Texas Workmen's Comp

May 9, 2007

  1. headcoach
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    headcoach Super Genius

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    Texas
    My understanding is no Health Plan will pay in place of Workmen's Comp, I had a client tell me if he did not cover himself and only his employees that his Unicare policy would pay. This is not my understanding, I know BCBS will not. Am I correct? Are there any exceptions?
     
  2. Crabcake Johnny
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    Crabcake Johnny Guru

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    South Carolina
    No health insurance company will pay a worker's comp claim if the person was required to carry it.
     
  3. somarco
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    somarco That Medicare Guy

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    Each state is different. I do recall several years ago working on a 24 hour self funded product for employers in the state of TX. At that time employers were allowed to opt out of the system provided they posted a bond and/or secured coverage that was comparable to the liability limits for WC.

    An employer can opt out entirely but (to my knowledge) cannot pick & choose who is to be covered by WC and who is not.

    WC premiums are based on total payroll. If the owner of a company is not on the payroll then presumably he would not be on the WC policy.

    If he is on the payroll, and has the option of not being covered by WC, then there is no reason for the health carrier to assume that risk.

    I believe if you read the policy you will see a disclaimer that work related claims will not be covered if the individual has WC but did not file, or had the opportunity to be covered but chose not to be.

    The claim then becomes the responsibility of the employer absent insured coverage.
     
    somarco, May 9, 2007
    #3
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