Watch Out For The Two Deadliest of Workers Compensation Pitfalls

Workers Compensation Deadlines

Recognize that the Texas Workers Compensation system is filled with deadlines for you as the injured worker. As the injured worker, you must know and abide by those deadlines imposed by the Texas Workers Compensation systems. Remember that ignorance of the law is not defense. Failure for your to abide by workers compensation filing and appeal deadlines can and will result in loss of some or all your workers compensation benefits. It is imperative that the injured worker be aware of when deadlines start to run and exactly what must be done to comply with the deadlines.

Some general but extremely important deadlines:

• Injured workers have 30 days to report an injury to employer.
• One year to report an injury to the Division of Workers’ Compensation.
• 90 days to dispute an Impairment Rating given by treating doctor; 90 days to dispute an Impairment Rating given by a Referral Doctor; 90 days to dispute an Impairment Rating given by a Required Medical Examiner; 90 days to dispute an Impairment Rating given by a Designated Doctor.
• 10 days to dispute a denial of a request to change your Treating Doctor.
• 10 days to dispute a denial of a request to extend your Statutory Maximum Medical Improvement date based upon spinal surgery.
• 7 days to submit a Supplemental Income Benefits quarterly application before the quarter begins.
• 10 days to respond to the insurance carrier’s request for a Required Medical Examination.
• 14 days prior to a Benefit Review Conference, you must exchange any documentation that you wish use with the insurance carrier.
• 15 days after a Benefit Review Conference, you must exchange any documentation that you wish to use at a Contested Case Hearing with the insurance carrier.
• 15 days to respond to a request for an appeal by the insurance carrier of the Decision from a Contested Case Hearing.
• 30 days to request Judicial Review in State District Court.

Taking The Advice of Employer or Insurance Company Adjuster

The main goal of insurance adjusters is to minimize payment on claims. Do not make the mistake of thinking an adjuster has your best interest in mind. Similarly, your employer most likely is more concerned with safety records and low insurance premiums that might increase with your filing of a workers compensation claim. These two parties have their own self interest and preservation as their main motivation. Do not make the mistake of trusting them or following their advise. Insurance companies often under pay on amount rightfully owed to injured workers, and those workers who are not legally represented pay the ultimate price. Insurance companies also lead you into making statements in recordings that will get you into trouble and give them cause to deny or limit your claim. Do not give permission for recorded statements unless you have talked to an attorney first.

Insurance doctor are just that and work for the interest of the insurance company. They will not have your best interest in mind when they see you. You should never agree to see an insurance doctor, unless ordered by the Texas Workers Compensation Division.

Carrier's Denial of Your Claim: The Hearing Process

If you workers compensation claim has been denied, you, as the Claimant, will need legal counseling and representation more than ever. The Claimant is entitled to a fair and independent examination of the insurance company’s reason for denial. This process is initiated by the injured worker through the Texas Department of Insurance, Division of Workers Compensation. The hearing process involves the following steps:

Benefits Review Conference:

The initial hearing with the Division of Workers’ Compensation is called a Benefit Review Conference (BRC). A BRC is an informal hearing conducted at the Texas Workers’ Compensation Field Office where the workers compensation claim was filed. The purpose of the hearing is to mediate your workers compensation case in front of a fair and impartial Texas Workers Compensation official. This official is not a licensed attorney, but is trained to mediate workers compensation disputes. The parties to a BRC are you, the Claimant, the insurance company, the employer, and their respective representatives.

Keep in mind that the insurance company will more than likely have an attorney representing their interests at this hearing. This is why it is imperative that the Claimant be adequately represented by an attorney at all step of the disputed hearing process. In addition, evidence in support of your position will be presented to the Texas Workers Compensation official and to the other parties at the BRC. Proper preparation of supporting evidence and a good understanding of workers compensation law are essential to succeed at this level.

Contested Case Hearing:

If an agreement cannot be reached through the Benefit Review Conference between the Claimant and the Carrier (insurance company), then the disputed claim will proceed to a final hearing called a Contested Case Hearing (CCH). The purpose of the CCH is to formally present evidence and testimony and have a fair and impartial Texas Workers Compensation official, a Hearing Officer, make a final decision regarding the dispute.

There are many rules and regulations, both statewide and local to the field office handling your claim, which will affect the CCH. Again, the insurance company will be very strongly represented by legal counsel during this hearing process. It is again imperative that the Claimant have adequate experienced legal representation in order to prevail at this level.

At the CCH, the Claimant can expect the hearing to be conducted much like a trial in court. There will be a formal Opening Statement required by both parties. The Claimant proceeds first by putting on their case-in-chief and introducing evidence. The rules of evidence will apply and the Hearing Officer will expect the evidence to be introduced in proper form. Once the Claimant rests, the insurance company will have their chance to develop their case and put on their evidence. Once both parties have rested, there will be an opportunity for Closing Arguments by both parties. The Hearing Officer will make a decision which will be presented to all parties through a Decision & Order (D & O). This D & O is not immediate, you will not receive the Hearing Officer’s decision at the time of the hearing. Instead, the Hearing Officer will write up his decision, file it with the Austin Central Office, and it will be mailed to all parties thereafter. The process usually takes two to three weeks.

Consult With Your Bailey & Galyen Workers Compensation Attorney About Other Third Party Cases:

Your workers compensation injury may also involve another additional claim against another person or company other than your employer. The Bailey & Galyen Workers Compensation Department has years of experience in identifying those claims that may require further legal work on your behalf. Let us review your workers compensation injury and in order for you to get the best and most comprehensive results.

Workers Compensation and Wrongful Termination: Know Your Rights

If you have lost your job after experiencing a workers compensation injury, you really need to consult with an attorney. Being fired for filing a workers compensation claim is illegal in Texas under the Texas Workers’ Compensation Act. The Bailey & Galyen Workers Compensation Department is committed to helping you preserve your employment after a workers compensation injury and/or facilitating a wrongful termination case on your behalf.

You can expect to experience ill will, hostility, and ridicule by your employer if your are injured on the job. Employers may even go as far a firing an employee after an injury, even if the cause of the injury was not the employee’s fault. Employers can not only blame the injured employee, but also make accusations of faking and exaggerating injuries. Employees should protect themselves against this kind of employer conduct. The law is on your side.

Call our nearest office for prompt HELP:

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Irving: Ph 972.993.3186 | McAllen: Ph : 956.949.1080 | Mesquite: Ph 972.993.3186
Weatherford: Ph 817.855.5545

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