What Happens if My Workers' Compensation Claim is Denied?

If you're injured on the job, you most likely will need to file a workers' compensation claim in order to get disability benefits, which will cover all your medical expenses and lost wages when you're out of work. Unfortunately, many valid workers' comp claims are denied each year because the insurance company believes they found a valid reason why they shouldn't pay.

Appealing a Denied Claim in Texas

If your workers' comp claim is denied in Texas, your workers' comp attorney can help you through the appeals process. Your employer's insurance company is required to notify you of the denial within 15 days of when you filed the claim. They must provide you a written statement with reasons for the denial.

To dispute a decision, you will need to request a benefit review conference (BRC) with Texas' Division of Workers' Compensation. This form will provide information on your injury, the benefits you are claiming, and why you disagree with the insurance company's denial of your claim.

During the BRC, your workers' comp attorney will help you tell your side of the story with evidence as the insurance company presents their side. A benefit review officer will review each side's documents and try to help both sides settle, but this person cannot make any decisions for your case.

If the insurance company does not settle with you at the BRC, your case will go to arbitration or a contested case hearing.

Arbitration

This is usually a quicker and cheaper option if you and the other side decide on arbitration. This is a more formal meeting than a BRC and involves you and the other side presenting your evidence to an arbitrator, who will then make a decision. Once this decision is made, you cannot appeal it.

Contested Case Hearing

Instead of going to arbitration, you can choose a contested case hearing (CCH). This is more similar to a trial and is held in front of a Division of Workers' Compensation hearing officer. Each side will then present their evidence and communicate, and you and your attorney will have to show compelling evidence as to why you are entitled to benefits.

The hearing officer will make a decision and mail it to both parties. Unlike arbitration, if you are unsatisfied with this decision, you can still Division of Workers' Compensation Appeals Panel.

Helping You With an Appeal

You don't want the go through the appeals process alone, which can be complex and full of procedural rules. Our Corpus Christi workers' compensation attorneys have over 55 years of experience advocating on behalf of injured workers in Texas.

We will provide you with the ethical and effective legal representation you need in order to receive workers' comp benefits that will help you recover from a work injury.

Contact The Edwards Law Firm at 361-698-7600 to set up your free case evaluation. You can also fill out our online contact form and we will get back to you as soon as possible.