Workers CompensationIs Medicare Being Denied to Texas Workers’ Comp Claimants?

August 20, 2014by Aaron Allison

The Division of Workers’ Compensation (DWC) has received numerous complaints from Medicare beneficiaries, because the Centers for Medicare and Medicaid Services (CMS) has been denying medical care to Texas citizens that have workers’ compensation claims.

Photo of a medical bill

Rod Bordelon, now the former Commissioner of the DWC, sent an open letter concerning the matter to Marilyn Tavenner, Administrator for CMS. He wants to ensure that people who make a workers’ comp claim are still eligible for Medicare coverage for injuries or illnesses that are unrelated to the work injury.

Can Worker’s Comp Claims in Texas Be Settled?

CMS is denying people medical coverage because of workers’ comp claims made years ago. It wants Medicare beneficiaries to confirm that a previous workers’ comp claim has been closed or settled before paying for treatment.

However, Bordelon says that in Texas, a workers’ compensation claim is never closed or settled, because the Texas Labor Code does not allow medical benefits to be settled. In other words, DWC cannot tell CMS that a beneficiaries workers’ comp claim is “closed,” because it never is “closed.”

The Texas Workers’ Compensation Act (TWCA) explains that a claimant’s case is never closed, because they may need additional health care if issues persist that are related to the work injury.

CMS has mandatory reporting requirements, which include receiving notifications from workers’ comp insurance carriers of any claims that are still “open” or “closed.” However, it does not have any guidance on how to handle Medicare claims for Texas citizens that have a workers’ comp claim that by law can never “close.”

Before ending the letter to Tavenner, Bordelon says, “CMS should not make coverage determinations for Medicare beneficiaries based solely on the existence of an open workers’ compensation claim without additional information.”

Workers’ compensation can be complicated to handle. It is important to hire an experienced workers’ comp attorney to help you get all of the benefits you deserve. 

The Law Offices of Aaron Allison – Austin Workers’ Compensation Attorney


Aaron Allison

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Aaron Allison

Aaron Allison, a second-generation personal injury lawyer from Austin, follows in the footsteps of his father, who founded their firm in 1978. Admitted to practice by the Texas Supreme Court, the Federal Court for the Western District of Texas, the 5th Circuit Court of Appeals, and the U.S. Supreme Court, Aaron brings extensive legal expertise to his clients.

Specializing in personal injury cases, Aaron offers a distinct advantage for Texas workers injured on the job. With Texas workers' compensation laws leading many attorneys to avoid these cases, Aaron is one of only 40 lawyers among 95,000 in Texas who represent injured workers in straight workers' compensation cases. His firm continues to provide dedicated support for those suffering catastrophic work injuries, maintaining a proud tradition of advocacy spanning decades.