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Frenchforever

Workers Comp Denial

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What happens if an employee

 

1.-Gets hurt in business hours, so he is eligible to get coverage under the workers compensation policy from the business,

2.-But the employee doesn't want to use it?

3.-Is the employer still liable for not able to apply the coverage?

4.-And does the employee planing to sue later, could it be a possibility?

5.-Can the employees Wife sue the business?

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1. His sole remedy is workers comp, any health insurance he has will deny coverage once it learns it is a job related injury and seek reimbursement from the workers comp carrier. 2. He has no insurance coverage. If he wants to pay for it himself, he is free to do it. 3. If the employer has coverage and makes it available to the employee, that is all that is required. 4. Any one can sue, but it will be dismissed, because workers comp is the exclusive remedy for injuries on the job, with a few exceptions not involved here. 5. Anyone can sue for anything, but what would she sue for that she could recover?

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Thanks for your reply, you answered all my questions, 

 

Regarding your last question, if the wife sues lets say because loss of consortium, can she sue above the limit of the policy?, lets say the business has 1M on employers liability, and the wife sues for 2M (just an example)

 

what happens if he diesm can she still sue in court or trough the policy?

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She can file suit for any amount she wants to put in her complaint.  There are plenty of zeros in a typewriter.  But her case will be dismissed because, if it existed at all, it would be derivative of her husband's claim which is barred by workers compensation law.  The injured worker death benefit in Texas is described at 

 

http://www.oiec.texas.gov/documents/448.9e.pdf

 

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If he was not injured on the job,they could sue for the amount of their damages, no matter what the policy limit is.  But in this fact pattern, they cannot successfully sue the employer for any amount. policy limits only limits what the insurance company will pay, not what you can sue for.

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On 3/25/2017 at 11:31 AM, Frenchforever said:

If an employee . . . [g]ets hurt in business hours, so he is eligible to get coverage under the workers compensation policy from the business, but the employee doesn't want to use it, is the employer still liable for not able to apply the coverage?

 

Liable to whom and for what?  What does "liable for not able to apply the coverage" mean?  Also, that the employee was "hurt [during] business hours" is neither necessary nor sufficient for workers' comp coverage.  The injury must occur in the course and scope of the employee's employment, regardless of whether the injury occurs during or outside "business hours."

 

 

On 3/25/2017 at 11:31 AM, Frenchforever said:

And does the employee planing to sue later, could it be a possibility?

 

Not really sure what this question means, but anyone can sue anyone for anything.

 

 

On 3/25/2017 at 11:31 AM, Frenchforever said:

Can the employees Wife sue the business?

 

Anyone can sue anyone for anything.

 

 

20 hours ago, Frenchforever said:

if the wife sues lets say because loss of consortium, can she sue above the limit of the policy?

 

If the injury occurred in the course and scope of the employee's employment, then a workers' comp claim is his exclusive remedy (subject to a few, relatively rare exception), and the wife would have no valid claim whatsoever.

 

 

20 hours ago, Frenchforever said:

what i am trying to find is in what scenarios can they sue trough court (meaning above the Policy limits)?

 

First of all, the existence of insurance coverage never limits how much one can sue for.  Second, "can sue" simply means that they have the ability to file a lawsuit and, as I mentioned twice above, anyone can sue anyone for anything.  If you're asking about exceptions to the workers' comp exclusivity rule, you can google something like "[name of your state] workers comp exclusivity exceptions" or consult with a local attorney.

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It sounds like it you are asking if an employee can get around the exclusivity provision of WC by not filing a claim and paying for care by some other method. The answer in all 50 states, is no. Exceptions to the exclusivity rule are pretty limited and reserved for cases where there was intentional or extremely negligent conduct which resulted in the injury. The bar is set fairly high on that as 99% of accident happen due to at least a little negligence.

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