If you were hurt at work, you are likely owed workers’ compensation benefits. But what if your employer tried to deny you the benefits you deserve? There are options under Texas workers’ compensation law. With an experienced attorney at your side, you can fight back against wrongful denials and seek the compensation and other benefits you’re entitled to.
At Griffin Law Group, LLC, our dedicated Texas workers’ compensation lawyer is ready to fight for you. Get started with a consultation to learn how he can help.
Why Texas Workers’ Compensation Claims Get Denied
Having your workers’ comp claim get denied can be very frustrating. It might even feel personal, but it often comes down to a few common reasons:
- Reporting the Injury Too Late: Injured employees must report the injury to their employee within 30 days. If you’re too late, the claim could get denied.
- Work-Related Disputes: Your employer might try to argue that the injury wasn’t work-related, even if it was. They could say it was a pre-existing condition or wasn’t part of your ordinary scope of work.
- Medical Evidence: The employer might say that there is not enough medical proof that what you are going through is connected to the injury at work.
- Follow-Through: Your employer could argue that you failed to follow medical advice, go to appointments, or other inaction that means they can deny your claim.
The denial letter is supposed to tell you why the employer denied the claim. When you know why they are trying to deny it, you can fight back against a wrongful decision.
What Do I Do After a Denial?
If your claim was denied, you’ll want to act right away. There are many deadlines and procedures you have to follow, but you can rest easy if you have an experienced attorney guiding you.
Review the Denial Letter Carefully
The letter should outline the insurer’s reasoning and provide instructions for disputing the decision.
Gather Supporting Evidence
Additional documentation can strengthen your case, including:
- Updated medical records
- Witness statements
- Accident reports
- Job duty descriptions
- Photos or videos of the incident
The better your evidence is, the more likely you are to prove that the injury was work-related and compensable.
Continue Medical Treatment
Too many people stop going to the doctor if their claim is denied. However, continued treatment is important for your health and your overall claim. If you don’t follow doctor’s orders, the claim could be limited or denied later.
Consider Speaking With a Texas Workers’ Compensation Attorney
The dispute process can be complex. Many injured workers choose to work with an attorney who understands the Texas Department of Insurance, Division of Workers’ Compensation (DWC) procedures and can help build a strong case.
Understanding the Texas Workers’ Compensation Dispute Process
Texas uses a multi-step dispute resolution system.
Benefit Review Conference (BRC)
This is a meeting between with:
- A DWC Benefit Review Officer
- The insurance company
- The injured worker and their attorney
The goal is to resolve the dispute through discussion and negotiation. If the issue cannot be resolved at the BRC, the case moves to a more formal stage.
Contested Case Hearing (CCH)
A CCH is similar to a trial. A DWC Hearing Officer listens to testimony, reviews evidence, and issues a written decision. This is often the most important stage of the process, as it determines whether the denial will be overturned.
Appeals Panel
If either party disagrees with the Hearing Officer’s decision, they can appeal to the DWC Appeals Panel. The panel reviews written arguments and may affirm, reverse, or modify the decision.
Judicial Review
If the dispute remains unresolved, the case can be taken to state court. This is the final level of appeal.
Get in Touch with a Texas Workers’ Comp Attorney to Fight for Your Rights
A denial of workers’ compensation benefits is not the end of the road for you. You have rights under Texas law to seek the compensation you’re entitled to. By filing the right documentation and proving your case, you can pursue the benefits you need after a work-related accident.
Consult a Texas workers’ compensation lawyer at Griffin Law Group, LLC for help. Contact us today for a consultation of your case.