What Should I Do If My Workers' Compensation Claim Is Denied in Texas?

If you've recently received a denial letter for your workers' compensation claim in Texas, it doesn't mean your case is over. Here's some advice from workplace injury lawyers in Houston, TX, on how to move forward after a denial.

What Should I Do If My Workers' Compensation Claim Is Denied in Texas? Advice from Workplace Injury Lawyers in Houston, TX

Learn Why Your Claim Was Denied

Review the reasons given in the denial letter. Was the denial due to a missed deadline, lack of sufficient medical evidence, or questions about whether the injury occurred at work? Is the insurance company arguing that your injury isn't severe enough to qualify for benefits, or are they challenging the extent of your treatment? If you don't fully understand the reasons easily, contact your workers' compensation attorney.

Gather Additional Evidence

If the denial was due to insufficient evidence, your attorney can help you gather additional proof to strengthen your case for an appeal. Insurers will look for clear medical documentation that supports the necessity and duration of your treatment. It may help to see a different doctor or specialist who can provide a new medical opinion to address the issues the insurer raised. Additional statements from coworkers who witnessed the incident or from your supervisor may also help.

File a Dispute With the Texas Division of Workers' Compensation (DWC)

You have the right to file a dispute with the Texas Division of Workers' Compensation (DWC), which oversees workers' compensation claims. Once you file a dispute, you may have a benefit review conference (BRC), where you and a representative from the insurance company can discuss the case before a DWC official, with the goal of reaching a mutual agreement. If you cannot reach an agreement, a judge will review the evidence and decide on the claim in a contested case hearing.

Consider Hiring a Workers' Compensation Attorney

An attorney specializing in workers' compensation law understands the strategies insurers use to minimize or deny claims. They can be especially helpful if you've already gone through an initial appeal and are considering taking your case to a hearing. Many workers' compensation lawyers work with the understanding that they get paid only if you win your case, so hiring an attorney won't break the bank. Click here to explore some of your options.

Understand Alternative Options

Consider alternative options for financial support. In Texas, some employers opt out of the workers' compensation system, so you may have the option to file a personal injury claim. A personal injury lawsuit makes it possible to seek compensation for medical bills, lost wages, and other damages that workers' compensation would not normally cover.

Another option might be disability benefits through the Social Security Administration. These benefits could provide additional support if your injury limits your ability to work long-term. The application process for disability benefits can take a while and be somewhat complicated. It can be a good idea to get legal help to pursue this as an option.

A denied workers' compensation claim doesn't have to be the end of your pursuit for benefits. It's wise to consult with a Texas workers' compensation attorney for help and advice.

Conclusion

A denial of your Texas workers' compensation claim is not the end of the road. By reviewing the denial reasons, gathering additional evidence, and filing a dispute with the Texas Division of Workers' Compensation, you can strengthen your case. Working with an experienced workers' compensation attorney can further improve your chances of a successful appeal, helping you secure the benefits you deserve. Don’t hesitate to seek legal guidance to protect your rights.