Need Help to Appeal a Workers Comp Denial?
Our Austin Workers Compensation Attorney Knows What to Do
Workers compensation insurance provides medical benefits and wage replacement to employees who sustain injuries during the course of their employment. Texas, unlike other states, does not require employers to provide this coverage. If your employer does opt to purchase workers comp insurance, then you may be entitled to benefits after a work injury, regardless of fault. However, in many cases, workers find their worker comp benefits denied by their employer and/or the insurer. Worse, state law effectively prevents employees from suing employers who have workers comp insurance. In some cases, this means that a workers comp denial could leave an employee without recourse to recover for an injury. Still, an experienced workers compensation lawyer may be able to help you appeal a denial and get the benefits you deserve.
The attorneys at the Law Offices of Aaron Allison have decades of experience helping individuals appeal denials of a valid workers compensation claims. As one of only four law firms in Central Texas that handles workers comp cases, we take pride in assisting injured workers to stand up for their rights. Workers comp lawyer Aaron Allison provides a high level of personal service and genuine attention to every client. If you need to appeal a workers comp denial after a workplace accident in Texas, then contact us today.
What Is the Workers Comp Appeals Process?
If you receive notice of the denial of your workers compensation benefits, then all is not lost; you have several chances to appeal a workers comp denial. However, the appeals process is even more complex than the initial claims process. So, if you do not already have an attorney, then you should contact one as soon as possible.
A workers comp attorney from our firm can negotiate with your employer and the insurance company to try to resolve your claim, based on the stated reasons for your denial. If necessary, then we will make a request to start the official dispute resolution process with The Division of Workers Compensation Insurance of the Texas Department of Insurance; this is the agency responsible for the administration of the workers compensation system.
The first step in an appeal brought before the Division of Workers Compensation is the Benefit Review Conference. This conference is essentially an informal meeting between you, your attorney, a Division of Workers Compensation Benefit Review Officer and your employer. This process is similar to mediation – we meet and debate the dispute with the goal of reaching an agreement.
Your employer and/or the insurance company may make a settlement offer at this stage. If you and your attorney agree this offer is fair, then you might be asked to sign a settlement agreement. However, if we cannot reach an agreement, then we may proceed to arbitration or go to a contested case hearing.
At a hearing, an officer will consider evidence submitted by all parties. You and your attorney must present your medical documents and may call witnesses to support the validity of your workers comp claim. The Hearing Officer will issue a written decision after the hearing.
If the outcome is not favorable, then we will appeal again. This appeal is reviewed by a panel. If that appeal does not change the outcome, then we will take the issue before the Texas State Courts. Our Austin workers compensation will stand by your side and assert your rights throughout multiple appeals, if necessary.
What Are Common Reasons for a Workers Compensation Denial?
One of the most common reasons a workers comp claim is denied is that the claim was not reported or filed in a timely manner. Texas law requires that an injured worker report his or her injury as soon as possible. Sometimes, this means that you must report an accident within a matter of days, or even a matter of hours. Then, the employer must report to the state or their insurance carrier just as quickly. Time is of the essence.
Another common reason for a denial is that an employer disputes the claim entirely. Employers often claim workplace injuries actually did not happen at work, or claim your current injury/illness was preexisting. If this happens in your case, then we can gather additional evidence that supports your workers comp claim. This evidence can include statements from witnesses where the accident occurred or a statement from your physician attributing your injury or condition to your workplace.
There are many other reasons for an injury claim denial. Some states exempt certain conditions as qualifying claims, such as stress-related injuries and conditions. Your injuries may also be too minor to warrant to a workers comp claim. However, your employer and/or the insurance company may look for any possible reason to deny your work injury claim. This may happen even if your claim is entirely valid. For an employer, denying a workers compensation claim means their insurance premiums probably will not go up.
Therefore, you should always appeal a workers comp denial. If you need assistance, then contact our Austin law firm today and have your claim denial letter ready. We can discuss your denial and your options for an appeal.
Denied Work Injury Benefits? We Help Appeal a Workers Comp Denial
Quality legal representation is the key to a successful outcome for your workers compensation appeal. Before speaking to your employer or the insurance company about the denial, contact The Law Offices of Aaron Allison online or at (512) 474-8346.
You can schedule a free consultation with an experienced Austin workers compensation attorney. We work with you to settle your case or, if necessary, aggressively pursue your case through trial. We have more than 30 years of experience helping people receive the benefits they deserve.