A Rare Outcome for a Texas Amputee

A Texas woman who was injured in a car accident on a return trip from a work meeting recently received a rare outcome in her workers’ compensation case. Texas Political Subdivisions, her employer’s insurer, denied her claims, stating that she was not deemed to be “on the job” when she was injured while driving back from a meeting. The Texas Division of Workers’ Compensation ruled that the insurer must immediately begin to pay for her reasonable and necessary health care expenses as well as temporary income benefits.

This type of outcome, known as an “interlocutory order,” is unusual. The Division of Workers’ Compensation normally waits to issue an order regarding payment of benefits until after both sides have participated in an administrative “contested case hearing.” This order, however, was issued after the benefit review conference, which occurs before the contested case hearing. Because of the immediate payment of benefits required by the Division of Workers’ Compensation pre-trial, this is an unusual ruling by the Division.


What is a Benefit Review Conference?

A Benefit Review Conference is held at your local Workers Compensation office. It is an informal meeting in which you will discuss your claim with a representative from the insurance company. A Benefit Review Officer who works for the Division of Workers Compensation will also be present at the meeting. It may be possible to resolve your contested issues at this meeting. If both sides are in agreement, you may enter into a written settlement with the insurance company. (A Benefit Review Conference is also available for people wishing to appeal certain medical fee dispute decisions filed after June 1, 2012).


What is a Contested Case Hearing?

A Contested Case Hearing happens after the Benefit Review Conference (if all parties choose not to proceed with arbitration). This is a formal hearing where a Division of Workers Compensation Officer will hear all the disputed issues that are still unresolved after the Benefits Review Conference. The Hearing Officer will issue a written decision and order.


Is it Possible to Review this Order?

Yes, it is possible to review the decision issued by the Hearing Officer. You may request a review of the decision by the Division of Workers Compensation Appeals Panel. All parties will submit a written statement to the Appeals Panel in support of their position. There is no hearing. The Appeals Panel will review the statements, the order issued by the Hearing Officer, and the record from the Contested Case Hearing, and then issue a written decision. The decision issued by the Appeals Panel is appealable to a court of law if one of the parties disagrees with the decision.

If you have been injured on the job or have been denied workers’ compensation benefits under any circumstances, you may have rights and additional recourse against your employer or its insurance carrier. It is important to consult with an experienced workers’ compensation attorney to know your rights and to be able to take action to get the benefits to which you are entitled. The lawyers at Napoli Shkolnik PLLC can assist you through each stage of the process, whether you have not yet filed a claim or whether you have already been denied benefits. Call (212) 397-1000 today to schedule a free consultation with a knowledgeable workers’ compensation attorney.