Workers’ Compensation

By Luis M. Julia

In this newsletter we will give you a basic understanding of the dispute resolution process and the steps involved under Texas workers’ compensation laws.

There are several steps in the dispute resolution process in a workers’ compensation claim: (1) Benefit Review Conference, (2) Arbitration or Contested Case Hearing, (3) Appeals Panel and (4) Judicial Review.

Benefit Review Conference (BRC)

The BRC is an informal meeting held at your local Texas Department of Insurance, Division of Workers’ Compensation (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, a Benefit Dispute Agreement will be drafted and executed by all parties and the Division to finalize the resolution of the dispute.

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, the hearing officer sends the decision to Austin, where it is finalized and mailed to all parties involved.

Appeals Panel

After the CCH, any party that disagrees with the hearing officer’s decision may request a review of that decision by the TDI-DWC Appeals Panel. Instead of holding a hearing, the parties submit written statements describing their positions, and those statements 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 dispute resolution process.

Judicial Review

If a party disagrees with the TDI-DWC Appeals Panel’s decision, the decision may be appealed to a court of law for civil trial.

Attorney Representation

The dispute resolution process of the Texas Department of Insurance, Division of Workers’ Compensation is both complex and difficult. The insurance company will always be represented by an attorney at every step of this process. As an injured worker, you have the same right to representation as the big insurance companies do, and you should hire an attorney to represent you for your claim. Your Bailey & Galyen workers’ compensation attorney will process your claim and all related paperwork in accordance with all DWC regulations and deadlines. Your Bailey & Galyen attorney will also attend dispute resolution proceedings with you and present the evidence you need to support your side of the dispute. The attorney’s fees will be deducted from your income benefit payments as ordered by the TDI-DWC so you do not pay out of pocket for representation. To get in touch with Bailey & Galyen’s Workers’ Compensation Department, please call 1-800-208-3804.

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