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Workers Comp Hearings and Attorney Help

1. What happens if the insurance company denies my claim, or refuses to pay benefits I request?

If you and the insurance adjuster can't agree on what should be paid, you can request a hearing through the dispute resolution process.

2. What are the steps in that process?

There are several stages. The first is you are required to document efforts to try to work it out with the insurance before you can request a hearing.

If that fails, you can request a benefit review conference (BRC) on a form DWC-45.

It will take about a month for that first hearing to take place. It is an informal meeting with an employee of the TDI-DWC (Benefit Review Officer) who mediates the dispute between you (with your attorney present) and an attorney from the insurance company. There is no record taken and no testimony under oath. The issues and evidence are discussed and a plan for moving the case forward should be the goal.

If you and the insurance representative can agree, the agreement on benefits is reduced to writing, sometimes there on the spot, and signed to finalize what the insurance must do and what you are giving up, if anything, in exchange. This agreement is binding in most circumstances and requires careful advice and consideration.

If you cannot reach an agreement, the case may be reset for another BRC or set for a final contested case hearing before a workers' compensation hearing officer, an attorney trained by the TDI-DWC to hear workers' compensation disputes.

A contested case hearing takes place approximately two months later. This is a formal hearing with a record made (sometimes by a court reporter, otherwise by audio recording). An interpreter can be requested in case of a language barrier for a party or witness.

Not later than 15 days from the date of the hearing, any evidence and witness information must be exchanged to the other party. The hearing officer may exclude evidence not timely exchanged.

Not later than 10 days prior to the hearing, a subpoena for the appearance of any witness must be requested. A subpoena duces tecum for the production of records carries the same deadline.

The hearing officer may permit witnesses to appear by telephone. This should be requested well in advance to ensure proper acommodation.

Documentary evidence (such as witness statements, claim documents, and medical records) must be prepared and catalogued for easy and comprehensible review by the hearing officer in order to make sure that all relevant evidence is brought to the hearing officer's full attention.

Applicable decisions from the Texas Supreme Court, courts of appeals, TDI-DWC Workers' Compensation Appeals Panel should be cited at the hearing to ensure that the decision conforms with relevant precedent. Statutory provisions from the Labor Code and rules from the Administrative Code will also be helpful. Often it is advisable to prepare copies of legal precedent for review by the hearing officer and opposing attorney.

3. Do I need an attorney to assist me with my workers' compensation claim?

The law does not require you to have an attorney to help you. But it is your right to retain an attorney if you wish. If you do not hire an attorney, you can get free assistance from a non-attorney "ombudsman" through the TDI-DWC. They do not represent you and they do not give legal advice. Their job is to help you represent yourself. Attorneys are highly trained, licensed by the Supreme Court of Texas, and often better able to advise you and plan for the long-term effects of decisions you make early on in the case. They are able to pursue cases into court when necessary, which ombudsmen cannot do. And an ombudsman cannot give you legal advice covering other legal issue that may be effected by your workers' compensation case, such as unemployment benefits, Social Security benefits, third party personal injury cases, wrongful termination, FMLA violations, and employment discrimination.

4. How much can an attorney charge?

All attorneys in workers' compensation in the state of Texas are limited by law to what they can charge. An attorney can charge no more than $150 per hour, plus expenses, for services related to your workers' compensation case. The insurance carrier will pay your attorney through a separate check by deducting 25% of each workers' compensation payment you are due to pay the attorney until the attorney's fees are paid in full or your benefits expire, whichever comes first.

In layman's terms, all that boils down to this. If you are not getting paid workers' comp benefits, your attorney is not getting paid. If you do get workers' comp benefits, your attorney can collect up to 25% of each payment based upon a bill for time and expenses that must be approved by the TDI-DWC. Your attorney can never get more than 25% of what you get, but does not automatically get 25% of your benefits. And if your benefits run out while you still owe your attorney money, you do not have to pay the rest of the fees out of your own pocket.

Contact San Antonio Workers Compensation and Accident Lawyer Alan Tysinger

Suffering an on the job injury or losing a loved one to an accident is an emotional and difficult challenge. Battling with insurance and getting the right legal answers is something you won't want to do alone. Attorney Alan Tysinger has experience and know-how to get to the truth of your injury case and hold the insurance or employer accountable. You can get a free consultation with a personal injury lawyer in San Antonio by calling toll-free 866-957-2667 or send a message online.