Issue 1: Are workers who travel out of state (including international locations) covered under SORM’s workers’ compensation program? There is no exclusion for Employees working in any foreign country. Sec. 501.024. EXCLUSIONS FROM COVERAGE. The following persons are excluded from coverage as an employee under this chapter:
- a person performing personal services for the state as an independent contractor or volunteer;
- a person who at the time of injury was performing services for the federal government and who is covered by some form of federal workers’ compensation insurance;
- a prisoner or inmate of a prison or correctional institution, other than a work program participant participating in a Texas Correctional Industries contract described by Section 497.006, Government Code;
- a client or patient of a state agency;
- a person employed by the Texas Department of Transportation who is covered under Chapter 505;
- a person employed by The University of Texas System who is covered by Chapter 503; and
- a person employed by The Texas A&M University System who is covered by Chapter 502.
Sec. 501.025. COVERAGE FOR OUT-OF-STATE EMPLOYEES.
A. An employee who performs services outside the state is entitled to benefits under this chapter even if the person:
- is hired or not hired in this state;
- does not work in this state;
- works both in this state and out of state;
- is injured outside this state; or
- has been outside this state for more than one year.
B. An employee who elects to pursue remedies provided by the state where the injury occurred is not entitled to benefits under this chapter.
The same exceptions would apply
Sec. 406.032. EXCEPTIONS. An insurance carrier is not liable for compensation if:
(1) the injury:
- occurred while the employee was in a state of intoxication;
- was caused by the employee’s willful attempt to injure himself or to unlawfully injure another person;
- arose out of an act of a third person intended to injure the employee because of a personal reason and not directed at the employee as an employee or because of the employment;
- arose out of voluntary participation in an off-duty recreational, social, or athletic activity that did not constitute part of the employee’s work-related duties, unless the activity is a reasonable expectancy of or is expressly or impliedly required by the employment; or
- arose out of an act of God, unless the employment exposes the employee to a greater risk of injury from an act of God than ordinarily applies to the general public; or
(2) the employee’s “horseplay” was a producing cause of the injury.
Issue 2: If treatment is obtained in a foreign country, are there special considerations before payment is made?
SORM has never specifically denied out of country medical expenses. SORM does maintain the rights to review the bills and demand that they are submitted in accordance with the Workers Compensation Act and reimbursed the same. In every case, the injured worker should get what ever care is needed for an emergency situation. SORM will make every attempt to cooperate with the treating facility. More often the injured worker may need to pay through private health care and be reimbursed. Electing treatment and follow-up can be made, but SORM will hold the billing provider to the same standards as an in-state facility. This would include pre-auth and legible documentation.