It’s no secret that injuries happen on the job. While some may assume these are unfortunate occurrences, it’s necessary to understand that you are entitled to file a claim for a workers’ compensation award. However, you may be shocked to learn your claim was denied despite suffering intense injuries and economic damages. It’s critical to understand that you have a right to appeal the decision, though you should understand the strict filing requirements and deadlines that are involved in this process. Under Texas law, most workers’ compensation appeals must be filed within the 15-day deadline, as missing this deadline can prohibit you from challenging the decision. The following blog explores your options for appealing a decision and how a San Angelo, Texas work injury lawyer can assist you through this often frustrating process.
What Is Workers’ Compensation in Texas?
When a worker is injured while at work, they may be eligible to receive compensation for the injuries they’ve sustained through workers’ compensation. This is a type of insurance that employers carry to offer injured workers compensation for injuries, but they must relinquish their right to sue. This compensation includes partial wages, medical coverage, and wrongful death payments. In Texas, this appeal is governed by the Texas Department of Insurance, Division of Workers’ Compensation. This agency sets strict procedural rules regarding filing and reviews.
It is essential to understand that Texas does not require employers to carry this insurance. As such, some injured workers must pursue a third-party claim.
What Benefits Does Workers’ Compensation Cover?
- Coverage for medical care for workplace injuries
- Partial wage replacement for work missed as a result of injury
- Disability benefits for partial or permanent impairment
- Death benefits for surviving family members
Texas-Specific Considerations
- Private employers in Texas are not mandated to carry workers’ compensation insurance
- Injuries must be reported within 30 days
- Failure to report the injury promptly can result in the denial of your claim
- Some injuries, like those caused because you were under the influence or violating company policy, may disqualify claims
How Can I Appeal a Workers’ Compensation Award?
If you are unhappy with the outcome of your workers’ compensation case, understanding the appeal process is crucial. It is your right to request an appeal. Generally, you must request a review of the decision through the Division of Workers’ Compensation Appeals Panel. This must be in writing, and you must include why you believe the decision was incorrect. You can use rules and evidence to your advantage.
If you want to file with the panel, you must submit your appeal within 15 days. If you receive your decision via mail, the decision will begin five days after you obtain the letter. However, if the decision was faxed, the deadline is 15 days from the electronic receipt.
Step-by-Step Texas Appeal Process
- Submit a written appeal to the Texas Workers’ Compensation Appeals Panel
- Clearly explicate why the decision was incorrect
- Include supplemental evidence, like medical records and witness statements
- Ensure you have submitted the appeal within the 15-day deadline to remain eligible
- Await review and determination by the Appeal Panel
Common Reasons for Appealing a Decision
- Claim denied despite a valid workplace injury
- Compensation awarded does not fully cover the cost of medical care
- The insurance company disputes the severity of the injury or disability rating
- Errors in documentation or missing information
What Should I Do if My Claim Is Denied or Seems Incorrect?
In the event your claim is denied or the funds you receive are insufficient, you may be able to appeal the decision. However, you’ll need to discuss the matters with your employer, as in some instances, errors in your filing or missing information can impact whether or not your claim is accepted. If this reflects your circumstances, you will likely be able to remedy the errors in the filing.
Immediate Actions to Take After Denial
- Review the denial letter to determine the reason your claim was denied
- Contact your employer or their insurer to determine if you can correct the issues with the filing
- Collect updated medical records
- Request a formal hearing through the Division of Workers’ Compensation, if necessary
When to Escalate Your Case
- If informal resolution fails, a formal hearing through the DWC can help
- Present evidence before the hearing officer
- If this hearing is still unsuccessful, you can further escalate the matter to the Appeals Panel
Do I Need an Attorney to Assist Me Through This Process?
If you sustain an injury at work, it’s imperative to contact an attorney as soon as possible, especially if your employer does not carry workers’ compensation insurance, as you must pursue a traditional personal injury claim to recover justice for your injuries.
An attorney can help you navigate the complexities of filing a workers’ compensation application to improve your chances of recovering the funds you deserve. However, if you are still denied, your attorney can help prove you are entitled to the benefits. The appeal process can be complicated, but having a competent lawyer to help guide you through this process can make it significantly more manageable.
Contact an Experienced Tom Green County Personal Injury Attorney
At the Mathis Law Firm, we understand that work-related injuries can cause a significant strain on your life. As such, we are dedicated to helping you and your family through these challenging times. Contact us today to learn how we will fight for the compensation you deserve if you are unhappy with the outcome of your workers’ compensation award.
