Benefit Review Conference (BRC) [Sections 410.021 - 410.034, Rules 141.1 - 141.7]

The benefit review conference (BRC) is an informal meeting held at the local Division office. At the BRC you will meet with someone from the insurance company to discuss the disputed issues in front of a Benefit Review Officer, who is a Division employee. During a BRC, you and the insurance carrier will discuss all information in an attempt to resolve your dispute. If the dispute is resolved, an agreement may be written and signed by you and the insurance carrier. If an agreement cannot be reached at the BRC, you may be required to attend a formal contested case hearing where the Hearing Officer will make a decision on the disputed issues.

Before you attend a benefit review conference or a contested case hearing, the Office of Injured Employee Counsel (OIEC) can provide you with an Ombudsman. An Ombudsman is a specially trained employee of the Office of Injured Employee Counsel (OIEC) who can assist you if you have a dispute with your employer's insurance carrier free of charge.  For more information on Ombudsman assistance see http://www.oiec.state.tx.us/topics/ombudsman.html.

Information for participants in a Benefit Review Conference.

Arbitration [Sections 410.101 - 410.121, Rules 144.1 - 144.6]

If the dispute was not resolved at the benefit review conference, the injured worker and other parties to the dispute may agree to resolve the dispute through arbitration instead of proceeding to a contested case hearing. The purpose of arbitration is to have an independent arbitrator hear both sides of a dispute and make a decision, which is binding to all parties.

If arbitration is chosen, the Division will randomly assign a certified arbitrator to the dispute. The injured worker and other parties may reject an arbitrator selected by the Division. Each party is allowed only one rejection of the assigned arbitrator. The decision of the arbitrator is final and cannot be appealed.

Contested Case Hearing (CCH) [Sections 410.151 - 410.169, Rules 142.1 - 142.20]

Following a Benefit Review Conference, if you do not choose arbitration, a contested case hearing (CCH) is the next level of dispute resolution. The CCH is a formal hearing conducted by a Division Hearing Officer who makes a decision about the disputed issue(s) that were not resolved at the benefit review conference. You and the insurance carrier must attend the contested case hearing. The contested case hearing is recorded, an official record is made, and sworn testimony is taken.

During the contested case hearing you may:

• present your side of the dispute;
  
• bring witnesses and question witnesses;
  
• introduce evidence to support your case; and
  
• request discovery of information you think the other side has that may be helpful to you.

Following the contested case hearing, you will receive the hearing officer's written decision and order by mail. If you disagree with the hearing officer's decision, the decision may be appealed to the Division's Appeals Panel.

Along with a copy of the Hearing Officer's decision and order, you will receive instructions regarding the timeframe to appeal.

Appeals Panel [Sections 410.201 - 410.209, Rules 143.1 - 143.5]

If a party disagrees with the decision and order of the Hearing Officer, the dissatisfied party may request review of the decision by the Appeals Panel. The request for appeal must be in writing. A hearing is not held. Instead, the parties submit written statements describing their position that are reviewed by the Appeals Panel along with the Hearing Officer's decision and the record from the contested case hearing.

If a decision is written as a result of an appeal, the Appeals Panel will do one of three things:

1. "affirm" the hearing officer's decision; this means that the Appeals Panel agrees that the decision of the hearing officer is legally correct and supported by the evidence;
   
2. "reverse and remand"; this means that the Appeals Panel does not agree with the hearing officer's decision and the case is being sent back to the hearing officer to issue another decision or to hold another hearing; or disagree with the hearing officer's decision and issue its own decision; or
   
3. "reverse and render"; this means that there was a legal error and the Appeals Panel issues a new decision.

The Appeals Panel decision is the final step in the Division's dispute resolution process. If a party disagrees with the Appeal Panel's decision, the decision may be appealed to a court of law.

Judicial Review [Sections 410.251 - 410.258, Rules 147.1 - 147.11]

An injured worker or other parties may appeal the Appeals Panel decision to district court. However, workers' compensation claim disputes may not be heard in court unless the dispute has first gone through the Division's dispute resolution process and the Appeals Panel has issued a decision. If the insurance carrier appeals to district court, it is important for the injured worker to respond to the court if you wish to protect your workers' compensation benefits.

Attending Proceedings

You must attend any dispute resolution proceeding related to a dispute about your claim, even if you did not request the proceeding. If you do not attend, the proceeding may be held without you present to give your side of the dispute. In addition, you may be fined if you do not attend a scheduled dispute resolution proceeding.

Ombudsman Assistance

Ombudsmen are Office of Injured Employee Counsel (OIEC) employees that can help you with resolution of a dispute on your claim after a proceeding has been scheduled. You may ask for help from an Ombudsman if you have not hired an attorney to represent you and you do not have any other type of representation. Ombudsmen may not give you legal advice. In addition, Ombudsmen may not make any decisions for you or sign agreements or forms. Ombudsman services are provided to you at no charge. For more information on Ombudsman assistance see http://www.oiec.state.tx.us/topics/ombudsman.html.

You may request Ombudsman assistance by contacting 1-866-393-6432.

Attorney Representation

You may hire an attorney to represent you for your claim. An attorney may attend dispute resolution proceedings with you and present any evidence that supports your side of the dispute.

If you hire an attorney, the attorney's fees will be deducted from your income benefit payments as ordered by the Division. The attorney's fees are limited to no more than 25 percent of the total amount of your income benefits, and payments may not exceed 25 percent of any one income benefit check.

An attorney may charge up to a maximum of $150 per hour, plus expenses, for work performed on your workers' compensation claim. If you dismiss your attorney for any reason, the fees that have been ordered by the Division will continue to be deducted from your income benefit payments until all ordered fees have been paid.

You may contact the State Bar of Texas for assistance in obtaining an attorney to represent you at www.texasbar.com or by phone at 1-800-252-9690.

For more information, view the Dispute Resolution Fact Sheets (PDF):

• Dispute Resolution
  
• Benefit Review Conference
  
• Contested Case Hearing
  
• Appeals Rights and Procedures
  
• Judicial Review

For more information contact: Webstaff@tdi.state.tx.us