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Blogs 2018 April Appealing a Workers' Comp Claim Denial
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Appealing a Workers' Comp Claim Denial

Posted By Law Office of James M. Stanley || 18-Apr-2018

Just because your workers’ compensation claim was initially denied, doesn’t mean you should give up. Fortunately, you have the right to fight the decision by contacting the Division of Workers’ Compensation Insurance of the Texas Department of Insurance.

As soon as you receive your denial letter, first try to resolve the issues with your employer or its insurance company. If a resolution cannot be reached, you should request dispute resolution from the Division of Workers’ Compensation Insurance of the Texas Department of Insurance.

Benefit Review Conference

The “Benefit Review Conference" is the first stage of the appeal process. This is an informal meeting where you and your employer's representative discuss your denial with a Division of Workers’ Compensation Benefit Review Officer. Similar to mediation, the goal is to obtain a fair agreement, such as a settlement offer along with a written statement.

Arbitration & Contested Case Hearing

On the other hand, if the parties are not able to reach an agreement, the next step can be either arbitration or a contested hearing.

At Arbitration, you will once again meet with a representative of your employer. An arbitrator will attempt to make a decision on the matter at hand. In the end, the arbitrator will come to a decision that is conclusive. Although arbitration often doesn' take a long period of time and is less expensive compared to a contested case hearing, if you choose to participate in this process, you lose the ability to seek a contested case hearing.

By contrast, you and your employer decide not to undergo arbitration, a contested case hearing will be scheduled. Rather than an arbitrator, a hearing officer from the Division of Workers’ Compensation oversee the case. The officer will assess all of the evidence submitted, such as medical records and witness accounts. In the end, the officer will make a decision.

Appeals Panel

If you do not agree with the decision in the contested case hearing, you may appeal to the Division of Workers’ Compensation Appeals Panel. Written briefs that argue you and your employers positions must be submitted. Briefs and the record from the contested hearing will be reviewd by the panel, not any new evidence. The panel will either affirm, modify, or reverse the decision in the contested case hearing.

Texas State Courts

If you disagree with the Appeals Panel decision, you can appeal to the Texas State Courts. Due to the complexities of the legal process, it is wise to hire an attorney to address the state courts, if you haven’t hired one already.

Interested in appealing your denial in Fort Worth, TX with experienced legal representation on your side? Request a free consultation with the Law Office of James M. Stanley today.

Categories: Workplace Injuries

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The following is a sampling of some of the many cases we have had the privilege to handle on behalf of our clients. Each case is unique and must be evaluated on its own merits. Past results do not predict future results.​​

  • Catastrophic High Pressure Water Injury Resulting in Ruptured Colon, Infections, Multiple Surgeries Required

    NET TO CLIENT $3,069,546.66

  • Catastrophic Brain Injury/Motor Vehicle Accident

    NET TO CLIENT $3,018,051.78

  • Electrocution involving Defective Product

    NET TO CLIENT $2,491,510.87

  • Wrongful Death caused by Employer Negligence

    NET TO CLIENT $1,119,736.98

  • Grandmother seriously injured when rear-ended by 18-wheeler oil

    NET TO CLIENT $977,516.95

  • Wrongful Death due to Employer Negligence

    NET TO CLIENT $852,773.73

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    NET TO CLIENT $841,000.00

  • Catastrophic Injury caused by Defective Product.

    NET TO CLIENT $714,000.00

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    NET TO CLIENT $728,664.19

  • Serious injury caused by 18-Wheeler blocking road

    NET TO CLIENT $584,309.41

  • Wrongful Death caused by Medical Malpractice.

    NET TO CLIENT $443,360.00

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    NET TO CLIENT $584,062.75

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  • Wrongful Death of a child

    NET TO CLIENT $499,266.40

  • Serious injuries to driver of 18-wheeler

    NET TO CLIENT $465,230.35

  • Wrongful Death caused by Medical Malpractice.

    NET TO CLIENT $359,520.00

  • Wrongful Death of a Child

    NET TO CLIENT $303,070.11

  • Wrongful Death of a Child

    NET TO CLIENT $380,345.57

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    NET TO CLIENT$345,526.90

  • Serious Personal Injury

    NET TO CLIENT $352,813.23

  • Wrongful Death of a Child

    NET TO CLIENT $320,706.81

  • Medical negligence by hospital

    NET TO CLIENT $284,156.68

  • Wrongful Death Alcohol-Related Accident

    NET TO CLIENT $341,061.50


*The amounts reflected are the actual dollar amounts received by clients after deduction of attorney’s fees and expenses.
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