|
|
Texas Workers Compensation
|
Dispute
Resolution
Workers’ compensation is a
state-regulated insurance program
that pays your medical bills and
replaces a portion of your lost
wages if you have a work-related
injury or illness and your employer
has workers’ compensation insurance
under the Texas Workers’
Compensation Act.
If a
dispute arises about your injury or
illness, the first thing you should
do is call the insurance carrier and
discuss your problem(s) with your
adjuster. If you are unable to
resolve the dispute, you may request
dispute resolution through the Texas
Department of Insurance, Division of
Workers’ Compensation (TDI-DWC), the
state agency that regulates the
delivery of workers’ compensation.
You may be required to attend one or
more dispute resolution proceedings
held at the local TDI-DWC office.
What is Dispute
Resolution?
There
are several steps in the dispute
resolution process in a workers’
compensation claim: Benefit Review
Conference; arbitration or Contested
Case Hearing; Appeals Panel and
Judicial Review.
Benefit Review Conference (BRC)
The BRC is an informal
meeting held at a local TDI-DWC
office where, you will meet with
someone from the insurance company
to discuss the disputed issues in
front of a TDI-DWC Benefit Review
Officer. If the dispute is resolved,
an agreement may be written and
signed by you and the insurance
carrier.
Arbitration
If the dispute was not resolved
at the BRC, the injured employee and
other parties to the dispute may
agree to resolve the dispute through
arbitration instead of proceeding to
a contested case hearing. At
arbitration an independent
arbitrator chosen by TDI-DWC hears
both sides of a dispute and makes a
decision. The decision of the
arbitrator is final and cannot be
appealed.
Contested
Case Hearing (CCH)
Following a BRC, if all of the
parties do not choose arbitration, a
CCH is the next level of dispute
resolution. A CCH is a formal
hearing conducted by a TDI-DWC
Hearing Officer who makes a decision
about the disputed issue(s) that
were not resolved at the BRC.
Following the CCH, you will receive
the Hearing Officer’s written
decision and order.
Appeals Panel
After
the CCH, any party that disagrees
with the Hearing Officer’s decision
may request review of that decision
by the TDI-DWC Appeals Panel.
Instead of holding a hearing, the
parties submit written statements
describing their position that are
reviewed by the Appeals Panel along
with the Hearing Officer’s decision
and the record from the CCH. The
Appeals Panel will issue a written
decision, which is the final step in
the TDI-DWC’s dispute resolution
process.
Judicial
Review
If a party
disagrees with the TDI-DWC Appeal
Panel’s decision, the decision may
be appealed to a court of law for a
decision.
Attorney
Representation
You
may hire an attorney to represent
you for your claim. An attorney may
attend dispute resolution
proceedings with you and present any
evidence that supports your side of
the dispute. The attorney’s fees
will be deducted from your income
benefit payments as ordered by the
TDI-DWC.
You may fill out the
form below to have an attorney
contact you and give you a FREE
evaluation of your case, and assist
with your Dispute.
Need help getting your
Workers Compensation Benefits? We
can help. Fill out the form below
and get a FREE case evaluation.
Have an advocate or attorney look at
your situation and assist you in
getting the benefits your deserve.
 |
|
