The Litigation Process in Workers’ Compensation Cases
When it comes to workers’ compensation claims, we want the insurance company to pay what it should for your medical care and income benefits. Insurance companies often don’t do that. They underpay, refuse to pay for your injuries, or deny your claim altogether.
How the Dispute Resolution Process Works
Step 1: Benefit Review Conference (BRC)
The first step in the “Dispute Resolution Process” is to request and attend a Benefit Review Conference (a “BRC”). BRCs are informal meetings with the injured worker, the worker’s attorney, the insurance company representative, your employer’s representative, and a state employee called a Benefit Review Officer (a “BRO”). At the BRC, both sides discuss evidence, and state their positions on any disputed issues. Sometimes matters get settled and the BRO will want additional information and a second BRC. But for the most part, your case is set for a worker’s compensation “trial” known as a Benefit Contested Case Hearing (a “CCH”).
Step 2: Benefit Contested Case Hearing (CCH)
The CCH is set for 60 days after the date of the BRC. A CCH is an administrative trial with evidence, witnesses and opening and closing arguments; however, there are several differences from a regular court case. One distinction is that your case is not heard by a jury. Rather it is heard and decided by an attorney called a “Hearing Officer.” Most CCHs last around 2 hours, although some have gone on for 2 days. Unless the Hearing Officer thinks that more evidence needs to be developed, the officer issues a written decision called a Decision & Order (“D&O”) in about 10 days, designating who won and who lost on each disputed issue.
Step 3: Appeals
If either side is unhappy with the decision, they can appeal within 15 business days from the date of receiving the D&O. The other side then has 15 business days to respond to the appeal in writing. The case moves on to the Texas Workers’ Compensation Appellate Panel ( the “AP”). The AP almost always affirms what the Hearing Officer decides. But they can reverse and render a new decision or reverse and send a claim—called a remand—back to the Hearing Officer for further work. Most often, however, the AP doesn’t even write a decision or they let the time expire to do so, and essentially affirm by silence.
This whole process is not necessarily the end. Once a case has completely proceeded through the administrative process, either party can appeal again, this time to a real court, and can request a real jury. That process is called “Judicial Review.” The case is tried again in a courthouse. Either side can appeal to one of our intermediate courts of appeal, and then even to the Texas Supreme Court.
If you have won through the Administrative process, and the insurance company has sued you (yes, they sue you) in a county or district court, you should contact us.
So, that is a general overview of on the job injuries in Texas. It is by no means comprehensive, and should not be taken as direct legal advice. Every situation is different. Almost every rule has an exception, and the law, rules, and cases interpreting them change often. If you do have questions about your, or a family member’s or friend’s on the job injury please contact us.