In most ways, Chad Hennings was no different than anyone else in the working world. Every day he reported to work was another day he could have been injured on the job.

Hennings’ occupation is what set him apart, forcing Texas courts to re-evaluate a piece of the workers’ comp law that has stood since 1991.

Hennings made a living tackling quarterbacks in the National Football League. He retired in 2001 after injuring his spine. Concerned he would need ongoing medical treatment, he filed a workers’ compensation claim.

Hennings’ claim played out in court for the better part of the decade. At issue was whether the benefits provided by his football contract made him ineligible for workers’ compensation benefits. Ultimately, the 10th Court of Appeals in Waco decided that Hennings was entitled to 15 weeks of disability benefits.

Most claims are not as complicated as Hennings’. Texas Mutual evaluates each claim individually.

Generally, a claim is compensable if the injury happened during the course and scope of employment. For example, a construction worker could smash his thumb while hammering a nail.

For a definition of course and scope, see the Texas Labor Code, Sec. 401.011 (12). As with most rules, there are exceptions to the course and scope rule. Again, state law provides direction.

Under the Texas Labor Code Sec. 406.032, insurance carriers may dispute compensability in the following situations.

Intoxication

If the employee was intoxicated at the time of injury, the claim may not be compensable, even if the employee’s intoxication was not the cause of the injury.

The law assumes that the employee had the normal use of his mental and physical faculties. If the insurance carrier can provide evidence of intoxication, the burden of proof shifts to the employee to show that he was not intoxicated at the time of his injury.

That is why Texas Mutual recommends that employers send employees for drug and alcohol tests as soon as possible after an injury. Consult an attorney before you launch a drug testing program to make sure you comply with the law.

Willful intent

Willful intent injuries happen when an employee intentionally injures himself or a co-worker.

Act of a third party

Act of third party injuries happen when someone injures one of your employees for personal reasons unrelated to their employment.

Off-duty activities

If an employee is injured during an off-duty recreational, social or athletic activity, the injury is probably not compensable. The law might make an exception if the employer required the employee to participate in the activity.

Acts of God

Acts of God include tornadoes, lightning and other forces of nature. Injuries caused by acts of God are usually not compensable unless the employee’s job duties put him or her at higher risk than the general public.

Horseplay

Sometimes, employees play pranks, practical jokes or engage in other horseplay. If they get injured in the process, their claims are probably not compensable.

Disputing compensability

Texas Mutual adjusters conduct thorough accident investigations and strictly follow the law to determine whether an injury is compensable. If we decide to pay a claim and you disagree, the law allows you to dispute our decision.

Call the adjuster assigned to the claim, and explain why you think the injury is not compensable. If we disagree, you may file a dispute with the Texas Department of Insurance, Division of Workers’ Compensation (DWC).

Start by submitting DWC Form-4, Employer’s Contest of Compensability, as soon as possible. The form is available in the Employer Forms section at texasmutual.com.

From there, the dispute enters the administrative phase. You may be asked to attend a Benefit Review Conference, Contested Case Hearing or another form of mediation. It is important that you show up and present your side of the dispute.

You can visit the Employers section at texasmutual.com to learn how to respond to injuries, monitor the status of your claims, control your claim costs and help injured workers get the prescriptions they need.

Article by David Wylie, Texas Mutual Insurance Company.

The economy is in recovery mode, and more companies are celebrating improved profits. Texas Mutual is doing some celebrating of its own, but our motivation is slightly different.

Reward Loyal Customers with Dividends

In late July, the company began distributing $155 million in individual policyholder dividends. Dividends reward loyal customers who share our commitment to preventing workplace accidents and minimizing their consequences.

So, while other companies are giddy over how much money they’re bringing in, your workers’ compensation carrier is thrilled at how much it is paying out to customers.

“As a mutual insurance company, Texas Mutual is not publicly traded, and it does not answer to stockholders,” said Bob Barnes, chairman of Texas Mutual’s board of directors. “Our policyholders – the Texas entrepreneurs who put their trust in us every day – own the company. When Texas Mutual enjoys financial success, it has a solid history of sharing with those who have contributed to that success.”

In 1999, Texas Mutual celebrated its first dividend: $25 million. Over the years, that number has grown to reflect the company’s strong financial position, as well as policyholders’ success at keeping employees safe and on the job.

By the end of the year, Texas Mutual will have paid more than $1 billion in dividends since 2000. The money has gone directly into our state’s economy, helping entrepreneurs improve their safety programs, buy new equipment, build new offices and hire quality employees.

“Money’s a big motivator,” said David Castro of Orion Drilling. “We can certainly free that money up to be used in a variety of different ways. We’ve reinvested in the company through employee safety training, buying new equipment and sustaining our zero-accident culture.”

Orion Drilling has earned seven consecutive dividends from Texas Mutual. Still, Castro knows that dividends are not guaranteed. They are a byproduct of everything Orion does to promote safety among its employees and get them back on the team if they get injured. To see why, you have to understand a few nuts and bolts of the dividend qualifying process.

Your dividend is based largely on your loss ratio. Your loss ratio, in layman’s terms, is based on your claim loss history. The best way to control your claim loss history is to prevent accidents from happening. The second best way is to help injured workers return to productive employment.

Take Safety Measures into Your Own Hands

Texas Mutual encourages policyholders to take advantage of the free Safety Resource Center at texasmutual.com. The site empowers you to evaluate your safety program and identify the root causes of your workplace accidents. From there, you can access streaming videos, DVDs and other free resources that meet your needs.

So far this year, policyholders have taken nearly 300 safety assessments, downloaded safety materials 21,000 times, watched streaming videos nearly 8,500 times and ordered materials 700 times.

“Texas Mutual is fortunate to have 50,000 owners who share its vision of a safer, more productive state,” said Ron Wright, Texas Mutual president. “Our policyholders have invested in their safety programs and supported injured workers during their recoveries. I hope this return on their investments will keep their businesses strong far into the future.”

Reduce Costs and Remain Competitive

When accidents do happen, a return-to-work program will help you get your injured workers well and back on the job. The return-to-work process thrives on communication among you, your injured workers, their doctors and Texas Mutual. Visit the Safety section at texasmutual.com for a free, downloadable Return-to-Work Kit.

In addition to safety and claim management, Texas Mutual’s dividend program rewards customer loyalty. Under the retention component of our dividend program, your dividend has the potential to increase each year through your fifth year with us.

Milberger Landscape and Nursery’s Experience 

That’s exactly what happened to Milberger Landscape and Nursery in San Antonio. The company earned its first dividend check in 2005. By 2010, its dividend had increased nearly 50 percent, thanks largely to the retention component.

“You gotta love it when you get money back,” said Butch Jouffray, general manager of Milberger. “This industry is competitive. It’s gotten even more competitive the past couple of years. Dividends help us keep our costs down, which keeps us competitive.”

In 2005, Milberger’s agent placed the company in the Texas Green Industry (TGI) safety group. Safety groups allow employers in similar industries to purchase their workers’ comp coverage as a group.

Milberger Landscape has earned additional dividends by participating in TGI. The company also gets premium discounts, and it has access to industry-specific workplace safety resources.

Contact Texas Mutual

Texas Mutual offers 28 safety groups representing a range of industries, including oil and gas, health care, construction and restaurants. For more information, ask your agent, or visit texasmutual.com.

The next phase of the dividend program will happen in November, when we distribute early-qualifier dividends among qualifying new policyholders.

If you have questions about dividends, Texas Mutual encourages you to contact your agent. You can also call our information service center at (800) 859-5995.

Article by David Wylie, Texas Mutual Insurance Company.