For many employees who get sick or injured on the job, worker’s compensation provides relief for medical expenses, lost wages and rehabilitation costs.
But for some first responders in Texas cities, getting those benefits has been difficult Claims are often denied, and in some cases those who do get awarded compensation face lawsuits seeking to overturn the decision.
It’s a phenomenon that Delger Erdenesanaa wrote about for the Texas Observer. She spoke with Texas Standard host David Brown. Listen to the interview above or read the transcript below.
This transcript has been edited lightly for clarity:
Texas Standard: You spoke with several first responders for your reporting, including a firefighter in Mission named Homer Salinas. What’s his story?
Delger Erdenesanaa: Yeah, Mr. Salinas: he’s a firefighter who’s worked for the City of Mission for about 20 years. And a few years ago, in 2017, he discovered he had kidney cancer, a type of cancer called renal cell carcinoma, which is something that firefighters get at a higher rate than the general population. Luckily, his was caught and treated fairly early and he’s recovered. But because of this link to firefighting, his union encouraged him to file for worker’s compensation. His insurer disputed the claim and he went through a whole process. But he won eventually. But now the insurer is suing him to get back the money that he got.
Wow, and that would be a lot for anyone, really, if he loses this case, right?
Yeah, for sure. So I’m not sure the exact dollar amount that he personally would have been on the hook for. You know, his private insurance would have had to pay for it otherwise.
You mentioned something, that I think we should drill down on. And that is that first responders, as some may not fully realize, they face a lot of elevated health risks because of their job, right?
Yeah, for sure. And I think the first responders that face the greatest health risks are probably firefighters. They’re exposed to a lot of different hazardous chemicals to their work, not just when they’re responding to an actual fire, but also just from their own fire engines. So these are diesel trucks and diesel is known to emit chemicals like benzene that can cause cancer. And, you know, they’re in these trucks day in and day out.
Tell us a little bit about the Texas Municipal League Intergovernmental Risk Pool. What exactly is that and why is this such a big part of your story?
Right. So instead of getting worker’s compensation through a private insurance company, many cities in Texas pool their money together. And that’s why it’s called a risk pool. And they’ve created the special organization. It’s technically a government agency to administer their workers comp.
Now, why is it that that organization is at the center of so much of this?
Well, honestly, they’re just like any other insurance provider in some ways. Even though they are technically a government agency, it seems the staff there are just looking out for their bottom line. Except in this case, they can say they’re trying to save taxpayer dollars by approving less claims. And so, they have been known to deny a lot of claims to put people through these really arduous dispute processes. And in really egregious cases like Mr. Salinas’ is to even sue people back for the money they already got.
Why is it that they seem to be doing this? You explain the rationale to save taxpayer dollars. But how do they account for the fact that so many first responders are having their claims disputed or denied?
Well, that’s a great question. I mean, they just say, we try to comply with all the worker’s compensation laws in Texas, which are set by the state legislature. And our legislature is generally more friendly toward the insurer than to the worker. So the system gives insurers a lot of leeway and a lot of opportunities to be able to dispute worker’s claims.
Did the agency have any formal statement when you asked them about these claim denials and disputes?
They did. Honestly, they didn’t say much. They just said we try to comply with the law. And they actually said they hadn’t been involved in lawsuits like the one against Mr. Salinas in the past few years. But the records for these lawsuits are spread across individual county courts, and they’re filed under the individual city’s names, not under the insurer’s name. So it’s honestly very messy and very hard to figure out just how many of these cases there’s been.
Do these workers have any recourse? And what are you hearing about how they’re dealing with these problems?
Yeah. So Mr. Salinas was one of the lucky ones. His union was able to get him a lawyer to fight back against this lawsuit. Unfortunately, a lot of other workers just give up on pursuing their claims if it’s too difficult. And some of them, in the cases of firefighters with cancer, for example, have even died before the whole thing is settled. Local governments, they can do some things. So the City of Mission has sort of come up with its own stopgap local policy. And there are some state legislators as well who are looking into the issue.
Do you have a sense that this is a priority, that this is something that the legislature might actually try to take action on?
Well, they have taken some action to try to help first responders in the past. So it’s possible.