Texas Workers Comp Claim Denied. What Are My Legal Options?

Workers Compensation
workplace injury

Submitted by Texas Workers' Compensation Attorney Ronald Ramos

Has your Texas workers’ compensation claim been denied? You still have legal options. Protect your rights and contact an experienced Texas workers’ compensation attorney immediately.

Workers’ Compensation Denials

A workers’ compensation claim denial is often a confusing and frustrating experience. Your claim could have been rejected for several different reasons. Unfortunately, sometimes claims are denied for improper reasons. The first step to resolving your dispute, is determining the precise reason as to why the insurance company denied your workers’ compensation claim. Employers, and their insurers, have a legal responsibility to issue specific written explanations for all workers’ compensation claim denials. Your claim may have been unfairly denied if any of the following three issues were present in your case:

  • You never received an explanation with specific reasoning as to why your claim was rejected;
  • You did receive the written explanation, but the explanation does not make sense to you; or
  • You did receive the written explanation, but it has inaccurate information or comes to an unfair conclusion.

Three Steps to Fight Back

  • Contact an attorney: Overturning an unfairly denied Texas workers’ compensation claim is always a challenge. You need the professional services of a qualified workplace injury attorney who can guide you through the complex appeals process. Crafting a winning appeal is critical and it takes an experienced hand.
  • Receive a truly independent medical evaluation: In the majority of disputed workers’ compensation cases, the full extent, and exact timing of the injuries, are the primary issues. Under Texas law, both parties to the dispute have the right to request an independent medical evaluation. Generally, your employer will request one if it disputes the findings of your chosen doctor. It is important to ensure that the independent medical exam is truly independent. Sometimes insurance companies will try to rig the game and get you in front of a doctor who is favorable to the company. Your attorney can make sure that this process is fair.
  • File for dispute resolution: The Texas Department of Insurance, Division of Workers' Compensation regulates workers’ compensation in the state of Texas. It is the agency responsible for facilitating resolution in workers’ compensation disputes. The Texas workers’ compensation dispute resolution process has a number of steps. This typically includes a benefits review conference, then arbitration or a contested case hearing, and in some cases further appeal. An experienced workers’ compensation attorney is a valuable asset at each stage of the process.

Contact An Experienced Workers’ Compensation Attorney

Ideally, injured Texas workers would receive full benefits quickly and without any complications. Unfortunately, Texas employers and their insurance companies, all too often, incorrectly deny injured workers access to workers’ compensation benefits. If you are covered by workers’ compensation insurance, your employer’s insurance company has a legal obligation to fairly process your claim. A worker’s compensation attorney can fight against unjust workers’ compensation claim denials. A denial does not mean that your case is over. You have the right to go through the appeals process. Contact an attorney for a comprehensive review of your case and an explanation of your rights and options.

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