Finding out that you lost a workers’ comp dispute can raise some serious questions. Will your benefits stop? Can the insurance company refuse to pay for your treatment? Is there still a way to challenge the decision?
The answers to these questions depend on your specific case. But the more you understand how the Texas workers’ comp process works, the better prepared you’ll be to protect your rights.
Below, we’ll explain what happens if you lose your workers’ comp case in Texas. We’ll cover how it can affect your benefits, what options may still be available, and what you should do next.
This Is What Happens After Losing a Workers’ Comp Case
When your workers’ comp claim is approved, the insurance company usually pays for injury-related medical care and part of the wages you lose while you’re out of work.
When you lose a workers’ comp case, you won’t receive the benefits in question. If the issue involves weekly income benefits, those payments may be denied, reduced, or stopped altogether.
A ruling involving medical benefits can affect your treatment. The insurance carrier may refuse to pay for your appointments, procedures, medications, or other care connected to your injury.
This can leave you facing unpaid bills or paying out-of-pocket for certain treatments. You may also lose access to care through the workers’ comp claim, including treatment from an approved or network doctor.
Still, losing a dispute doesn’t always end the entire claim. You may still qualify for other benefits that weren’t challenged or decided.
Note: In general, you can’t turn around and sue an employer that carries workers’ compensation insurance. Texas law usually treats workers’ comp as your main remedy against a subscribing employer.
How Do Disputes Work with Texas Workers’ Comp?
You may need to start a dispute when the insurance company denies your claim, cuts off your checks, or refuses to pay for treatment you know you need.
The process typically starts when the carrier sends you a written notice explaining why they denied your claim or a specific benefit. Read that notice carefully because it tells you exactly what they’re challenging.
You can then request a Benefit Review Conference (BRC) by filling out DWC Form-045. At that conference, you and the insurance company will meet with a Benefit Review Officer. The Officer will look at the disputed issues and attempt to help both sides reach an agreement.
If the dispute isn’t resolved after the BRC, the case may move to a Contested Case Hearing (CCH). During the hearing, an administrative law judge will listen to testimony, review evidence, and issue a written decision.
If you lose the CCH, you can send an appeal to the DWC appeals panel. The goal here is to explain what legal or factual errors were made. Simply saying the result was unfair usually isn’t enough. The argument should point to the evidence, the hearing record, or the law supporting a different outcome.
Once the administrative process is over, you may be able to pursue judicial review in a Texas district court.
Throughout the process, you can expect the insurance company to push back, challenge your evidence, and look for reasons to avoid paying the benefits you’re seeking.
What Should I Do After Losing My Workers’ Comp Case?
The first thing to do is speak with a Texas workers’ comp attorney as soon as possible. A lawyer can review the decision, explain what benefits were affected, and determine whether an appeal makes sense.
Keep getting appropriate medical care when you can, and save every bill, record, prescription, test result, and work restriction. Updated medical opinions may also be helpful as you try to challenge the carrier.
Save every letter, email, notice, and message from your employer or the insurance company. Get names and contact information for any witnesses and hold on to anything else that backs up your side.
Then move fast. If you miss the appeal deadline, the insurance company may get to shut the door on your case for good.
What Are the Possible Outcomes After Losing?
Losing doesn’t always mean the case is over. An appeal could lead to a better result, another hearing, or the original decision staying in place. In some cases, the dispute may also be worked out through an agreement.
Just don’t expect one large payment to close out your entire claim. Texas workers’ comp generally doesn’t allow injured workers to trade away future medical benefits for a lump-sum settlement.
There may also be another path outside the workers’ comp system. If your employer didn’t carry workers’ comp coverage, or if someone else’s negligence caused the accident, you may be able to file a separate lawsuit.
How Should You Deal with the Insurance Carrier After a Loss?
Don’t assume the insurance company is trying to help you just because the adjuster sounds friendly. Their job is to protect the company.
Before giving a recorded statement, talk to a lawyer. The insurance company could twist your words to question how you got hurt or how serious the injury is.
If the carrier cuts off benefits or refuses to pay for treatment, ask them to explain why in writing. You should also request a copy of your claim file so you can see the records, reports, and medical opinions they relied on.
What If the Employer Is a Non-Subscriber?
An employer without coverage is known as a non-subscriber. You can check your employer’s workers’ comp status on TXCOMP.
A non-subscriber case follows a completely different set of rules. Instead of going through the workers’ comp system, you can sue the employer for negligence. To win, you’ll need evidence showing the employer caused or contributed to your injury.
Learn about the differences between workers’ comp and non-subscriber claims.
Contact Grossman Law Offices Today
Losing a workers’ comp decision doesn’t always mean your case is over. But the longer you wait, the fewer legal options you may have.
Grossman Law Offices has more than 35 years of experience helping injured Texans stand up to insurance companies and other powerful defendants. We’ve recovered millions of dollars for clients in injury cases just like yours.
We’re available 24/7 to hear what happened and help you understand your options. Your consultation is free.
Contact us today to learn what comes next.
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