Appealing a Denied Workers' Comp Claim in Texas

A disputed claim generally must first go to a benefit review conference with the Texas Department of Insurance, Division of Workers' Compensation; a party is not entitled to a contested case hearing unless one is held, except as the law or rules allow. To appeal an administrative law judge's contested-case decision, a party must file a written request for appeal with the appeals panel within 15 days after receiving the decision (weekends and holidays not counted). To seek judicial review of the appeals panel decision, a party must file suit within 45 days after the division mailed the decision (mailing is deemed to be the fifth day after the decision was filed).

Disputes generally start with a benefit review conference (an informal mediation) at DWC, followed by a contested case hearing before an administrative law judge (or arbitration if elected). To appeal the judge's decision, a party must file a written request with the DWC appeals panel within 15 days after receiving the decision (not counting weekends and holidays). A party may then seek judicial review by filing suit within 45 days after the appeals panel decision is mailed.

The employee must file a claim for compensation with the Division of Workers' Compensation no later than one year after the injury (or, for an occupational disease, one year after the employee knew or should have known it was work-related). Missing the deadline relieves the employer and insurer of liability unless there was good cause or the employer/insurer does not contest the claim.