An overview of the process necessary to file a request for a Benefit Review Conference in a Texas workers' compensation claim.
Identify The Issues In Dispute
Determine what the argument is about. In many cases, the issue will be whether or not you sustained a compensable injury, extent of injury, disability, or impairment rating.
Exchange Evidence & Attempt Informal Resolution
New changes to Rule 141 require that before a BRC request can be made, the requesting party must send a copy of all documentation and pertient information about the dispute to the opposing party. This means that you will have to mail all of your medical records or other related documents to the adjuster before requesting a BRC. Sometimes, this will mean that you are sending the adjuster documents the insurance company already has.Next, you must demonstrate that you have attempted to resolve the dispute with your adjuster. This means that you will have to provide documentation detailing the dates and times that you called the adjuster to discuss the issue in dispute. So give the adjuster a call. I typically write a letter to the adjuster detailing the issues and asking her/him to pay the beneits that I think are owed.
Complete Form DWC-045 Request For A Benefit Review Conference
This form can be downloaded from the Division of Workers' Compensation website at the web link provided below. Complete the form. You will have to give a description of the issues in dispute. Explain the time periods that you have not been paid or the injuries that have been disputed. Make sure you sign and date the form. YOU MUST attach the documentation of your communications with the adjuster to the form to show that you have attempted to resolve the dispute on your own. DO NOT attach all of the medical records or other documentation that you exchanged with the insurance company in Section 2 above.
File The Request For BRC
I recommend that you hand deliver your DWC-045 with the attachments to your local Division Field Office. The records attached to your request should not be originals. When you file the request, two copies should be presented to the Field Office receptionist. One copy will be for the Division to keep and process. The second copy will be for the Division to stamp "received" and return to you. This is your evidence that you filed these documents. A copy of the BRC request must be mailed to the adjuster as well.
Receive Notice Of Your BRC
The Division will process your request for BRC. Division personnel may contact you or the adjuster to see if there is any way to resolve the disupte informally. Within four to six weeks, you will receive a notice of the date and time of your BRC.
Another Exchange Requirement
After the BRC is scheduled, and not later than 14 days prior to the BRC, you must file provide a copy of all of the documents or information related to the dispute to the Division of Workers' Compensation. At the same time, you must send to the adjuster a copy of any new documents that you have obtained since the exchange was made in Section 2 above.Any documents that are obtained after this date must be brought to the BRC and given to the Division and the insurance carrier representative.
Consider Hiring An Attorney
The insurance carrier will usually send its attorney to the BRC to act on its behalf. This is a legal proceeding. Why would you go to a legal proceeding with the stakes so high and not hire an attorney to represent you? At the BRC, the issues will be certified for a hearing before a judge. If the issues are not set up correctly, or if technicalities are missed because you just don't know the law, you could cost yourself dearly. It is much easier and less costly to hire an attorney to do the job right to start with, than to have a lawyer come in later and try to undo any mistakes that have been made. If you are considering using an Ombudsman provided by the Disivion of Workers' Compensation, then you should consider the discussion of ombudsman assistance linked below.