Getting hurt at work is rough. Having your workers’ comp denied makes it worse. Fortunately, you have opportunities to get informal reconsideration of your claim.
If informal reconsideration is unsuccessful, several formal avenues are available, such as arbitration or a contested case hearing within Texas’s Division of Workers’ Compensation.
Ultimately, you can seek judicial review when your workers’ comp is denied.
What Are the Informal Channels for Resolution?
Review of denied workers’ comp begins at the employer level. Although it may be intimidating, a good first step is to ask your employer why your claim was denied. It is possible that your description of your injury was too vague.
Perhaps your employer misunderstood what happened or the extent of the injury. Although it can be hard not to get angry or defensive if you feel that your injury is not being taken seriously, try to focus on what your employer is saying.
Then you should use their answers to clarify what happened and improve your injury report. You would be surprised how many claims get resolved this way, and the injured employee gets their comp.
However, if speaking with your employer does not resolve the issue, you can request a meeting called a benefits review conference.
You, your employer or its insurance carrier, and a representative from Texas’s Division of Workers’ Compensation attend this meeting. The idea is that the three parties working together can reach an agreement.
If the benefits review conference does not reverse your claim being denied, you have some more formal options.
What Are the Formal Channels to Resolution When Your Workers’ Comp Is Denied?
If speaking with your employer and attending a benefits review conference has not resolved the denial of your claim, your next step can either be to agree to arbitration with your employer or opt for a contested case hearing.
Arbitration means that a neutral third party hears your case. In arbitration, each side puts on its case before the arbitrator. However, a defining feature of arbitration is that the arbitrator’s decision is generally final.
This means that if your Texas workers’ comp complaint is denied, there is no opportunity to appeal. You are probably stuck with the arbitrator’s decision.
The alternative is to go for a contested case hearing. In a contested case hearing, each side puts on its case before a third-party neutral. This neutral is a hearing officer from Texas’s Division of Workers’ Compensation.
After the hearing officer hears both sides, there is a waiting period while the officer writes an opinion. Once the hearing officer issues an opinion, you have a choice. Unlike with arbitration, you can appeal the result of a contested case hearing.
If you choose to appeal, a panel called the Appeals Panel reviews the record of the contested case hearing. You do not have an opportunity to put on evidence again. The Appeals Panel makes its decision from the written record.
If the denial continues to this point, you can seek judicial review.
Contact a Waco, Texas Workers Compensation Lawyer Today
As you can see, after your Texas workers’ comp claim is denied, the next decisions you make will shape the scope and finality of your remedies.