Loophole Prevents Texas Workers’ Comp Patients From Receiving Medicare

DALLAS (KRLD) — There may be a loophole that blocks anyone who has ever used workers’ compensation in Texas from getting Medicare claims paid.

KRLD’s L.P. Phillips has been investigating how the state has a conflict with the feds, putting patients in the middle.

In 2011, Esther Erwin was hurt on the job by a broken cabinet. She needed stitches in her head. Because it happened at work, it was automatically paid as a worker’s comp claim.

This year, she went to the doctor for a swollen wrist — nothing to do with that 2011 injury. Medicare refused to pay her doctor because of her previous worker’s comp claim.

“Medicare requires a letter stating that that workers’ comp claim was closed, but in Texas, you can’t close a workers’ comp claim,” said Erwin.

She’s right. The commissioner of Workers’ Compensation in Texas, Ryan Brannan, says no worker’s comp claim in Texas is ever closed.

“Most states keep claims technically open — Texas being one of them,” said Brannan.

We have tried reaching out to Medicare representatives but have not received a response.

Hear L.P.’s full interview with Ryan Brannan

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