to deal with.
16:04
SPEAKER_02: It's just a broken system.
16:05
SPEAKER_00: The police officers that I represent and have represented over the years, they call it getting it both ways.
16:10
SPEAKER_02: Yeah.
16:10
SPEAKER_00: I'm getting it from the insurance company.
16:12
SPEAKER_00: I'm I'm confused.
16:14
SPEAKER_00: Um, they're denying, they're disputing.
16:16
SPEAKER_00: I'm not getting the medical treatment I need, I'm not getting healthy, so I can go back to work and I'm taking all kinds of static from the department and from my my coworkers at the department that you know, you need to get over here and help us.
16:28
SPEAKER_02: Yeah, the admin thinks you're full of shit to begin with.
16:30
SPEAKER_02: Well, yeah.
16:30
SPEAKER_02: Yeah.
16:30
SPEAKER_00: Yeah, but but they're taking it, you know, from fellow officers.
16:34
SPEAKER_00: It's like, why aren't you back yet?
16:36
SPEAKER_00: You know, it's been two months, it's been a month and a half, why aren't you back yet?
16:38
SPEAKER_02: Well, and then on top of the reality is that we're shorthanded.
16:41
SPEAKER_02: So then the guys that are at work are having to work double time, and so they're getting pissed.
16:44
SPEAKER_02: It's just a bad deal.
16:45
SPEAKER_00: Yeah, it is.
16:46
SPEAKER_00: I mean, the the one of the broken components of workers comp, one of the downsides of workers comp is injured first responders are not getting back to work sooner.
16:58
SPEAKER_00: And and and some of the changes that that are trying to be made at the legislature and the law facilitates that.
17:04
SPEAKER_02: Yeah.
17:05
SPEAKER_00: It fixes some of the broken components in the machinery to where we can get these officers back to work and back serving the public sooner.
17:15
SPEAKER_02: And I think the most difficult work workers' comp situation that that we're we are gonna have to deal with as a profession is the mental PTSD aspect because we physically can't see it.
17:26
SPEAKER_02: Right.
17:26
SPEAKER_02: And I think that's I just wanted to touch on that real quick, is that we can't physically see that.
17:30
SPEAKER_02: And so we see these people that that don't have a limp that can physically walk, can physically touch things, but we can't physically see a PTSD, you know, uh a mental illness at that point or a mental situation going on.
17:46
SPEAKER_00: And so it's just a the PTSD, uh, I can tell you, um, there's an old saying in workers' comp um if you can't see it on an X-ray or you can't see it from an MRI, if you can't see the the scar, did it happen?
18:04
SPEAKER_00: And mental injuries and uh make up a large proportion of first responder comp claims.
18:12
SPEAKER_00: I talk to police officers every week that are suffering.
18:16
SPEAKER_02: Yeah.
18:16
SPEAKER_00: Um and the system is suspicious of that.
18:20
SPEAKER_00: It's gotten better over the years, but the the suspicion is is that if you didn't fall off a ladder and and break your arm, if if the fact pattern of your injury is not that simplistic, if it's a mental injury or trauma, it's harder.
18:34
SPEAKER_00: It's harder for us to see it.
18:36
SPEAKER_01: And then you add to that, uh, because of the bureaucracy and the game playing of these workers' comp insurance carriers, uh, you know, I was on the phone with a guy for two hours the other day who was going through uh, you know, the mental part of it.
18:50
SPEAKER_01: Uh his claim was approved by the workers' comp insurance carrier.
18:54
SPEAKER_01: Uh and uh Aaron, you may know more about this, but apparently this guy was uh an officer for Austin Police Department.
19:02
SPEAKER_01: And I mean, I think he'd been through I I forget how many wrecks he told me on his on his police motorcycle.
19:10
SPEAKER_01: Uh witnessed his friend uh get killed in the motorcycle in front of him in a crash.
19:15
SPEAKER_01: He gets approved for the PTSD, but there's no mental health professionals in the city of Austin that are willing to see him because they don't want to mess with the city of Austin's workers' comp.
19:29
SPEAKER_00: I I get that all the time.
19:30
SPEAKER_00: Officers call me all the time, and and they're like, uh, well, even if their PTSD is accepted by the carriers, which a lot of the time it isn't.
19:39
SPEAKER_00: The insurance carriers don't want to be on the hook for the medical.
19:43
SPEAKER_00: Now, when they were creating the law in 1991, the legislators needed to put something in the law which would be shown to be in the injured workers' favor.
19:51
SPEAKER_00: So they put lifetime medical in the law for the accepted condition, what the insurance company accepts the condition to be.
20:01
SPEAKER_00: Okay.
20:01
SPEAKER_00: Um and PTSD, when you're talking about mental trauma injury, you're talking possibly years of therapy, psychological treatment, medications for anxiety and depression.
20:12
SPEAKER_00: That's a big expense.
20:14
SPEAKER_00: And the insurance companies don't want to pay it.
20:16
SPEAKER_00: Uh the only part of workers' comp law that the insurance carriers hate is the lifetime medical aspect of it.
20:23
SPEAKER_00: And so even when an insurance carrier accepts the PTSD diagnosis, which is rare, I get calls from officers that say, I'm there I I'm who do I go to under workers' comp for my PTSD treatment?
20:38
SPEAKER_00: I can't get in with a psychiatrist.
20:40
SPEAKER_00: I've called all these psychiatrists, I've called these counselors, like I don't do workers' comp.
20:44
SPEAKER_00: I don't take workers comp.
20:45
SPEAKER_00: What should I do?
20:47
SPEAKER_00: Um and it's difficult.
20:49
SPEAKER_00: It's hard for me to tell them, keep calling, keep calling, or I try to find someone that takes workers' comp, communicate that to them.
20:56
SPEAKER_00: Um but there's a lot of trust involved in who's treating you for a mental injury.
21:01
SPEAKER_00: I had a police officer call me last week, been a police officer for 32 years at a high level, um, and told me that um he was having a problem.
21:11
SPEAKER_00: Um you'd seen the traumatic events and the cumulative effect of traumatic events over the years, and then there was an event that was particularly horrific.
21:19
SPEAKER_00: And he had a break and really was suffering.
21:23
SPEAKER_00: And he said, you know, I have really good health care insurance to my wife's employment, and I went out and saw the psychiatrist who take, you know, health care insurance rates, and I trust them, and they've been treating me for a little while, and I'm recovering and I'm not suffering as much.
21:38
SPEAKER_00: If I went into the workers' comp, what would my expectation be?
21:41
SPEAKER_00: And I said, Well, first, it if they're going to accept it, the insurance carrier, and they're not going to make me take it up in front of a judge and fight it for you.
21:48
SPEAKER_00: If they're going to accept it, I said you're going to have a hard time finding mental health professionals in the workers' comp system who accept that payment.
21:56
SPEAKER_00: And it may not be mental health professionals that You have a rapport with or that you trust, which is critical to your recovery.
22:04
SPEAKER_00: And I actually told him, I said, well, and he'd already retired.
22:08
SPEAKER_00: He went ahead and took his retirement.
22:10
SPEAKER_00: And I said, you know what?
22:11
SPEAKER_00: You're better off where you're at.
22:13
SPEAKER_00: You're better off where you're at.
22:15
SPEAKER_00: Forget workers comp.
22:16
SPEAKER_00: And I actually told him, get away from workers comp, just keep going the way you're going, because it's the path of least resistance.
22:22
SPEAKER_00: And he was in a financial situation where he could he could afford that.
22:25
SPEAKER_00: And so that was the and I, you know, having to tell a first responder to abandon a system which is supposed to be assisting them.
22:37
SPEAKER_00: Um it was kind of depressing for me when I got off the phone.
22:40
SPEAKER_00: I was glad I told him what I told him.
22:41
SPEAKER_02: Yeah.
22:42
SPEAKER_00: And it was for his benefit.
22:43
SPEAKER_00: But at the same time, I thought, well, just another example of a broken system.
22:49
SPEAKER_01: Yeah, and Clint, uh, I'm sorry, I almost called you Clint there for a minute.
22:53
SPEAKER_01: Uh you know, Tyler, and that's another thing.
22:55
SPEAKER_01: You know, I talked to these members uh, you know, that are fighting the workers' comp insurance companies, and I, you know, I know they're joking when they say it, but a lot of them tell me that fighting with the workers' comp insurance, that they may need to file another claim for PTSD for having a fight with the insurance company over it.
23:11
SPEAKER_01: Uh and and you know, we can laugh about it, but it's it's you know, it it truly is a sad thing.
23:16
SPEAKER_01: Well, if we weren't laughing, we'd be crying.
23:17
SPEAKER_01: Yeah, yeah.
23:18
SPEAKER_01: Ain't that the truth?
23:19
SPEAKER_01: That's true.
23:19
SPEAKER_01: Uh so let I'd like to take it back to, you know, not necessarily the mental injury, but let's talk more about the physical injury.
23:26
SPEAKER_01: Uh, you know, they they go down for that strained sprain and they get that uh designated doctor opinion uh that says, yeah, you know, and then and most of the designated doctors around the state are, Aaron, correct me if I'm wrong, they're what's their profession again?
23:39
SPEAKER_00: Uh the vast majority of designated doctors in the designated doctor pool are chiropractors.
23:45
SPEAKER_01: That's right, that's right.
23:46
SPEAKER_01: The the chiropractor, right?
23:48
SPEAKER_01: The guy that went through how many years of medical school does it take to get be a chiropractor?
23:51
SPEAKER_00: No, they'll go to medical school, they go to chiropractic school for two to three years and and get a certificate.
23:56
SPEAKER_01: Gotcha.
23:57
SPEAKER_01: Uh so when that chiropractor comes out with that designated doctor opinion and says, Okay, uh yeah, for your strain sprain, uh, you know, you've reached max medical improvement and uh there is no impairment rating, but the officer is still not feeling well.
24:14
SPEAKER_01: They're obviously they can tell something that's going on.
24:16
SPEAKER_01: Uh Aaron, what do they have to do next?
24:18
SPEAKER_00: Well, uh what the carriers do, why they love sprain strain, is when they send you to a designated doctor uh and ask the designated doctor, is this person as good as they're gonna get maximum medical improvements, what that means.
24:30
SPEAKER_00: You mean chiropractor?
24:31
SPEAKER_00: Well, yeah, yeah.
24:32
SPEAKER_00: Well, designated doctor, registered by the division of workers' comp, but more likely than not is gonna be a chiropractor.
24:38
SPEAKER_02: Okay.
24:38
SPEAKER_00: Um and is he a max medical improvement as good as he's gonna get?
24:41
SPEAKER_00: And if he is, what's his impairment rating under the American Medical Association Guidebook to injury fourth edition, which Texas follows by statute?
24:49
SPEAKER_00: Well, a designated doctor, chiropractor, um, can only rate what the insurance carrier has told them they accepted.
24:59
SPEAKER_00: So I send injured officer off to a designated doctor, and on the request forms that I send to the designated doctor and to the division, I put in there, carrier has accepted sprain strain only.
25:11
SPEAKER_00: Now, designated doctor, is he at maximum medical improvement for a sprain strain injury, the baby injury, a pulled muscle?
25:17
SPEAKER_00: And the designated doctor is like, well, if that's the only injury you accepted, yeah, he would be.
25:23
SPEAKER_00: And what would be his impairment rating?
25:25
SPEAKER_00: Well, under the AMA guides fourth edition, a sprain strain rates a 0% impairment rating.
25:31
SPEAKER_00: There you go.
25:32
SPEAKER_00: And the carrier at that point, once an injured worker is placed at maximum medical improvement with a 0% impairment rating, no more money benefits are forthcoming.
25:40
SPEAKER_00: Zero.
25:41
SPEAKER_00: And the medical benefit is what for what the carrier accepted, which is a sprain strain injury.
25:47
SPEAKER_00: How much medical do you need for a sprain strain?
25:49
SPEAKER_00: Physical therapy, some massage therapy for a few weeks, and you're you're good to go.
25:53
SPEAKER_02: Yeah.
25:53
SPEAKER_00: That's not the case most of the time.
25:55
SPEAKER_00: Most of the time, the injured officer has a torn labrum or a torn rotator cuff.
26:03
SPEAKER_00: Okay, and physical therapy isn't going to get it done.
26:06
SPEAKER_00: They need to see a surgeon.
26:09
SPEAKER_01: Right.
26:09
SPEAKER_01: And and so what what's that process?
26:12
SPEAKER_01: When they get that, when when they get sit down to that designated doctor, and they're saying, okay, it's a strain sprain, uh, you're at max medical improvement, and now you here's your impairment rating is zero.
26:23
SPEAKER_01: But they know they can feel it, they're still messed up.
26:26
SPEAKER_01: What do they have to do next to to get that process going, to get the workers' comp insurance carrier to get them the treatment that they actually need?
26:34
SPEAKER_00: Well, I mean, find a lawyer to represent you in the workers' comp system would be the the first thing I would tell you.
26:41
SPEAKER_02: You mean a paralegal or a lawyer?
26:43
SPEAKER_02: A lawyer.
26:43
SPEAKER_02: Okay.
26:44
SPEAKER_00: So the the the same rules applaud, don't go to late to to loggers as they do for the chiropractors for the doctors to go to a guy who's got a doctorate of jurisprudence for three years of being in law school and is licensed by the Texas Supreme Court.
26:56
SPEAKER_00: That's go to that guy.
27:00
SPEAKER_00: And what I would do in that situation is the first thing I would do is I would notify the division that I'm the injured worker's attorney, and then I would get the information for the adjuster assigned to the file, and I make one phone call.
27:13
SPEAKER_00: One.
27:14
SPEAKER_00: And ask him, Are you what are you accepting here?
27:17
SPEAKER_00: We're only accepting a sprain strain.
27:19
SPEAKER_00: Well, that doesn't appear to be what the injury is.
27:23
SPEAKER_00: Um has he had an MRI?
27:25
SPEAKER_00: Has the primary care physician sent him out for an MRI?
27:28
SPEAKER_00: The guy's been in physical therapy and battery work for two and a half months for a shoulder injury, and you're calling it a sprain strain, and it ain't.
27:34
SPEAKER_00: It has to be something else.
27:35
SPEAKER_00: Let's go through the diagnostics and find out what's wrong with this person.
27:40
SPEAKER_00: Um and I ask him when we do get an MRI back that does show the tear on the shoulder, the tear in the knee, the disc pathology injury in the back or the neck.
27:49
SPEAKER_00: Um, I call the insurance carrier and say, yes or no.
27:52
SPEAKER_00: Are you accepting it?
27:53
SPEAKER_00: Are you gonna deny it?
27:54
SPEAKER_00: Well, we're not denying it.
27:56
SPEAKER_00: Well, then are you accepting it?
27:58
SPEAKER_00: Well, I don't know.
28:00
SPEAKER_00: Maybe.
28:00
SPEAKER_00: No, I'll tell you what, you either accept it in writing today, so it's accepted forever, and you have to pay medical for that condition forever, or let's set a hearing and let's take it through the dispute resolution process and get it in front of a judge.
28:13
SPEAKER_00: You force the issue on the carrier.
28:15
SPEAKER_00: Because the way the law exists right now, an insurance carrier never has to be held to what the injury is.
28:23
SPEAKER_00: They can deny on what the injury is in perpetuity.
28:26
SPEAKER_00: I've had officers that went and had shoulder, knee, back surgeries under workers' comp.
28:32
SPEAKER_00: They paid for it.
28:34
SPEAKER_00: And then after the surgery was performed, they come back and say, you know, that torn labrum in your shoulder, the torn meniscus in your knee, the disc injury in your back or neck, it didn't come from work.
28:44
SPEAKER_01: Now, Tyler.
28:49
SPEAKER_01: The medical insurance company paid for the surgery but then came back and said that's not covered?
28:58
SPEAKER_02: What I heard.
28:59
SPEAKER_00: Yeah.
29:00
SPEAKER_00: The insurance company, when you see these specific cases where the insurance company permits the injured worker to go to the orthopedic, they don't deny, he gets the surgery approved by medical review, he has the surgery, and then some period later, come back the insurance company comes back and says, you know what, we never should have paid for that surgery because the tear in your knee, the tear in the shoulder, whatever the injury was that required surgical intervention, it didn't happen.
29:26
SPEAKER_02: But that's simply because of the insurance.
29:28
SPEAKER_02: I mean, that that's simply because they have to cover that injury for the rest of their life.
29:31
SPEAKER_00: Is that essentially?
29:32
SPEAKER_00: That and the insurance companies have something called the subsequent injury fund.
29:36
SPEAKER_00: The subsequent injury fund is a fund for which insurance companies can apply to.
29:41
SPEAKER_00: And if it's shown that they paid benefits of any type, medical benefits, lost wage benefits, impairment income benefits, when they should have, when they shouldn't have done it.
29:50
SPEAKER_00: Right.
29:50
SPEAKER_00: And they provide documentation to the fund, they can be reimbursed from the fund.
29:55
SPEAKER_00: I've had cases where I had a client who was injured, had a shoulder surgery.
29:59
SPEAKER_00: Months after the shoulder surgery, he's completely done with comp, he's healed, he's back to work.
30:03
SPEAKER_00: The workers' comp carrier came back and said, you know, that tear in the shoulder, we should never have paid for it.
30:07
SPEAKER_00: And he called me up and he goes, What's going to happen to me?
30:11
SPEAKER_00: Am I going to have to reimburse an insurance company?
30:13
SPEAKER_00: And I said, No, no.
30:14
SPEAKER_00: Under Texas law, the injured worker never reimburses the insurance company for a benefit they paid.
30:20
SPEAKER_00: Let them go to the subsequent injury fund.
30:22
SPEAKER_00: But I told him, I said, now if you ever have trouble with that shoulder again, six years from now, seven years from now, insurance carrier is not going to cover it, any future medical you need.
30:31
SPEAKER_00: So you see that from time to time.
30:33
SPEAKER_00: But most of the time, where the denials come from is based on the example that JW gave, which is first, the insurance carri only wants to accept a sprain strain.
30:43
SPEAKER_00: And they try to end the case or get the case to a stopping point with a designated doctor answering the question on the accepted injury, which is a sprain strain.
30:52
SPEAKER_00: And that's when the phone rings and the police officer calls me and says, What is this?
30:57
SPEAKER_00: Right.
30:58
SPEAKER_00: What what is this mess?
30:59
SPEAKER_00: And that's when, you know, they're going to need a lawyer.
31:02
SPEAKER_02: Is there a time frame from when a claim has to be filed for a workman's comp?
31:07
unknown: Yeah.
31:08
SPEAKER_00: The time frame is under Texas law, the statute is one year from the date of the injury.
31:13
SPEAKER_00: You have to file notification to the divisional workers' comp that you were injured on the job.
31:18
SPEAKER_00: Now there's exceptions under the law for what we call the one-year rule.
31:23
SPEAKER_00: Okay.
31:24
SPEAKER_00: Um, and and the the exception to the rule is the clock on the one-year rule doesn't begin to run until the employer or the insurance carrier issues what's called a first notice of injury or illness.
31:40
SPEAKER_00: Okay.
31:41
SPEAKER_00: And in so I've had a case, a recent case, with a police officer that two years after the date of his injury, and it was a mental trauma injury, um, he never notified the division of workers' comp.
31:55
SPEAKER_00: But the insurance carrier and the employer hadn't filed the first notice of injury until a year and a half after the date of the injury.
32:01
SPEAKER_00: So he was well within the one-year rule.
32:03
SPEAKER_00: And that exception, uh, the judge found that exception on the one-year rule.
32:08
SPEAKER_00: But the hard fast layperson's understanding of statute should be: I got one year from the day I was hurt to notify the divisional workers' comp that I was hurt on the job.
32:19
SPEAKER_00: It can be done with a phone call.
32:20
SPEAKER_00: They'll fill out the paperwork for you over there.
32:23
SPEAKER_00: Okay, or they'll send it to you and you send it back into them and then it's it's on the file.
32:28
SPEAKER_00: Another uh time limit is the 30-day rule.
32:31
SPEAKER_00: You have 30 days from the day that you're injured on the job to notify the employer that you were hurt.
32:37
unknown: Okay.
32:37
SPEAKER_00: And that's why at the beginning, uh, I said the first thing I would tell an injured worker is go get the emergency medical attention you need.
32:46
SPEAKER_00: The very next day, communicate to the employer that I was hurt on the job and document it in an email.
32:54
SPEAKER_00: And that satisfies the 30-day rule.
32:56
SPEAKER_00: And we've actually seen that.
32:58
SPEAKER_00: This last case I had uh for an officer that I tried uh about three weeks ago was they went, you didn't tell us it was in 30 days you were hurt.
33:06
SPEAKER_00: You didn't tell you didn't file a notification of injury within a year, you're out.
33:10
SPEAKER_00: Doesn't matter what your injury is.
33:12
SPEAKER_00: Well, we were able to overcome that from the evidence and show that he had communicated with his sergeant and his captain that he was injured within 30 days of this event.
33:20
SPEAKER_00: And then, of course, the exception under the one-year rule, and we're able to prevail on his case and get him his benefits.
33:26
SPEAKER_00: But it doesn't always go that way.
33:29
SPEAKER_02: Well, and I think the rank and file, for the most part, 99% of departments in Texas, they notify the sergeant verbally, and then the sergeant completes the supervisory report, and it's it kind of goes from there.
33:39
SPEAKER_02: But that that paperwork's generally never even given to the employees.
33:42
SPEAKER_02: They're just banking on the supervisor to completing the you know proper paperwork.
33:46
SPEAKER_00: And if it doesn't get filled out, then it's the law is specific in who you have to communicate your injured to.
33:52
SPEAKER_00: Anyone that's in a supervisory role above you, your sergeant, your lieutenant, your captain, your commissioner, anybody.
33:59
SPEAKER_02: Yeah.
33:59
SPEAKER_00: Anybody and and make it easier for the judge to find for you and do it in an email.
34:05
SPEAKER_00: Document it.
34:06
SPEAKER_02: Yeah.
34:06
SPEAKER_00: You know, um, judges prefer to have a document in front of them that shows them what you did and when you did it, as opposed to sworn testimony.
34:13
SPEAKER_00: Yeah.
34:14
SPEAKER_01: Yeah, and then a lot of you know, a lot of HR departments and cities and counties, you know, they're just as confused on the entire workers' comp mess as a lot of the you know injured, injured officers are.
34:24
SPEAKER_01: And uh so can't stress it enough, you know, get that email out, you know, get it out to them as quickly as possible.
34:30
SPEAKER_01: Uh so you know, we talked a lot about the injuries and and that kind of mess.
34:35
SPEAKER_01: Uh, Aaron, in your experience, once an injured officer is injured, uh, and they they get sent down, and now you have this uh strain sprain evaluated, and uh they say, okay, yeah, you're you're you know, ready to go back to work.
34:52
SPEAKER_01: Uh, but obviously the officer can tell that there's something wrong.
34:56
SPEAKER_01: Uh and then now you start your process of okay, notifying the insurance company there's more to it.
35:02
SPEAKER_01: Uh, we need to get an MRI, we need to get CT, whatever the case may be.
35:06
SPEAKER_01: Uh, then you, you know, then the injured employee does that, and now workers comp is saying, yep, we're we're we're denying.
35:13
SPEAKER_01: Uh, how long does it take you know for you to get through that process?
35:17
SPEAKER_01: Uh, you know, you the first step is that benefit review conference.
35:20
SPEAKER_00: Sure, sure.
35:21
SPEAKER_00: Filing from the moment that I file for the benefit review conference hearing, which is the initial hearing in a workers' comp case, to the moment that I get a decision and order from a judge, on average, in your standard workers' comp case, five months.
35:35
SPEAKER_00: Couldn't be longer.
35:37
SPEAKER_00: Could be longer.
35:38
SPEAKER_00: Um, but on average, it's five months.
35:40
SPEAKER_00: That's how long the process takes.
35:42
SPEAKER_00: That's how backed up the dockets are.
35:44
SPEAKER_00: Um, that's how long it takes to get a decision order from the judge.
35:47
SPEAKER_00: But the process is when there's a dispute in a workers' comp case, the first thing you do is set it for a benefit review conference.
35:53
SPEAKER_00: And the first benefit review conference is everyone shows up by Zoom.
35:57
SPEAKER_00: I'm there, my clients there, the insurance lawyer's there, the representative from the employer's there, and a benefit review officer who works for the state, I call them bros, is there.
36:05
SPEAKER_00: And bro, bro, bro, bro.
36:08
SPEAKER_00: And the first thing you do is you lay out the case.
36:11
SPEAKER_00: Here's the facts of the case, here's what's happened in the case.
36:14
SPEAKER_00: The insurance care isn't paying or providing this benefit, which they're required to do, and we want them to.
36:19
SPEAKER_00: And everybody gets on the same sheet of music.
36:22
SPEAKER_00: A lot of the times you'll come back for what's called the second BRC.
36:25
SPEAKER_00: After the first BRC and everybody's educated and knows the facts, and we're all singing off the same sheet of music, then it's go get your evidence that you may need.
36:32
SPEAKER_00: Go marshal up a case, come back for the second BRC six, seven weeks later, and you say, okay, we know this now, we've discovered this now, here's the facts, here's some evidence in the case that would show that you owe this benefit.
36:44
SPEAKER_00: Are you gonna do it?
36:46
SPEAKER_00: 98% of the time, the insurance care lawyer will fold their arms and say, we ain't gonna do it.
36:51
SPEAKER_00: Go make a judge tell us to do it and then we'll do it.
36:54
SPEAKER_00: Go prove your case.
36:55
SPEAKER_00: You have the burden of proof.
36:57
SPEAKER_00: I don't have to prove anything under the law.
36:59
SPEAKER_00: You're the one alleging an injury or you're alleging you're entitled to this benefit.
37:03
SPEAKER_00: Go get a judge to tell you that you're entitled to it and force us to do it.
37:08
SPEAKER_00: So the benefit review conference process was designed as a way to mediate cases, to try to reach a compromise on cases so they don't have to go in front of the judge.
37:17
SPEAKER_00: But I would say nine out of ten times, uh, it's going to the judge.
37:21
SPEAKER_00: And I tell that to a client the first day I take their case, and I know what the dispute is going to be.
37:25
SPEAKER_00: It's like your expectation should be that more likely than not, we're gonna wind up in front of a judge on this case.
37:30
SPEAKER_01: I know I've had a lot of a lot of our members that will tell me, hey, uh, I've got this benefit review conference that I got to go for.
37:36
SPEAKER_01: Uh, and a lot of them believe that that benefit review conference is gonna have some resolution to it.
37:43
SPEAKER_01: And more more times than not than I can count, uh, with the little with the little bit of experience that I have, and you your experience far outweighs and far trumps mine.
37:52
SPEAKER_01: But what I'm finding is they'll go to this benefit review conference and they'll come back and they'll tell me, yeah, that was a complete waste of my time.
37:59
SPEAKER_00: Uh yeah, the the benefit review conference, the benefit review conference from a lawyer's perspective satisfies a couple of requirements.
38:08
SPEAKER_00: One, you know exactly where they're coming from, what their position is, and what they're arguing supports that position.
38:14
SPEAKER_02: Right.
38:15
SPEAKER_00: And they know where you're coming from and what you think supports your position.
38:18
SPEAKER_00: So everybody gets the issue written down by the bro, which is in the language that's gonna go in front of the judge on the day of trial.
38:26
SPEAKER_00: Okay, she's gonna know what the specific issues or questions are on the case because of what the bro put into the notes for the judge.
38:34
SPEAKER_00: That's one.
38:35
SPEAKER_00: Uh, another way is to see what evidence do you have that would defeat my case, and they want to look at you and say, what evidence do you have that would defeat my case, and how do I counter that?
38:46
SPEAKER_00: Um, and how do I go get evidence that counters your evidence and everything else?
38:50
SPEAKER_00: So it's kind of a it's it's finding out what everybody knows and then strategically how we're gonna fight each other, how we gonna argue this in front of the judge.
38:58
SPEAKER_00: But nine out of ten times the benefit review conference does not result in a settlement or a mediation or a resolution to the case.
39:06
SPEAKER_00: Nine out of ten times you're gonna go talk to a judge.
39:09
SPEAKER_01: So one of the things that we you know we started recommending to our members here, uh, and and Aaron, I don't want to put you in any kind of bad spot.
39:16
SPEAKER_01: So if you if you have a personal feeling on this, just be mindful.
39:19
SPEAKER_01: Uh something around the neighborhood of potentially 35,000 members could be watching this video.
39:25
SPEAKER_01: So you know, we we started telling our members when they're calling in, they're fighting with the insurance carrier, we're saying, hey, reach out to the division of of workers comp and TDI and get an ombudsman.
39:38
SPEAKER_01: Uh they have some there that are specific to put you know to public safety.
39:43
SPEAKER_01: Um and so I guess a good question for you is is at what point do you do you think it would be good for one of our members to just sit back and go, you know what, I don't need a lawyer?
39:56
SPEAKER_01: And the reason I asked this is because and it's one of our witnesses that testified last Monday on on House Bill 790, which is our workers' count bill.
40:03
SPEAKER_01: Uh the witness testified that he called in to the ombudsman, and the ombudsman spent a lot of time uh telling that injured employee, uh, basically trying to persuade him not to get an attorney involved.
40:17
SPEAKER_01: Uh because it would slow down the process.
40:19
SPEAKER_01: Now, mind you, his process took 25 months from the date of their injury to the day that he could go back to work.
40:26
SPEAKER_01: And he had you know just got a just got notification by his boss saying if you cannot come back to work by this day, we're gonna send you down for a fit for duty and you're gonna be terminated.
40:34
SPEAKER_01: Uh so 25 months, workers' comp uh ombudsman told him, yeah, just you really don't want to get attorney involved, it's gonna slow down the process.
40:44
SPEAKER_00: Well, I would say this about ombudsman.
40:47
SPEAKER_00: First, I'd say is they're really hard-working folks who work for the state of Texas and and and do the very best job they can do.
40:53
SPEAKER_00: Uh then I in the same breath, I'd say they're not attorneys.
40:56
SPEAKER_00: They're not experts in the law.
40:58
SPEAKER_00: They can't give legal advice.
41:00
SPEAKER_00: Um they're not if you have a broken arm, you go to a doctor.
41:07
SPEAKER_00: Okay?
41:08
SPEAKER_00: You don't go correction.
41:09
SPEAKER_00: Unless you're workers' comp, then you go to a chiropractor.
41:11
SPEAKER_00: Then you go to a chiropractor.
41:13
SPEAKER_00: Right.
41:13
SPEAKER_00: A subpar.
41:14
SPEAKER_00: So the ombudsman, the the idea behind the ombudsman was here's the history of it.
41:20
SPEAKER_00: In 1991, when they changed workers' compensation law, they wanted the lawyers out of it.
41:25
SPEAKER_00: And so what they did is they made workers' comp where you a lawyer could make a lot of money in a comp case, basically, other than making it super complicated, labor-intensive, bureaucratic, and everything else.
41:34
SPEAKER_00: The way they got the lawyers out was to take the financial incentive of doing workers' comp away.
41:39
SPEAKER_00: All the lawyers, my father included and his friends, that older generation of attorneys who did workers' comp as part of their personal injury practice, quit in 1991.
41:48
SPEAKER_00: There's 12 lawyers that I know of in the state of Texas who still represent the injured worker in a workers' comp case, and about 25, 30 lawyers on the defense side, the insurance carri side.
41:58
SPEAKER_00: So an entire state of Texas and 29 million citizens, what do you have?
42:01
SPEAKER_00: 50 lawyers who know how to do a workers' comp case?
42:03
SPEAKER_00: That's pretty comparable.
42:04
SPEAKER_00: Yeah.
42:04
SPEAKER_00: Um, so the ombudsman is a state employee who's not a lawyer.
42:12
SPEAKER_00: Yeah.
42:13
SPEAKER_00: And he's trying to work with very complex issues in a complex area of the law.
42:19
SPEAKER_00: He has a ton of case files on him, and he gets paid the same whether he wins, loses, or draws the case.
42:28
SPEAKER_00: Uh, and that's a harsh statement, but it's a true statement.
42:31
SPEAKER_00: Yeah.
42:31
SPEAKER_00: Okay.
42:32
SPEAKER_00: Um, if you're injured on the job and you have a workers' comp dispute, you need to find a lawyer who is who does workers comp as part of his practice to represent you.
42:41
SPEAKER_00: It gives you the best percentage of chance of success in recovery on your case.
42:48
SPEAKER_00: When you've got a broken arm, go to the doctor.
42:50
SPEAKER_00: You know, when you have an injury to your eye, go to an eye doctor.
42:54
SPEAKER_00: When you have uh, you know, uh uh sinus infection, go to it in your nose and throat specialist.
42:59
SPEAKER_00: Okay, um, that's what you do.
43:01
SPEAKER_00: You go to a specialist.
43:02
SPEAKER_00: And I know we're hard to find.
43:04
SPEAKER_00: Um, I have clients call me all the time and say, I've been looking for a lawyer for a month.
43:08
SPEAKER_00: I've called 17 different law firms, and they all tell me workers comp, I don't do workers comp, get out of here.
43:13
SPEAKER_00: Um, and I just found you.
43:15
SPEAKER_00: Are you the right guy?
43:16
SPEAKER_00: Can you help me?
43:17
SPEAKER_00: Yeah, you know, and if I had a nickel for every time that I've heard that over the telephone, well, I'd be a couple years closer to retirement.
43:25
SPEAKER_01: And and so just kind of uh, you know, I want to start kind of wrapping up here, but one one big question that that I've gotten from a lot of our members, uh Tyler, and I imagine you've probably gotten this question too, is is hey, if I'm going through this workers' comp claim, then then you know, uh I know TMPA is, you know, they provide legal for us, and and uh, you know, one thing I will say right here, I'll interject, is if if our members are facing losing their job, then they need to call in so that way we can get them assigned an attorney.
43:55
SPEAKER_02: Yes.
43:55
SPEAKER_01: Uh because that's gonna be detrimental to your employment.
43:58
SPEAKER_01: That's an administrative action.
44:00
SPEAKER_01: So we're absolutely going to cover that.
44:01
SPEAKER_01: But the the big question I get is is why how come, you know, y'all y'all gave me this really great attorney, you know, the the Bob Gorskys, the Greg Kagel's, you know, the different attorneys all around the state.
44:12
SPEAKER_01: Yeah, uh, you're giving us these great attorneys.
44:15
SPEAKER_01: How come they can't repres represent me on the workers' comp case?
44:18
SPEAKER_01: And so one of the things that we looked into was, you know, that's a great question.
44:22
SPEAKER_01: Why why can't we?
44:23
SPEAKER_01: Uh and then we asked our friend uh Aaron here of whether or not we could uh, you know, if there's a way that we can put it into the legal plan to for TMPA to help pay, you know, for some of that.
44:35
SPEAKER_01: And Aaron, why don't you uh tell our listeners what uh what you what you informed us on?
44:40
SPEAKER_01: Sure.
44:41
SPEAKER_00: The only way that I can be paid in a worker's compensation case by law is through the benefit checks of the injured worker.
44:48
SPEAKER_00: Up to 25% of each check to pay off my approved attorney's fee time from the divisional workers comp.
44:54
SPEAKER_00: Here's how it goes.
44:55
SPEAKER_00: Every weekend, and I work every weekend, I sit down with every workers' comp case I have, and I look at every single one.
45:02
SPEAKER_00: And if I worked on it that week, I put the time that I worked on it on a sheet of paper, and on Monday morning, one of my paralegals connects into the divisional workers comp and puts in my time and codes it for the division.
45:12
SPEAKER_00: And there's a person over at the division workers comp who reviews my attorney's fee time on each one of those cases.
45:18
SPEAKER_00: And as long as it meets attorney fee guidelines, they'll approve it.
45:22
SPEAKER_00: And the next week a letter comes back, it's an approval letter for that client for that period of time that I billed.
45:27
SPEAKER_00: And I send that to the insurance carrier.
45:30
SPEAKER_00: And if and only if the injured worker is getting lost wage benefits or impairment income benefits, I'm paid up to 25% of each one of their checks to pay off my approved time.
45:40
SPEAKER_00: The average I bill on a worker's comp case, the average I bill, sometimes less, sometimes a little bit more, because it depends on what I got to do, is around$3,500.
45:49
SPEAKER_00: That's what I bill, but not what I get paid.
45:52
SPEAKER_00: A lot of the times I have to win the case to get paid.
45:54
SPEAKER_00: There's no money benefits forthcoming because of the denial.
45:57
SPEAKER_00: Aaron, go up and win your case, and if the injured worker gets his money benefits, then you get paid.
46:02
SPEAKER_00: But in those cases, if I lose the case, I don't get paid.
46:05
SPEAKER_02: Well.
46:05
SPEAKER_00: And that's why they did that in 1991.
46:08
SPEAKER_00: They wanted the lawyers out of it.
46:11
SPEAKER_00: They wanted it, the insurance companies wanted the lawyers out of it.
46:16
SPEAKER_00: Everything's easier when you don't have a lawyer fighting for somebody.
46:20
SPEAKER_00: That was the that was the reasoning of the carriers.
46:22
SPEAKER_02: They thought I guess that they thought that was gonna fix the problem.
46:25
SPEAKER_00: I guess.
46:26
SPEAKER_00: They I can tell you nobody was happier than the insurance industry in 1991 when they changed the law.
46:32
SPEAKER_00: Uh in the 1980s, they ran up to the legislators screaming, we're going broke on the current workers' comp system, and there's a crisis, and we're just not going to write any more policies of workers' comp in the state of Texas.
46:43
SPEAKER_02: Yeah.
46:43
SPEAKER_00: Sound familiar?
46:44
SPEAKER_00: And then when the law came out in 1991, they stood over the legislators and they stood over the lawmakers who wrote it.
46:52
SPEAKER_00: And they had a enormous influence in the writing of the original statute in 1991.
46:58
SPEAKER_00: Well, to their benefit.
47:00
SPEAKER_01: And so what would just what would happen if you were to take money from, say, uh the injured worker he wanted to pay you out of pocket or TMPA or anybody else?
47:09
SPEAKER_00: I would be in violation of Texas law and Texas statute, and I would be disbarred.
47:14
SPEAKER_00: I would lose my license to practice law in the state of Texas, or I should.
47:17
SPEAKER_00: If I I would be if someone reported me to the state bar of Texas and they investigated and found out that I'd been paid in that fashion, contrary to Texas statute, I'd be in danger of losing my livelihood.
47:28
SPEAKER_02: Damn.
47:28
SPEAKER_00: Yeah.
47:29
SPEAKER_01: So that's you know, that's why, you know, when we get those calls and and they say, you know, why why can't TMPA help us out on this?
47:36
SPEAKER_01: That's why.
47:36
SPEAKER_02: Yeah.
47:38
SPEAKER_02: So well, this uh it's a pretty interesting episode.
47:44
SPEAKER_02: Thank you for coming on and explaining everything, dude.
47:46
SPEAKER_02: It's uh pretty in-depth and pretty complex.
47:49
SPEAKER_02: Uh and just to be up front and blunt, it's it's it's it's a convoluted bullshit wrapped up spider web if you just want to be honest about it.
47:58
SPEAKER_02: Yeah, I appreciate you very much having me on.
48:00
SPEAKER_02: I'm I'm I'm hopeful that we can kind of get through the uh make some good changes, and I'm I'm hopeful this this bill will will uh get passed.
48:09
SPEAKER_02: If not this session, maybe next, but I'm hopeful this this session it'll it'll move forward.
48:13
SPEAKER_01: Yeah, so right now we've got some good uh good movement with it.
48:16
SPEAKER_01: We got some good momentum.
48:18
SPEAKER_01: Uh now granted there's been some pretty big players that have come out uh this past week on it.
48:24
SPEAKER_01: Um we're gonna try to you know try to get some things worked out on that end, but uh yeah, thing about the legislature is things can change five minutes from now.
48:34
SPEAKER_01: So yeah, we're we're gonna keep plugging away at it and try to keep making the system better for our members.
48:41
SPEAKER_02: Yeah, absolutely.
48:42
SPEAKER_02: Well, guys, we're fixing to wrap this up.
48:44
SPEAKER_02: We're gonna end this with three rapid fire questions.
48:49
SPEAKER_02: Are you ready?
48:50
SPEAKER_02: Right.
48:51
SPEAKER_02: All right.
48:53
SPEAKER_02: Favorite cop movie or line from a cop movie, favorite cop car, and favorite adult beverage.
49:02
unknown: Okay.
49:03
SPEAKER_02: I would ask JW, but he's already he's already answered.
49:05
SPEAKER_00: Yeah, I've already answered.
49:06
SPEAKER_00: Favorite adult beverage, uh, Jack Daniels on the rocks.
49:09
SPEAKER_00: Okay.
49:09
SPEAKER_00: It's my house with this king.
49:11
SPEAKER_00: Um, let's see.
49:12
SPEAKER_00: Favorite cop.
49:15
SPEAKER_02: Favorite cop car.
49:16
SPEAKER_00: Favorite cop car?
49:17
SPEAKER_00: Oh, the crown vic.
49:18
SPEAKER_00: I've ridden, I've I've ridden around in a bunch of that.
49:20
SPEAKER_00: Say that again.
49:21
SPEAKER_02: The Crown Victoria.
49:22
SPEAKER_02: There you go.
49:22
SPEAKER_02: Crown Victoria, Clint McNear.
49:24
SPEAKER_02: Save that forever.
49:26
SPEAKER_01: Let's just specify it was always the front seat of the Crown Victoria.
49:30
SPEAKER_01: Yeah, okay.
49:31
SPEAKER_01: Right, right, yeah, yeah.
49:34
SPEAKER_02: And favorite cop movie or line from the cop movie.
49:37
SPEAKER_02: Favorite cop movie.
49:40
SPEAKER_00: Brief.
49:41
SPEAKER_00: I'm blank.
49:43
SPEAKER_00: I can't think of my favorite cop movie.
49:45
SPEAKER_00: And I have so many because I love cops.
49:48
SPEAKER_00: Um reason a lot of guys become lawyers is because they couldn't become cops, couldn't pass a physical.
49:56
SPEAKER_00: Yeah.
49:56
SPEAKER_00: Um my favorite cop movie.
50:02
SPEAKER_00: Guys, feed me some.
50:03
SPEAKER_00: Help me out here.
50:04
SPEAKER_00: Give me a list.
50:05
SPEAKER_00: The other guys is probably the best.
50:07
SPEAKER_00: Let me fly a peacock.
50:09
SPEAKER_00: It's a pretty good one.
50:10
SPEAKER_00: Yeah.
50:11
SPEAKER_00: Yeah.
50:12
SPEAKER_00: Yeah.
50:12
SPEAKER_00: That's that's gotta be up there in the top three.
50:15
SPEAKER_00: That's gotta be up there in the top three.
50:16
SPEAKER_00: I'll just slide on that one.
50:17
SPEAKER_00: What about you, J-Do?
50:19
SPEAKER_01: Uh, you know, I the other guys is is a pretty good one, but uh, you know, cop out.
50:27
SPEAKER_01: It's pretty good.
50:28
SPEAKER_01: Yeah, Bruce Willis.
50:30
SPEAKER_01: Uh trying to think of the other fell other fellow's name, but uh, that's that's a pretty good movie.
50:35
SPEAKER_02: Yep, yep.
50:37
SPEAKER_02: Well, uh again, man, I can't I can't thank you enough for coming down and uh talking about these talking points.
50:43
SPEAKER_02: I appreciate what you do, not just for our members, but for all of law enforcement and for all of public safety.
50:48
SPEAKER_02: So it's it's my honor.
50:50
SPEAKER_02: It's my honor to appreciate it.
50:51
SPEAKER_02: J Dub, we appreciate you uh marching the halls of the Capitol.
50:55
SPEAKER_02: Uh you put up the good fight.
50:56
SPEAKER_02: And uh, man, you only got what three more months?
50:59
SPEAKER_02: Maybe you can take a break unless they unless they extend it.
51:02
SPEAKER_01: Yeah, uh May 29th is is last day.
51:06
SPEAKER_01: So we're we're hoping there.
51:08
SPEAKER_01: And you know, just keep in mind it's it's uh not just me.
51:11
SPEAKER_01: And we've got a team, team down there, you know, Dallas Reed and Mitch.
51:14
SPEAKER_01: You know, we're all down there plugging away.
51:16
SPEAKER_02: So yeah, well, we appreciate it, brother, and uh keep up the good fight.
51:20
SPEAKER_02: This about wraps it up, guys.
51:22
SPEAKER_02: Uh, you guys stay safe, hit that subscribe button, download these episodes, please, please, please download the episodes.
51:28
SPEAKER_02: Again, it kind of measures our success on the uh analytics side of these podcasts, and subscribe to the YouTube channel.
51:35
SPEAKER_02: I'm Tyler Owen, your host.
51:37
SPEAKER_02: God bless you guys, and as always, may God bless Texas.
51:40
SPEAKER_02: We're out of the house.