Sometimes things don’t go as planned, and sometimes you’ll be denied Workers’ Compensation after a workplace accident. Luckily, you may appeal this decision. Working with a workplace injury lawyer in Houston will greatly help you when you wish to appeal a decision made regarding Workers’ Compensation. Disability claim lawyers specialize in advocating for individuals who are seeking compensation or benefits due to their disabilities.
Ask a Workplace Injury Lawyer in Houston: How Do I Appeal a Decision?
Workplace injuries aren’t uncommon, and your employer has most likely taken steps to protect themselves in the case one occurs. Visit this page to learn a little more about workplace injuries and contact a lawyer who may be able to help if you’ve sustained one.
Because workplace injuries are so common, many Texas employers carry Workers’ Compensation insurance. Not every employer is legally required to have Workers’ Compensation insurance, so you may end up having to file a civil lawsuit to recover compensation. However, if your employer does have this insurance and your claim is denied, then you don’t have to go straight to filing a lawsuit. There are steps to take to appeal the decision.
What Do I Do If My Workers’ Compensation Claim Is Denied?
1. Have Legal Representation
Having an experienced attorney at your side is a must when dealing with any legal situation. In your case, you’ll want a work accident lawyer who has helped people appeal Workers’ Compensation claims previously. It’s best to start working with an attorney as soon as you’re injured in a work accident. If you start working with an attorney early, you’ll have one at your side already if your Workers’ Compensation claim is denied.
Your attorney may reach out to your employer’s insurance company that’s responsible for paying Workers’ Compensation. Sometimes your attorney will be able to get the insurance company to go back on the decision. However, this won’t always work, and if it doesn’t, you’ll have to attend some informal and formal meetings.
2. Go to a Benefit Review Conference
You’ll need to attend a benefit review conference, which is an informal hearing. Your attorney will attend with you, and you’ll discuss the matter with a representative of the insurance company. Your attorney may advise you on the things you should say during this conference, and they’ll likely do a lot of the talking on your behalf as they understand the legalities of the situation.
This conference may be all it takes for the insurer to go back on the insurance company’s decision. However, sometimes the insurance company simply won’t budge, so you’ll have to take the next step.
3. Attend Arbitration or a Contested Case Hearing
The meeting you’ll attend if you weren’t awarded Workers’ Compensation during your benefit review conference is more formal and is quite similar to a trial in a courtroom. Both sides will need witnesses and evidence, and there’ll be a judge present to make a decision once each side has presented their case. You may attend arbitration or a contested case hearing.
Arbitration
Arbitration sees both sides meet once more, only this time a neutral third party will be present, known as the arbitrator. The arbitrator will take all the evidence into account and then make a decision. With arbitration, both sides agree to adhere to the arbitrator’s decision in advance. This means you cannot appeal the arbitrator’s decision.
Contested Case Hearing
With a contested case hearing, a judge makes the decision regarding whether you can receive Workers’ Compensation. Like with arbitration, both sides will present their evidence at a hearing in front of the judge. However, you won’t find out the judge’s decision at the end of the hearing. Instead, they mail you a decision on whether you’ll be receiving Workers’ Compensation.
If the judge decides you won’t be receiving Workers’ Compensation, then your attorney can appeal this decision on your behalf. This appeal will be in writing and sent to the Appeals Panel, and the panel will review the hearing. The panel will send you their decision in writing, either awarding or denying you Workers’ Compensation.
What Happens If the Appeals Panel Denies My Workers’ Compensation Claim?
If the Appeals Panel denies your Workers’ Compensation claim, then you have one option left: a civil lawsuit. Your civil lawsuit may see you seek a settlement to cover your damages instead of Workers’ Compensation. However, you may end up going to trial, but you can sometimes settle without it. At trial, if applicable, the jury will come to a verdict. You may be able to appeal this verdict if the jury decides not to award compensation.
If your Workers’ Compensation claim is denied, then you may appeal the decision. You’ll attend several meetings to try and come to an agreement and be awarded Workers’ Compensation. If you’re not awarded Workers’ Compensation, then your attorney may advise you to pursue a settlement through a civil lawsuit.
