Workers’ compensation is an insurance benefit. Your employer pays
for it, but the benefits come from an insurance company. Most of us know
that insurance companies try to avoid paying for benefits whenever possible.
As a result, many initial applications for compensation are denied.
Texas has many options for workers who have been denied their benefits.
You don’t have to immediately jump to a hearing, and you could avoid
a hearing altogether.
Here are the steps you should take if you’ve been denied compensation.
- Secure Representation
When you’ve been denied workers’ comp, your first step is to
find an attorney. They can work with you throughout the entire process
of gaining your benefits. Before moving to formal processes, your lawyer
can reach out to the insurer. It may be possible for them to work out
a compromise and resolve the situation without needing any next steps.
- Attend a Benefit Review Conference
If the insurer won’t make a compromise through your attorney, the
next step is to attend a benefit review conference. This is an informal
hearing where you, your attorney, and a representative of the insurance
company can discuss the matter. Hopefully, all positions will be considered,
and you will obtain your rightful benefits. When the insurer won’t
budge, it’s time to move to a more formal process.
- Attend a Formal Meeting
After trying to work with the insurance company and still being denied,
it’s time to attend a formal, official meeting. This process is
similar to a courtroom trial. Your lawyer will gather evidence and witnesses,
and so will the opposing side. There will be a judge who will make a decision
on your benefits.
There are two options for this meeting: arbitration or a contested case hearing.
You and the insurance company can agree to an arbitration. In this process,
a neutral third party is hired to hear both sides of the argument. The
arbitrator will consider all evidence and make a judgement. Both sides
agree beforehand to go with the arbitrator’s decision, so it will
be final. There is no chance to appeal.
Contested Case Hearing
Much like an arbitration, the case will be heard before a judge. In this
case, the judge is with the Division of Workers' Compensation (DWC).
The verdict is not given immediately. After both sides present their arguments,
the hearing ends. The judge then makes their decision and mails it to
If you still find yourself without benefits, your lawyer can appeal the decision.
After the hearing, you can submit a written appeal to the Appeals Panel.
It is best to have your lawyer draft this document. Once the Panel receives
the appeal, it will review the hearing. They will look over the decision
and study the record of the hearing. Afterward, they will create a written
decision and send it to you.
If all else fails, it may be necessary to file a civil lawsuit. Discuss
this option with your lawyer. They can help advise you on whether you
can move forward, taking the case to civil court.
If you have been denied workers’ compensation, contact us today.
We are familiar with the hearing and appeal process, and we may be able
to help you receive your benefits. Call (817) 591-4222 for a free consultation, or
contact us online.