3 Things You Should Know About Dispute Resolution

By Grace Fogle, Hearings Supervisor

For more than a century, the workers’ comp system has been protecting employees from the consequences of on-the-job accidents. But even with insurance carriers, employers, injured workers and regulatory agencies working toward a common, clearly-defined goal, disagreements happen.

For example, if the insurance carrier accepts a claim as compensable, the employer might disagree. Or, the injured worker might dispute the amount of income benefits that he or she is receiving from the insurance company. The Legislature established an administrative process to resolve these types of disputes. The first stage in the process is the benefit review conference (BRC).

A BRC is an informal meeting held at a local Texas Department of Insurance, Division of Workers’ Compensation (DWC) office. During a BRC, the parties meet with someone from the insurance company to discuss the disputed issues in front of a DWC benefit review officer.

In an ideal world, your injured workers would get well and back on the job without disputes. But if you find yourself in a BRC, here are three things you need to know:

  1. The law requires parties in a dispute to attempt to resolve the issue before they request a BRC.
  2. To request a BRC, you must complete DWC Form-045, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC), and submit details and documentation of efforts to resolve the dispute.
  3. You might be required to provide documentation related to the claim, such as medical records, statements from co-workers who witnessed the accident, and the accident report you filed with your insurance carrier.

More information
For more information about BRCs, visit the Texas Department of Insurance at http://www.tdi.texas.gov/wc/idr/brcinfo.html. For more information about the dispute resolution process, visit http://www.tdi.texas.gov/wc/employee/dispute.html.

Stay tuned
In my next post, I will explain the next step in the dispute resolution process: arbitration/contested case hearings.

About the author
Grace Fogle has nearly 30 years’ experience in the insurance industry. She joined Texas Mutual in 1993 as a senior hearings specialist. In 2006, she was promoted to supervisor of the hearings team. Grace holds a bachelor’s in nursing from Incarnate Word College.

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