was your workers compensation claim is denied?

Having your workers' compensation claim denied by the insurance carrier can be frustrating and stressful. However, it's important to understand that claim denials are not the end of the road. This subpage provides guidance on what to do when your workers' compensation claim is denied and the steps you can take to appeal the decision.

Understanding Claim Denials

Claim denials can occur for various reasons, including:

Lack of Sufficient Evidence: The insurance carrier may believe there isn't enough evidence to support your claim.

Disputes Over Causation: The carrier may dispute whether your injury or illness is work-related.

Missed Deadlines: Failing to report the injury promptly or meet other deadlines can lead to claim denials.

Steps to Take After a Denial

Review the Denial Letter: Carefully read the denial letter provided by the insurance carrier. It should outline the specific reasons for the denial.

Consult with an Attorney: Consider seeking legal advice from an experienced workers' compensation attorney. They can review your case and provide guidance on the best course of action.

Gather Additional Evidence: If your claim was denied due to insufficient evidence, work with your attorney to gather more supporting documentation. This may include medical records, witness statements, or expert opinions.

Request a Reconsideration: In some cases, you can request a reconsideration from the insurance carrier. Your attorney can help you prepare a strong appeal.

File an Appeal: If the reconsideration is unsuccessful, you have the right to file a formal appeal with the Texas Department of Insurance, Division of Workers' Compensation (DWC). This involves submitting a Request for a Benefit Review Conference (BRC) or a Contested Case Hearing (CCH).

Prepare for Hearings: If your appeal proceeds to a BRC or CCH, your attorney will help you prepare and represent you during the hearings.

Continue Medical Treatment: While your claim is under review, it's crucial to continue receiving necessary medical treatment for your injury or illness.

Legal Support Is Essential

Dealing with a denied workers' compensation claim can be complex, but you don't have to navigate it alone. Seeking the assistance of an experienced workers' compensation attorney is often the most effective way to address a claim denial, protect your rights, and work toward obtaining the benefits you deserve. Remember, even if your initial claim was denied, there are legal avenues available to pursue the compensation you need to recover from a workplace injury or illness.