Walmart Associate / Employee Injured at Work in Texas
Walmart employees and associates in Texas, if they are injured at work in an accident, may be able to obtain benefits under the Walmart work Injury Plan. These benefits are in addition to what such an injured employee may be able to obtain in an arbitration proceeding prosecuted by a Walmart work injury attorney. The plan is lengthy, and is summarized in what is referred to as a Summary Plan Description. If you were injured while working for Walmart or one of its associated companies in Texas, you should be sure to review the summary plan description and comply with it to obtain certain benefits.
Walmart’s Summary Plan Description for Texas injured associates contains a section addressing non-covered medical expenses. That section indicates that while Walmart’s plan will provide benefits for certain medical expenses, there is a list of medical expenses which are not covered. For example, expenses that exceed any fee schedule adopted by Walmart’s plan claims administrator, or the usual and customary charge for the same or similar treatment, is not covered. Likewise, services or supplies to which your physical condition resulting from your work injury which do not cause any improvement in that injury. Moreover, pain management programs, acupuncture, chiropractic treatment, substance abuse services, behavior modification, and similar services may not be covered under Walmart’s work accident plan for Texas associates.Further, you cannot recover for charges for services performed by a person who normally lives with you, your spouse, your parent, a child of you or your spouse, or a brother or sister of you or your spouse.
While Walmart’s work injury plan in Texas provides some wage replacement benefits, it does not in our understanding provide for loss of earning capacity, physical impairment, mental anguish, and pain and suffering, to the extent it does not compensate for these things. Walmart’s injury plan administrator could pay some wage replacement benefits and still, later, determine that you have not suffered an injury covered by Walmart’s plan or even deny any further benefits under that plan.
Walmart Texas’s medical provider referrals must be made, for any treatment you receive from a work injury, through one of Walmart’s approved physicians. Walmart’s claims administrator must also desire to make that referral and will provide advance either approval or disapproval of all such referrals. Walmart reminds its Texas injured associates that it is their responsibility to determine the status of any such approval or disapproval, and that any cost for supplies or services relating to any disapproved referral will be solely your responsibility.
Walmart indicates in its Work Injury Plan that, although its payment of benefits under its plan are conditioned on your use of only medical providers which Walmart and its administrator approves, you can still seek any medical care that you deem appropriate from any provider of your choice. However, any such medical care would be at your own expense. We find that this is a typical situation in work injury cases in Texas, and you might consider using any health insurance benefits you have to obtain such care.
Walmart points out in its plan that, even though it and its claims administrator will expect you to only use Walmart-approved medical providers, neither Walmart or its claims administrator are responsible for any actual medical or other healthcare services provided to you by any such healthcare providers. Walmart, even though it approves healthcare providers for you to see in the event of a work injury, points out that the healthcare providers are not agents of Walmart, its plan, or its claims administrator. Walmart indicates that it is not liable or responsible for omissions or acts of any healthcare provider.
If you have been injured while at work in Texas, and your employer does not have worker’s compensation coverage, such as Walmart, then you may consider retaining an attorney who handles work injury claims. Employment accident injury claims must be filed either in a lawsuit or an arbitration, as required by certain injury plan documents.
Dean Malone
Dean Malone