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Wednesday, October 20, 2010

New Benefit Review Conference Rules For Texas Workers' Comp Cases

I know from the phone calls I receive that injured workers have a hard time getting a benefit review conference scheduled in Texas. Now, the Division of Workers' Compensation has made it even harder by adopting new Rule 141, effective October 1, 2010.

The Division has stated that failure to follow the new rule precisely will result in a denial of the BRC request. Furthermore, it was made clear in the Division responses webassets/brcinitials.jpg

to comments and questions submitted by system participants during the rule adoption process that the main purpose of the new rule is to limit an injured worker's right to dispute an impairment rating so that more ratings will become final under the ninety day rule.

So that you can protect your rights and pursue justice, here is a step by step explanation of the new requirements:

1. All injured workers' should send a letter to the adjuster identifying the nature of the current dispute and an expectation or request for resolution. A follow up phone call is not a bad idea either. Document each attempt to resolve the dispute with the adjuster.

2. Even if the adjuster already has all of your records, send a copy of all relevant documentation and pertinent information to the adjuster for review. This is called an exchange. If the dispute is over temporary income benefits, make sure to exchange all of your medical records to the adjuster because your functional ability will usually be the main thing in dispute.

3. If contacting the adjuster and proving documents and information does not resolve the dispute, then you can file a Request For Benefit Review Conference, which is form DWC045. Attach documentation about the letters and phone calls to the adjuster attempting to resolve the dispute. Do not attach all of the records that were mailed as part of your exchange.

4. Signing the DWC045 is an attestation that you have made reasonable efforts to resolve your dispute and that all documents and information pertinent to the dispute have been provided to the workers' comp insurance company. Now file it at your local Division of Workers' Compensation Field Office and send a copy to the adjuster.

5. You should expect to receive a letter from the Division providing the date and time of your benefit review conference. This usually takes from three to six weeks.

6. Not later than 14 days prior to the BRC, you must provide a copy of all of the documentation and pertinent information about the dispute to the Division and the adjuster. This may mean that you are duplicating what has already been done, but until the Division amends this process, it will remain a requirement.

7. If any records are received after that date, then take them with you to the BRC. You will need to take a copy for the insurance company representative and for the Benefit Review Officer.

As you can see, this is a very detailed process. It will be important to fill out the DWC045 correctly. Any innaccurate information given, even if unintentional, will result in a denial of the BRC request.

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