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.
First, once you receive a notice of a claim denial, you should contact
your employer or its insurance company to attempt to resolve the issue
directly. 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 initial stage of dispute resolution before the state agency is a “Benefit
Review Conference,” which is an informal meeting where you and a
representative of your employer will meet with a Division of Workers’
Compensation Benefit Review Officer. Similar to mediation, the parties
discuss the dispute in order to reach a fair agreement, such as a settlement
offer to you that requires a written statement.
Arbitration & Contested Case Hearing
On the other hand, if the parties cannot agree, you may agree to proceed
to arbitration or you can go directly to a contested case hearing.
At Arbitration, you will once again meet with a representative of your
employer. Chosen by the Division of Workers’ Compensation, an arbitrator
will discuss the dispute with all parties. In the end, the arbitrator
will make a decision that cannot be appealed. Although arbitration often
takes less time and costs compared to a contested case hearing, if you
choose to participate in this process, you waive your right to a contested
case hearing in front of a hearing officer and you waive all future appeal rights.
By contrast, if the parties 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 will preside over the
hearing. The officer will assess all of the evidence submitted, including
medical evidence to support the existence of your work injury and any
witnesses to the accident. In the end, the officer will issue a written
decision adjudicating the issues surrounding the contested case hearing.
If you do not agree with the Hearing Officer’s decision, you may
appeal to the Division of Workers’ Compensation Appeals Panel. You
and your employer, or its insurance company, must submit written briefs
that argue your respective positions. The Appeals Panel will review the
briefs and the record from the contested case hearing, which means that
no new evidence may be presented. The panel will then decide whether to
affirm, modify, or reverse the decision of the Hearing Officer.
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.