The dispute resolution process can seem overwhelming but with the skilled, caring guidance of an experienced attorney at our firm, we can walk you through with confidence.  

Espinoza & Brock Knows How to Successfully Handle a Workers’ Comp Denial

A denial to your claim is not the end of the road—you have options.  At Espinoza & Brock, we take pride in protecting the rights of workers.  We have offices in San Antonio and El Paso and aim to bring our quality legal services to all those who need it across Texas.  Our attorneys have handled thousands of disputed claims and stay up to date with ever changing rules, laws and procedures - so you don’t have to. This is why you are family when you become a client of Espinoza & Brock.  We work tirelessly to get you the fair compensation you need. 

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Why Was My Claim Denied?

Your employer’s workers’ compensation insurance company is a for-profit business that is trying to save its money. The only thing better than a small payout for them, is no payout.  These companies have adjusters and attorneys on their side who are skilled in finding administrative technicalities (like improperly filled out forms) and procedural formality errors (like a form being turned in after a deadline).  They may even claim that your injury had nothing to do with work—all in an effort to punch holes in your claim. 

Some common reasons for compensation denial include:

  • Failure to timely report the injury to the employer
  • Claiming no injury in the course and scope of employment 
  • Limiting the extent of the compensable injury and resulting off work benefits
  • Claiming an injury is pre-existing 
  • Denying the claim because of a positive drug or alcohol test
  • Injury resulted from personal animosity or horseplay
  • Challenging the injured workers status as an employee
  • Disputing a high impairment rating 
  • Denying supplemental income benefits

The Dispute Resolution Process

Successfully litigating your denied claim requires skilled navigation through the dispute resolution process.

Benefit Review Conference (BRC)

An informal, mediation-like meeting between you and  your attorney and a representative or attorney for the insurance company before The Texas Department of Insurance, Division of Workers’ Compensation (TDI DWC) in an effort to reach a settlement. You may have up to two BRCs for any given issue, if necessary. 

Contested Case Hearing (CCH)

If the parties do not reach an agreement at the BRC, the case goes up in front of an Administrative Law Judge (ALJ) at a Contested Case Hearing. After presentation of evidence and testimony from both sides, the ALJ will issue a Decision and Order in writing resolving the issues at hand. 

Appeals Panel

If either party disagrees with the ALJ’s decision, they can send a written appeal to the Appeals Panel in Austin, Texas.  A written decision will be sent to all the parties.

District Court

The non-prevailing party can file a de novo appeal with the appropriate District Court, and the case will be heard as a new case. 

Schedule a No Risk Consultation Today

Not every compensation denial case is the same so it’s vital that you go over your specific situation with us.  Our knowledgeable workers’ compensation attorneys and staff can guide you through the dispute resolution process.  Getting a positive outcome to your case requires a personalized strategy.  You need the experienced representation by a professional who fully understands the workers' compensation laws and court system. Now you have friends in the workers' compensation system. Not just friends - family. 

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Don't Fight AloneEspinoza & Brock Can See You Through It

There are deadlines and procedural requirements associated with all of the proceedings discussed above.  Injured workers are expected to know and follow all of these rules, procedures and deadlines, or get an attorney to help them do so.  The insurance will be equipped to fight, and you should do the same.  Arm yourself with a qualified workers’ compensation attorney by calling us today.  We will ensure that you are fully informed on what your options are and which one gives you the best chance success. Don’t ever feel like you don’t deserve help with your work-related illness or injury. You work hard for your families and our work injury attorneys in San Antonio & El Paso work hard for you.

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