What are the steps involved in the state's administrative dispute resolution process?

The administrative dispute resolution process in the Texas workers' compensation system involves the following key steps:

1. Benefit Review Conference (BRC):

   • If the insurance carrier denies a claim or disputes the payment of certain benefits, you can request a Benefit Review Conference.

   • The BRC is an informal, administrative proceeding where you and the insurance carrier will meet with a Texas Department of Insurance (TDI) dispute resolution officer to try and resolve the issue.

2. Contested Case Hearing (CCH):

   • If the BRC is unsuccessful in resolving the dispute, you can request a Contested Case Hearing.

   • The CCH is a more formal administrative hearing where both sides present evidence and testimony before a TDI hearing officer.

   • The hearing officer will then issue a written decision on the disputed issue.

3. Appeals Panel:

   • If you or the insurance carrier disagree with the hearing officer's decision, either party can appeal to the TDI Appeals Panel.

   • The Appeals Panel will review the evidence and the hearing officer's decision, and then issue a final administrative ruling.

4. Judicial Review:

   • If you or the insurance carrier is still unsatisfied with the final administrative decision, you can appeal to the state district court system for a judicial review.

   • This involves filing a lawsuit and presenting the case before a judge, who will make a final determination on the disputed workers' compensation issue.

Throughout this administrative dispute resolution process, both you and the insurance carrier have the right to be represented by an attorney. An experienced workers' compensation lawyer can help guide you through the proceedings, present evidence, and advocate on your behalf to ensure your rights are protected.

It's important to note that there are strict deadlines and procedural requirements at each stage of the dispute resolution process. Missing a deadline or failing to follow the proper steps can jeopardize your ability to have your case heard and your benefits dispute resolved.