Workers’ Comp Appeals Process

Workers’ Compensation Insurance Denial in Texas

Workers’ compensation insurance can be beneficial to employers and their employees by providing financial protection to both parties. When the system works as it should, an employee who was injured in the course and scope of their job files a claim to receive reimbursement for medical bills and wage replacement. The insurance policy protects the employer from the threat of personal injury lawsuits by employees, and it protects the employee from having to pay for expenses related to their injury.

When a workers’ comp claim is denied, however, the employee is put in a difficult position. The existence of the policy can limit the legal action they are able to take against the employer. Fortunately, a personal injury attorney can offer assistance with the workers’ comp appeals process.

Why Are Workers’ Comp Claims Denied?

Common workers’ compensation denial reasons include the following:

• The injury was not reported promptly. In Texas, you have 30 days to report an injury to your employer and one year to send a completed claim of compensation form to the Division of Workers’ Compensation.
• The insurer argues that the injury was not related to the job. In order to qualify for workers’ comp benefits, the injury had to occur during the “course and scope” of your employment. That means that if you sustain an injury while deviating from your duties, that does not qualify for workers’ comp benefits (ex: you are traveling for work and decide to go sightseeing on your own time and get injured).
• The insurer argues that the injury was preexisting. People with a history of health problems such as back and neck pain may find their workers’ comp claim in jeopardy. Even if the particular injury is new — or the incident at work exacerbated an existing injury — the insurance company will claim that the job was not the major contributing cause.
• The employee didn’t seek medical treatment. Visiting the doctor or hospital immediately after the incident creates a paper trail that proves the existence of the injury. Without that record, it’s easier for an insurance company to claim that you were not injured at all, that it didn’t happen at work, or that it was not serious enough to require medical care and therefore must not be causing you any real problems.
• There were no witnesses. Documents are a key component of a successful claim, but witness statements can also be crucial. If no one can attest to the circumstances of your injury, it can be your word against your employer’s.

If your workers’ comp claim was denied for one of these reasons, contact a personal injury lawyer to discuss your case.

What Recourse Do I Have if My Workers’ Comp Claim Has Been Denied?

A workers’ comp claim denial can leave you feeling frustrated and hopeless about your chances of recovering compensation, but your case doesn’t have to end there. The appeals process permits you to continue pursuing your claim.

This step is more complicated than the initial claim submission, and you will want an attorney in your corner who can handle the negotiations. Your attorney will initiate a dispute resolution with the Division of Workers’ Compensation. During the dispute resolution, both parties meet together with a review officer and try to settle the claim through mediation. If the matter is not resolved and you do not receive a favorable outcome, your attorney will appeal once again, taking it all the way to state court if necessary.

How Can Aaron Allison Help?

If your workers’ comp claim was denied, that does not mean it was illegitimate or that it is no longer worth pursuing; it means you need an advocate with the knowledge and resources to settle the case and produce a just outcome. At the Law Offices of Aaron Allison, our experienced workers’ compensation attorney will navigate the red tape to increase your chances of securing fair financial recovery for your workplace injury. Contact us online to schedule a free case review.

Aron Allison, Attorney

For 50 years, my father, served as a trial lawyer to get just compensation for the people of Austin. At age 14, I began to take up the mantle to continue my father’s practice as a second generation trial lawyer serving Austin’s community. The strength of his legacy continues through its commitments to a communal presence, honoring that each case is as unique as the individual pursuing compensation.

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If your in an accident or have an issue with a workers comp issue Aaron Allison is the guy to call. He is the attorney who will get you everything you need plus will give you the right advise on what to do and how to do it. Mr. Allison will take time out of his day, which can be hours, talking to you and giving you valuable advise on your legal issues. He always calls you back and always remembers details of what you have discussed in the past. One of my favorite things about him is he is not your typical B.S. attorney your used to dealing with. He always talks to you in a honest and straight forward way and he always clarifies if you don’t understand. Very easy guy to talk to, who will fight tooth and nail for you and will always have your best interest at heart.

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