In Texas when you are injured on the job you can file a claim for workers’ compensation as long
as your company is not a nonsubscriber. However, even if you are covered by workers’
compensation, you might find your claim is rejected. When this happens you miss out on the
coverage needed for your medical expenses and lost wages. If your claim is rejected, you can
seek help from a workers’ comp attorney.
Why are Workers’ Compensation Claims Denied?
There are many legitimate reasons your workers’ compensation case might be denied including:
● There were no witnesses to your accident
● You failed to report the injury, or delayed reporting the injury
● Your medical records and your accident report have discrepancies
● Your claim was filed after you are laid off or fired
● You refused to sign medical authorizations
● You refused to sign a recorded statement for the insurance company handling the claim
All of these reasons can lead to a rejected workers’ compensation claim.
How to Appeal Your Denied Claim
In Texas, you can appeal a denied workers’ compensation claim. However, it can be a long and
drawn-out process without guidance. A workers’ comp attorney can help you with your appeal.
This begins with a benefit review conference (BRC) with Texas’ Division of Workers’
Compensation. Your attorney can complete the form with the information required including
details about your injuries, what you are claiming and why you are disputing the decision to
deny your claim.
What Happens After the BRC is Filed?
Once filed your lawyer will represent your case and ensure the benefit review officer has all the
information required during the review process. Their job is to review your documents as well as
the insurance companies to determine if you are in fact eligible for benefits. However, they are
not the person who makes the final decision should the insurance company refuse to settle
during the BRC. Instead, the case will be sent to arbitration or a hearing.
What is Better, Arbitration or a Hearing?
Arbitration is cheaper and also usually resolves the issue sooner. It is a meeting where both
sides present their case to an arbitrator, who makes a final decision that cannot be appealed.
For a contested case hearing, you go through a process very similar to a trial The case is heard
before a Division of Workers’ Compensation hearing officer where both sides present evidence.
The benefit of going through the hearing process is that if the decision of the hearing officer is
not in your favor, you still have one final step you can take to present your case before a
Division of Workers’ Compensation Appeals Panel. Your rejected workers’ comp attorney will
advise you which process is recommended for your case.
Why Hire a Workers’ Comp Attorney?
A rejected workers comp attorney handles all aspects of your appeals process. They
understand the small details that can lead to further rejection and losses for appeals. Their
expertise provides guidance so you can receive the compensation you deserve. They can also
act as a nonsubscriber attorney should your company not offer workers’ compensation.
If you or a loved one have been injured in a work accident and believe you should be entitled to more benefits than your employer provided, do not hesitate to contact Tony Malley of the Malley Law Firm.