How to Find the Best Houston Workers' Comp Attorneys
Written by AskTheLawyers.com™
Written by AskTheLawyers.com™
AskTheLawyers™
Find Houston Workers’ Comp Lawyers Near You
Workers’ Comp Lawyers Can Help Appeal a Denied Claim
If you have been injured or developed an impairing medical condition at work, you may be considering filing for a workers’ compensation claim. Even if you file the claim to the best of your ability, your claim can still be rejected. If the claim is rejected, you may be able to re-file or remedy the error. However, this depends on why your claim was rejected in the first place. Here are some of the most common for a workers’ compensation claim in Texas.
The Most Common Reasons for Denied Workers’ Comp Claims
It is without a doubt that most Houston insurance companies will search for any and all possible reasons to deny a workers’ compensation claim. These rejections, however, must follow both state and federal laws. There are very common reasons as to why a workers’ compensation claim can be rejected. A few reasons include the following:
1. You filed for a workers’ compensation claim after the company’s time restriction
If you have been injured at work or have otherwise developed a medical condition due to your workplace atmosphere, you will want to file for a workers’ compensation claim. Receiving benefits from the claim can greatly help your economic status in the event that you have high medical bills and are unable to work. You should know, however, that if you have missed a deadline in your filing process, you might lose some benefits. In the worst-case scenario, you will not be able to collect any of the workers’ compensation benefits. In order to avoid this misfortune, you first must begin by notifying the appropriate supervisor immediately after the illness or injury occurred. Once you have done so, depending on the rules and regulations of the region in which you are filing, you or your employer will need to file a workers’ compensation claim. It is important that you know your state’s rules and regulations for filing. Every jurisdiction will have different deadlines that you must abide by. If you missed the deadline, that could result in rejection. In order to prevent a rejected claim based on time restrictions, contact an experienced attorney. A qualified personal injury attorney will know when it is appropriate to submit the paperwork for filing a claim. He or she will be able to direct you through the process and make sure that you do not miss any deadlines, which could jeopardize your ability to receive workers’ compensation benefits.
2. There is a debate whether your work-related injury actually occurred at your place of work
There are several reasons as to why this argument can be presented. A few of the most common reasons include:
- You were not on the clock when the injury or ailment occurred;
- You were involved in misconduct when the incident took place; and/or
- Your medical condition did not arise from your workplace exposure.
With any of the above reasons, in order to dispute the rejection, you will need to gather sufficient evidence that will demonstrate your validity and otherwise support your claim. You can do so by collecting:
- Medical records that demonstrate the relationship between your ailment and your work history;
- Co-workers or other eyewitness corroborations that can support your claim;
- Work time cards, which demonstrate that you have worked during the questioned hours.
3. Your medical condition does not meet the required guidelines
Unfortunately, Houston guidelines do not cover all medical conditions. Your medical condition may be regarded as being too miniscule to qualify for benefits. The duration of your injuries may also be a contributing factor to a rejected claim. Be sure to check with Houston specific regulations to determine if your conditions qualify for workers’ compensation benefits.
4. You filed for a workers’ compensation claim after you left your employment
It is usually the case that an insurance company will deny your workers’ compensation claim if the claim was filed after you quit your job, were laid off, or were fired. You might have the opportunity to contest the claim denial if you gave notice of the injury before your last day at work. Certain states have special rules in regard to filing for a workers’ compensation claim after you have left your employment. If you qualify for an exception, you may have the opportunity to appeal your rejected claim.
What to Do If Your Workers’ Compensation Claim Is Denied
Texas laws state that your employer has 15 days from when you file your claim to either start paying benefits or give written notice that your claim is denied. If your workers’ compensation claim was denied, it is important that you do not give up your right to your benefits. The rejection could be due to a simple error on either your behalf or the insurance company. Contact a professional attorney who has experience in the matter and can help you appeal the decision.
In the event that you decide to appeal a rejected claim, be aware that the process can vary by region. Speak to an attorney as soon as possible to make sure you meet all your deadlines. The help and guidance of a knowledgeable and experienced attorney will also be able to help you understand if appealing your denied claim is the best option for you.
There are many reasons why a workers’ compensation claim could be denied, and appeals are complicated ordeals. They often involve rules of evidence and other civil procedures that a judge will likely expect you to understand. An experienced workers’ compensation attorney can help you build a strong case. Speak to a qualified legal professional to give your claim the best chance at being successfully approved.
About The Houston Workers’ Comp Appeal Process
To begin appealing a denied workers’ comp claim in Houston, you must request a benefit review conference, or BRC. In your request, you will outline why you disagree with your denial, what benefits you seek, and the nature of your injury.
When you meet for your BRC, you and the insurance company will have a chance to explain your case and present any necessary documentation. A benefit review officier will also be present for this discussion. They will not issue a ruling, but they will help the two parties communicate offers and hopefully come to an agreement. If you cannot agree on a settlement, then you have two choices: a contest case hearing, or arbitration.
- Contested Case Hearing (CCH)
In a contested case hearing, or CCH, you will argue your case in front of a Division or Workers’ Compensation hearing officer. This is more like a trial. Both sides submit arguments and evidence, along with opening and closing statements. The hearing officer will make a decision about your benefits and mail the results to both you and your employer. If you don’t like this decision, you can appeal your case to the Division of Workers’ Compensation Appeals Panel.
- Arbitration
Your other option besides a CCH is arbitration. This is generally a faster and easier option than CCH. To proceed with arbitration, both sides must agree to it. If both sides are on board, they will work with an arbitrator assigned by the Division of Workers’ Compensation. Similar to the benefit review conference, you can present documents that prove your claim. You can also call witnesses to testify on your behalf. Once both sides have presented the case, the arbitrator will make their decision. And here’s the important thing to remember about arbitration: this decision is final. Unlike a CCH, you cannot appeal the decision.
- Present Your Written Case to The Appeals Panel
If the CCH didn’t end in your favor, you’re not quite out of options yet. You can submit a written request to the appeals panel. You must submit this within 15 days of the CCH’s decision. In this case, you will include a written testimony and any necessary documents. The appeals panel will also consider the record of the contested case hearing. Once the panel issues its decision, either side has 45 days to appeal the decision through the Texas court system.
- Seeking Justice Through the Civil Court System
If you still did not receive a result in your favor, you can file a lawsuit within the Texas civil court system. As complex as the above process is, it becomes even more intricate when you start filing lawsuits. You need to have an experienced attorney by your side throughout the process. One tiny mistake can ruin your entire claim. Give yourself your best chance of success by enlisting the help of an experienced workers’ compensation attorney in Houston as soon as you hear that your claim has been denied.
