I’ve been injured at work, what should I do and can I make an accident claim?
You must report your injury to your employer within 30 days from the date on which the injury occurred or from the date when you found out that his illness was related to his work. Failure to provide this information to your employer within 30 days, you may lose your right to get the benefits.
You must also send the completed form, Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC-041S) to the Division of Workers ‘Compensation (Division of Workers’ Compensation -DWC, by name and acronym ) within the span of one (1) year from the date the injury occurred, to protect their rights.
For more information, please see page Notice of Rights and Responsibilities for Injured Employees in the Workers’ Compensation system or contact the Consumer Assistance Program al1-800-252-7031.
A death has occurred in my family caused by a work-related accident; Is this covered by workers’ compensation benefits and the accident claims process?
The cause of death benefits can be paid to the legal beneficiaries of a person who dies as a result of injury or illness related to work. If the employer of the person who died has a workers’ compensation insurance, a spouse, children, grandchildren, or other dependents or parents may be eligible for benefits on death.
A person who incurred the responsibility of the burial expenses may also be eligible to receive a payment of up to $ 6,000 for burial expenses if the death resulted from a compensable injury. For answers to questions about whether you can be an eligible recipient and whether you are entitled to benefits because of death, see the Web site of The Cause of Death Benefits or contact the Consumer Assistance Program of the Division of Workers’ Compensation (DWC) at 1-800-252-7031.
Will I need the assistance of a lawyer with my workers’ accident compensation claim?
You do not need the assistance of a lawyer, but you have the right to obtain the services of a lawyer at any time you wish. The lawyer can assist you in administrative procedures and dispute resolution can present facts and evidence and their part of the dispute.
How I can find a personal injury lawyer?
How much can an attorney charge?
How I can find an accident claims lawyer?
Molis can not recommend a lawyer. For more information on lawyers in the state of Texas, please read the website of the State Bar of Texas (State Bar of Texas, by its English name).
How much can an attorney charge?
A lawyer may charge a maximum of $ 150 per hour, plus its, costs for work performed on your workers’ compensation claim. A maximum of 25% of your benefits may be retained to recover your attorney’s fees. For more information, please read the Attorneys’ Fees in DWC rules .
Some useful information here on accident claims and insurance company complaints.
The Texas Department of Insurance (TDI Texas Department of Insurance, by name and acronym in English) helps consumers resolve their complaints against insurance companies, maintenance organizations health (Health Maintenance Organizations – HMO, by name and acronym in English), insurance agents and adjusters. Every year we help more than 30,000 consumers who receive more than $ 35 million in additional payments of claims and reimbursements.
To file a complaint, visit their website on http://www.tdi.texas.gov/pubs/consumer/cb003s.html.
Note: To help you resolve your complaint, we must share the information you sent us to the person or company that has been named in his complaint. Once your complaint has been filed with TDI, you may be subject to be disclosed to anyone who requests it, according to the Public Information Act Texas (Texas Public Information Act, by its English name).
Certain information, such as medical records, financial information and email addresses, are generally considered confidential under state and federal law. Any information that is considered confidential by law, is not subject to be disclosed.
How can we help
TDI can help resolve complaints from homeowners insurance, title, health and workers’ compensation. Some of the most common types of complaints we help solve are:
Personal injury claims
Benefit claims and disputes
suspicions of insurance fraud
We do not have jurisdiction over service providers, including body shops and paint, construction contractors, and physicians, so we can not help you with this type of complaint.
Send complaints against providers of services to the agency licenses issued or is in charge of compliance and regulation.
Complaints Against Health Plans
TDI can help with complaints against health plans fully funded (fully funded health plans, by its English name). Fully funded plans are plans for which the insurance company or HMO assumes all risk of paying for claims. Most plans offered by small and medium employers are fully funded.
TDI does not handle complaints against self-funded plans. However, many large employers are self-funded plans are regulated by federal law and are under the jurisdiction of the Department of Labor of the United States (US Department of Labor, for its name in English). These employers separate funds and contributions from employees every month to pay claims. They can hire an insurance company, HMO or third party administrator to handle claims and documents.
If you have a self-funded through a government or church employer plan, follow the process for appeals that appears in your benefit booklet and other plan documents.
If the plan is self-funded and offers a private employer or union, present their complaints to the Office of Security Administration Benefits Employees of the United States Department of Labor (US Department of Labor’s Employee Benefits Security Administration, by its English name) in the regional office in Dallas.
If you are unsure what type of plan you have, check your plan documents or ask your plan administrator. You will also find information on how to file a complaint and how to use the dispute resolution process.
Before Filing a Complaint
If you have a complaint, first contact your company. Many complaints can be resolved by calling the company and talking to them about your problem.
Most insurance companies in Texas have telephone lines of customer service to your customers to call for free. The toll-free number should be listed in your policy. You can also get the number by calling our Consumer Helpline at 1-800-252-3439 or if you use the function “Find Companies” in our website at www.tdi.texas.gov .
When you call the company
Have your policy number handy.
Request a written response to your complaint.
Follow up in writing. Describe your complaint and how it expects the company to resolve it.
Send copies (not originals) of letters, memos, invoices, canceled checks, advertising materials or other documents confirming his complaint checks
Most auto policies and homeowners have an evaluation process to settle disputes relating to the amount of damages that the company will pay. You also have the right to appeal the decision of the company or litigate the matter in court. Ask your company if your policy has a process of evaluation.
Filing a Complaint
There are several ways to file a complaint:
If your dispute involves a claim for workers’ compensation, call the Hotline Injured Employee Assistance (Injured Employee Hot Line, by its English name) at 1-800-252-7031 or the local office Division of Workers ‘Compensation TDI (TDI Division of Workers’ Compensation, by its English name). The local office will tell you how to schedule a benefit review conference to help resolve your dispute.
We will need information
We need the following information to investigate your complaint:
your name, address and phone number where you can be reached during the day
the exact name of the insurance company
the full name of the agents and adjusters who are involved
your policy number
your accident claim number and date of loss
a copy of both sides of your insurance card, if appropriate
a description of your problem
what you think would be a fair resolution to your complaint
copies of all relevant documents, including invoices, canceled checks, advertising materials
checks and any letters between you and the company or agent.
Processing Your Complaint
After you send your complaint, we will do next
we will send you a letter of acknowledgment.
We will notify the company about your complaint and ask you a detailed answer.
we will send a copy of the response from the company and an explanation of the results, usually within 45 days after we receive your complaint.
We determine if the problem was processed properly and according to the terms of the policy or certificate of coverage.
We determine whether the company, agent or adjuster infraccionó state insurance laws and take legal action when laws have been ticketed.
Although we do our best to help you resolve your complaint, there are certain issues that can not be resolved through the complaint process.
Determine who committed malpractice or who is to blame in an accident. Usually you will have to resolve these issues in court.
Resolve a dispute between you and the insurance company when the only evidence is the word from him.Compel a company to pay for a disputed claim or make an exception to the policy if the company’s refusal to pay the claim not infraccionó any law or regulation of insurance.
Give legal advice nor make medical judgments.
Even if we can not resolve your complaint, complaints and questions help us identify some issues and potential problems with insurance companies, HMOs, agents or adjusters. Our participation may also make companies more carefully consider their concerns.
If you are not satisfied
If you are not satisfied with the results, you can consult a lawyer to discuss their concerns. You can also request an alternative dispute resolution (Alternative Dispute Resolution -ADR, by name and acronym in English) to solve problems with your insurance company. The ADR process uses techniques such as mediation with a neutral third party to help resolve disputes out of court.
Look in your phone book listings of attorneys and mediation services. If you need help finding a lawyer, call the Information Service Recommendations of the Bar Association of the State of Texas (State Bar of Texas Lawyer Referral Information Service, by its English name) at 1-800-252-9690 or visit the Web site at www.texasbar.com .
Get Ready to the Claims
Cost of the complaints we receive are related to the settlement of accident claims. Follow these tips to help avoid problems in the settlement of a claim:
Read your policy carefully. A policy is a contract between you and the insurance company or HMO. Do not rely solely on your agent to tell you what your policy covers.
Read the Declaration of Consumer Rights (Consumer Bill of Rights, by its English name). Insurance companies and HMOs should be included along with the policies or renewals of personal automobile insurance, homeowner’s insurance and credit life. This explains your rights and responsibilities. To obtain a copy, call your insurance company or visit our website at www.tdi.texas.gov/commish/rights.html .
Keep copies of all documents and take note of the calls between you and the insurance company or HMO. Include the date, the subject was discussed in the conversation and the name and position of the person with whom you spoke.
Keep a written record of all conversations you have with your insurance company or agent. Make a follow-up email after any call.
Ask the company to explain the specific language of the policy that is being used for the settlement of your claim. The disagreement could be because you and the insurance company or HMO are interpreting the policy differently.
Tips and Accident Claims Automobile and Homeowners
Keep all receipts for repairs you make to your property after suffering damage. The policies of automobile and homeowner might require you to make reasonable and necessary to prevent further damage their property receive reparations. Your policy covers the cost of these repairs. If possible, take pictures or videos of the damage before making temporary repairs.
Do not make permanent repairs until a claims adjuster has inspected the damage. Keep damaged to inspection by the claim adjuster property. Ask the adjuster a detailed explanation of the offer of settlement of the claim. For homeowners claims, this should include sales tax, depreciation and pending depreciation for policies with replacement cost coverage. The slope depreciation is the amount of money the company will not pay you until repairs are completed or the replacement of items is made. Ask your adjuster how this amount is determined.
Be prepared to negotiate for a fair settlement. Do not hesitate to negotiate a better deal with the company.
Rabbits for accident claims and Medical Claims
Ask your doctor to give your insurance company or HMO details about their treatment, medical condition and prognosis.
Consider the IRO process. If your company or HMO refuses to pay for ongoing treatment or recommended because they determined that the treatment was not medically necessary or appropriate, you can order a mandatory review by an Independent Review Organization (Independent Review Organization -IRO by your name and acronym). Independent reviews are available if Texas law requires your plan or if the plan participate voluntarily participates in the IRO process. For more information, call the IRO Information Line at 1-866-554-4926 or TDI in Austin at 512-322-4266. You can also send your email to URAGrp@tdi.texas.gov .
Consider mediation. If you have health coverage through a preferred provider plan and have a dispute with a pending bill you have received from a doctor who is not in the hospital network, you may be able to resolve through mediation. If you choose mediation, your doctor outside the network and the plan will meet to discuss the pending bill. If mediation is unsuccessful, you may have to resolve the dispute in court. Visit our Web site for more information about the program and the requirements www.tdi.texas.gov/consumer/cpmmediation.html .
Tips for Workers’ Accident Claims Compensation Claims
Workers’ compensation is an insurance program regulated by the state to pay their medical bills and replaces a portion of lost wages if you are injured at work or have a work-related disease. To receive workers ‘compensation benefits, your employer must have workers’ compensation insurance or be self-insured. Texas employers are not required to have workers’ compensation insurance.
If you suffer an injury or work-related disease, you should tell your employer within 30 days from the date you were injured or became ill, or within 30 days from the date when he first learned that your injury or illness might be work-related. If you do not notify your employer in a timely manner, it could cause you to lose your right to benefits.
You should also notify the Division of Workers ‘Compensation (Division of Workers’ Compensation -DWC, by name and acronym in English) about your injury or illness in the course of one year from the date you were injured or got sick, or in the course of a year from the date when he learned that your injury or illness might be work-related. If you do not notify DWC in a timely manner, it could cause you to lose your right to benefits.
If you have a dispute regarding your workers’ compensation claim, contact your local DWC. Disputes related to workers’ compensation claims are handled through a formal administrative process. For more information, call the Hotline Injured Employee Assistance (Injured Employee Hot Line, by its English name) at 1-800-252-7031.
Deadline to pay an accident claim
exas law requires insurance companies to pay claims quickly first part (first-party claims, by its English name). A claim is the first part introduces you to your insurance company. Insurance companies must be licensed.
Initiate investigations and request the necessary information within 15 days from the date a complaint is received. Surplus lines companies, also known as “surplus lines” (surplus lines, by its English name) have 30 days to complete this process. (A company surplus or surplus lines is a company from out of state who does not have a license in Texas but that it is permitted to insure risks that companies in the standard market are not willing to insure.)
Accept or reject your claim within 15 working days from the date of receiving all required information. This deadline can be extended to an additional 15 days if it has been declared a weather or natural disaster. Note: If the company can not accept or reject your claim within the time limit, the company must tell you why you need more time . The company will then have up to 45 additional days of this notice to accept or reject your claim.
Tell you in writing why they have rejected their claim.
Payment to you within five business days after notifying you will pay your claim. Offshore insurance companies must pay your claim within 20 working days after notifying you will pay your claim.
Prompt payment laws do not apply to claims of liability insurance the insurance company against another person or those claims (third party) related
health plans self-funded
guarantees mortgage or title insurance
fidelity bonds, collateral or guarantee
marine insurance (insurance other than transit waterways).
Avoiding Future Accident Claims Complaints
Insurance Homeowners, Tenants and Condominium
Know what your policy covers and what the limits are. You may want more coverage than your policy provides. For a higher premium, you can buy additional clauses that increase coverage or provide additional coverage for those items not covered in your basic policy. Some of the most common riders add replacement cost coverage and increase coverage for jewelry, fine art, photographic equipment and computers.
If you operate a business from your home, ask your agent or company what coverage you have and what you may need.
Make sure your coverage meets your needs. Check the limits of its coverage, including coverage of the contents of your home. Your current coverage may not be enough to replace personal items if you have added or bought new items or if the replacement cost increased due to inflation.
Also, some policies may pay only actual cash value for your home and its contents, rather than the replacement cost. Note: Replacement cost is what you would pay to build or repair your home again, as construction costs current. The actual cash value is the replacement cost of your property minus depreciation.
Review your deductibles to make sure they fit your current financial situation. Higher deductibles lower your premium, but when you have a claim you will have to pay more out of pocket.
Keep documents on improvements you make to your property.
Keep an inventory of personal property including furniture, clothing and valuables. Record a video or take photographs of the interior and exterior of your home. Keep these photographs or video in a safe or in a place outside your home (as in his office or in the home of a relative).
The homeowner policies do not cover damage from rising waters. If you are concerned about the possibility of flooding, consider buying flood insurance. You remember not have to live in an area prone to flooding to suffer losses from flooding. For more information on flood insurance coverage, call your insurance agent or company or call the National Flood Insurance Program (National Flood Insurance Program, by name) that administers the Federal Emergency Management Agency (Federal Emergency Management Agency -FEMA, by name and acronym) at 1-800-427-4661 or visit their Web site at www.fema.gov .
Learn coverages and coverage limits of your policy.
Consider your needs. Check your auto policy includes coverage for determining whether or car rental reimbursement or comprehensive coverage, also known as coverage for damage not caused by a collision. Comprehensive coverage pays for theft and damage resulting from causes other than accidents, such as hail and flooding. The rental car coverage pays for a replacement car while yours is in the repair shop due to a covered loss. It may not be available if your car turns out to be a total loss.
Review your deductibles. See the deductibles for collision and comprehensive coverage to make sure they fit your current economic situation and the age of your car.
Keep all documents on the improvements made to his car.
Life insurance, accident and health
Check your health plan is fully funded or self-funded. It may not be obvious.
Read your benefit booklet to find out what benefits are covered. Check your policy or health benefits plan to ensure it meets their health needs. Pay attention to the restrictions, exclusions, policy limits, maximum lifetime coverage and definitions of the policy.
Determine if your policy or benefit plan covers your medical needs. For example, find out if your policy covers such things as outpatient services or outpatient surgeries. Limited benefit policies cost less but probably will not provide benefits or services that you need to cover most of the cost of their health services.
Read the annual statements of their life insurance or annuities. Be aware of economic changes that may affect the value of your policy.
Get approval for hospitalizations or recommendations to suppliers, if required. Understand how and when you have to notify the insurance company or HMO after an emergency hospitalization.
If your policy is a preferred provider plan (Preferred Provider Plan -PPP, by name and acronym), make sure you understand the financial consequences if used outside the network provider.
Ask if your policy allows the medical provider charge you for charges not covered by your health care plan.
Follow the procedures and time frames for health care and for making complaints, grievances, and appeals.
Present their complaints and appeals to the person or office that is shown in your benefits booklet and other plan documents.
For more information or help
For answers to general insurance questions for information on filing an insurance-related complaint, or to report suspected fraud, call the Consumer Helpline (Consumer Help Line, for its name in English) at 1-800-252-3439 between 8 am and 5 pm, Central Time, Monday through Friday or visit our website at www.tdi.texas.gov .
You can also visit www.Helpinsure.com for help in purchasing car insurance, homeowner, condominium or tenant. Use www.TexasHealthOptions.com to learn more about health care coverage and options.
For printed copies of consumer publications, call 24 hours a day to Order Line Publications ( Publications Order Line, by its English name) at 1-800-599-SHOP (7467).
To report suspected arson or suspicious activity involving fires, call the Office of State Fire Marshal, through the hotline to report Arson (Arson Hot Line, for its name in English) 1-877 -4FIRE45 (434-7345), on duty 24 hours a day.
The information in this publication is current as of the review date. Changes to the laws and rules made after the revision date may affect the content. See updated information on our Web site. TDI distributes this publication for educational purposes only. This publication is not an endorsement by TDI of any service, product or company.
For more information contact: ConsumerProtection@tdi.texas.gov or 1-800-252-3439
We don’t like Donald Trump, and we are pretty sure you won’t too. He doesn’t stand for the things that we stand for as far as we can tell from his statements so far, and as far as minority groups go he might not be the best choice as a presedential candidate. So with that in mind we collated his most idiotic statements from his recent presedential announcement speech on this video.
Whilst we’re at it, here are some of his superb (hmmm…) quotes:
“Even a race to Obama, [Hillary Clinton] was gonna beat Obama. I don’t know who would be worse, I don’t know, how could it be worse? But she was going to beat – she was favored to win – and she got schlonged, she lost, I mean she lost.” –Donald Trump, using a vulgar Yiddish word in reference to Clinton
“I know where she went – it’s disgusting, I don’t want to talk about it.
No, it’s too disgusting. Don’t say it, it’s disgusting.” –Donald Trump on Hillary Clinton taking a bathroom break during a Democratic presidential debate
“I think our country does plenty of killing also, Joe.” –Donald Trump, seemingly unconcerned that Russian President Vladimir Putin kills journalists who disagree with him, when pressed to condemn such actions in an interview with MSNBC’s Joe Scarborough
“There were people that were cheering on the other side of New Jersey, where you have large Arab populations. They were cheering as the World Trade Center came down.” –Donald Trump, making an unfounded accusation regarding the 9/11 attacks
Fantastic news here, as it’s been revealed that The Big Apple (New York City) has just made a significant financial investment in a new legal aid program for the city’s immigrant community groups.
As Don Tagala reports, Mayor Bill De Blasio’s new initiative aims to help undocumented immigrants too. This could be of great help to many of the minority groups the Molis website is looking to help and support with legal advice.
If you or someone you love were injured in a car accident or in a situation that was caused because someone was negligent or reckless, it is important to consider their legal options.
You can file a personal injury lawsuit against the person or entity that caused his injuries, and discussing the matter with an attorney or accident claims lawyer means you can find out more about what to do to pursue this matter.
For a personal injury claim, this means you will have the opportunity to hold the guilty party responsible for what they would have been forced to endure. This means you can seek financial damages that can help you start living a normal life.
Such damage can cover all of your medical care, future medical expenses, loss of earnings, emotional trauma, pain and suffering and possibly more. True, the recovery of financial damages can not return a lost loved one.
Money can not totally erase all memories and wounds associated with an accident. This can relieve, however, several loads you deal with when you try to rebuild and move on with your life. This can bring you peace of mind in knowing that the responsible party has been held responsible for their behavior.
This can help you meet a brighter future – even if you feel that this would be too difficult or completely impossible. The best way to achieve success in your work injury claim is a personal injury attorney in your area.
Driving Accident and Personal Injury Claims
A professional personal injury lawyer will be able to help and support you with the following types of accident claim.
Car accident – car accidents, drunk driving accidents, motorcycle accidents, truck accidents, pedestrian accidents, boating accidents and bicycle accidents
We also cases involving premises liability (accidents or injuries in other property), car accident injuries and neglect safety. In any of these types of cases, they may leave a victim with nothing. Physical pain and trauma of the accident are enough to cause serious problems.
Add to this the difficulty of dealing with an insurance claim, legal and financial difficulties, and you have a situation where the future may seem totally helpless.
Always Use an Experienced Personal Injury Lawyer
An experienced injury lawyer can turn all this. Authorizing an accident victim to take legal action against the party that caused his injuries, a lawyer can assist in reconstruction and recovery. Although it is impossible to go back and prevent an injury occur first, holding the party responsible for the financial damage can make a significant difference to a victim and his family.
Find out more about your options and what can be done to address this situation. For a free, confidential review of your case, please contact our law firms. We not only offer a free initial consultation, we work on a contingency fee basis for all personal injury cases. This means you pay no legal fees unless we win your case for a negotiated settlement or jury award.
Please always consider using a personal injury lawyer for the best advice. For additional reading please see this blog post about the accident claims process in Texas.