Texas Walmart Associate Work Accident Plan Benefits
Walmart employees, in Texas, have available certain benefits pursuant to the Walmart associate Work Injury Benefit Plan. There is a specific procedure that an employee must follow to obtain those benefits, even if the employee chooses to retain a work injury lawyer to a assist with arbitration of such claims.
A Walmart associate must notify his or her supervisor on duty at the time of an injury, immediately after being injured at work, no matter how minor the injury appears to be. This would also include any disease exposure. The plan also provides that, for an injury due to a known exposure to an occupational disease or an accident, the Walmart associate must provide, within three calendar days following the date of the accident, appropriate notice. If you are a Walmart employee who has been injured, you should review that portion of the plan document. It seems to be internally inconsistent and nonetheless, must be followed.
A Texas injured Walmart associate/employee must also submit a written incident report, and a medical authorization form to his or her supervisor within 24 hours after the injury is reported. We have found, from handling work accident claims in Texas, that the written incident report can be very important in an arbitration proceeding or lawsuit. Many times, our clients’ supervisors indicate in that incident report that our client was not at fault for the accident. It is important to be truthful when completing the incident report and to point out any discrepancies written by anyone else in that report, or any discrepancies in any statements, immediately in writing. If you attempt to change the description of what occurred and/or point out discrepancies at a later date, it may look like you were being untruthful.
Walmart requires that an injured worker receive his or her first medical treatment from an approved medical provider within 14 calendar days after the injury is reported. The claims administrator may assist the injured Walmart associate in arranging for appropriate treatment.
Our law firm has found that, with certain employers in Texas, approved medical providers appear to be those who seem more interested, in our opinion, in getting the employee back to work than actually providing appropriate care. We are not saying that this is true with regard to Walmart or its medical providers, and we do not name any specific providers in this post.
All care by Walmart-approved medical providers must be pre-approved by Walmart’s Texas work injury claims administrator. Walmart will provide to an injured Texas associate a list of approved medical providers, without charge. Walmart does point out in its work injury plan document that injured Texas Walmart employees remain entitled to seek any medical care they deem appropriate from any provider of their choice at their own expense. In our experience, employees might have health insurance available, which could cover additional healthcare providers.
Importantly, for purposes of Walmart’s work injury plan in Texas, all determinations relating to an injured employee’s payment of benefits or ability to return to work are made by an approved physician. Unfortunately, if an injured Walmart employee disagrees with the approved physician, the employee may have to return to work nonetheless. Moreover, the Walmart claims administrator has the right to require an injured Walmart employee to be examined or reexamined by a Walmart-approved physician as many times as that person determines to be “reasonably necessary or appropriate” while receiving benefits under the plan.
Walmart points out that it has the right but not obligation to obtain insurance contracts to provide funds to Walmart that can be used by it to pay all or a portion of any benefits under its Texas associate work injury plan. Walmart points out that no such insurance policy proceeds are considered plan assets for purposes of ERISA.
What should you do when you are injured as an associate or employee of Walmart in Texas? You need to comply with Walmart’s summary plan description. If you fail to comply with Walmart’s job accident plan, then you may not be able to receive medical care at Walmart’s cost. You might also consider consulting with a Texas work injury attorney who is accustomed to asserting claims against employers who, like Walmart, have chosen not to obtain worker’s compensation coverage. Such an attorney can point out to you remedies you might have available in arbitration, which are not otherwise available as a benefit through a work injury plan.
Dean Malone
Dean Malone