It is not required by law in Texas for businesses to have workers compensation insurance
. However, when an employer does carry this insurance in Texas, then their employees are protected in case of accidental injury or death at work
. In most cases, benefits will be awarded regardless of fault, unless the injury was due to roughhousing, inebriation or other circumstances that disqualify an employee from benefits. If the employee and the insurance company cannot agree about a workers compensation claim then that is a dispute.
An employee’s entitlement to benefits is just one example of a possible workers compensation dispute
. Additional disputes can be about the extent of the injuries, the selection of medical professionals, kinds of treatments and amount of benefits that should be paid. In cases like that it is important to contact your company's insurance company and try to work through the issue with an adjuster. If that does not resolve the dispute then you should contact the Texas Department of Insurance, Division of Workers Compensation (TDI-DWC) to seek a resolution. A worker who decides to take this step is wise to seek legal representation
because successfully completing the dispute resolution process outlined below can allow you to settle out of court.
The TDI-DWC has a multiple step program
in place to solve these complaints. The first stage is the Benefit Review Conference (BRC). This is an informal meeting at a TDI-DWC office between the injured worker and a representative from the insurance company. At the meeting, a discussion will take place about the issues with a Benefit Review Officer. If a compromise can be met, then a written agreement is crafted by the Officer, which can be signed by both parties and becomes legally binding.
If a BRC does not resolve the issue, you can try arbitration. A third party arbitrator will be assigned to the case to listen to each side of the disagreement. After each side has a chance to explain, the arbitrator will confirm a settlement that is final and cannot be appealed.
If you choose not to try arbitration, another option is to hold a Contested Case Hearing (CCH). A hearing officer settles the parts of the dispute that were not concluded in the BRC in a more formal setting. The difference between a CCH and arbitration is that a decision made by this officer can be appealed. Rather than conducting an additional meeting, each party submits a written statement to start the appeals process. The appeals panel will write a decision, which would consider the hearing officer’s decision as well as the record from the CCH. The only other recourse to resolve the dispute is to take the claim to court.
Disputing a workers compensation resolution is an arduous process. It is important to have legal representation to present your case both in formal meetings and through written communication. If you are having an issue resolving these kinds of issues, then contact an experienced workers compensation attorney in New Braunfels