How to appeal a denial of workers’ compensation benefits

| Mar 23, 2021 | Workers' compensation |

Many people in El Paso work in warehouses, factories or large construction sites. These types of jobs are often physically demanding, and the work environment can present many hazards, making it common for workers to suffer on-the-job injuries. When this happens, the injured worker may want to seek workers’ compensation benefits for the damages they suffered. The following is an overview of the dispute resolution process injured workers can file if their workers’ compensation claim is denied.

Step 1: Discuss the matter with an attorney or ombudsman

If your initial claim for benefits is denied the first step is to discuss the situation with your attorney or ombudsman. These professionals may be able to provide advice on your rights and options so you can make informed decisions. They may also be able to advocate on your behalf in future proceedings.

Step 2: Discuss the matter with the insurance carrier

If your initial claim for benefits is denied, after speaking to an attorney or ombudsman, the next step is to discuss the matter with the insurance carrier or have your ombudsman or attorney do so. It may be possible to work out a resolution directly with the insurance carrier.

Step 3: The benefit review conference

If you are unable to reach a resolution directly with the insurance carrier, you can request a benefit review conference. This is an informal meeting attended by you, your attorney or ombudsman, a representative from the insurance carrier and a DWC benefit review officer. You can discuss your issue and if it is resolved, a written agreement will be drawn up and signed by the parties and benefit review officer.

Step 4: The contested case hearing

If you are unable to resolve your issue at the benefit review conference, you may request a more formal hearing known as a contested case hearing. A DWC administrative law judge will hold the hearing and issue a decision. Arbitration may be an alternative choice.

Step 5: Appealing the hearing decision or responding to an appeal

If the ALJ does not rule in your favor, you may request a review from the Appeals Panel. Conversely, if the employer disagrees with the ALJ’s decision, they can also request a review from the Appeals Panel. Each party will provide the Appeals Panel with a statement in writing regarding their position on the matter. The Appeals Panel will review these statements, the ALJ’s ruling and the hearing record, and will then issue a written decision.

Step 6: Judicial review

Generally, the Appeals Panel is the final step in the DWC’s dispute resolution process. However, the Appeals Panel’s decision can be appealed to a court in a process known as judicial review.

Learn more about workers’ compensation in Texas

Ultimately, this post is for educational purposes only and does not contain legal advice. Those who want further information on workers’ compensation in Texas may find our firm’s website to be a useful resource.