Dispute Resolution Step II – Contest Case Hearing

By Kirk Lair, Senior Hearings Specialist

By Kirk Lair, Senior Hearings Specialist

Getting injured workers well and back on the job is the workers’ compensation system’s priority. But even with all stakeholders working toward a common goal, disagreements happen. The system’s dispute resolution process was designed to ensure all parties are treated fairly.

In a previous post, we covered the first step in the dispute resolution process: the benefit review conference (BRC). The law allows two BRCs per disputed issue(s). If the parties do not reach an agreement, the dispute can take one of two paths.

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) can appoint an independent arbitrator to resolve the dispute if both parties agree. Because the arbitrator’s decision is final and cannot be appealed, however, most disputes proceed to the contested case hearing (CCH) stage instead.

A CCH is similar to a jury trial. An administrative judge hears testimony, reviews evidence and issues a binding decision. Unlike decisions issued during arbitration, the administrative judge’s ruling is not final. If any of the parties disagree with the CCH decision and order, they can request a review by an appeals panel.

The appeals panel includes three judges who review the evidence, the CCH judge’s opinion and the written appeal filed by the parties to the BRC. The appeals panel may overturn the decision, concur or return the issues to the judge to review and apply the law correctly based on their findings. If there is still no resolution, the parties can file a lawsuit at the district court level. Due to the significant expense and time involved in litigation, however, parties must carefully consider whether to proceed.

The dispute resolution process is a necessary component of the workers’ compensation system. I believe, however, that we sometimes lose sight of our priorities when we rely on the process too much. We tend to stop working proactively to resolve disputes prior to going through the dispute resolution process. The result can be unnecessary delays in income benefits and medical treatment delivery.

The workers’ compensation system exists to help carry injured workers through difficult economic situations, and get them well and back on the job. That is what the Legislature envisioned when it created the system 100 years ago, and that is what we should all be working toward. It takes all parties (employees, employers, medical providers and insurance carriers) working together to accomplish our common goal as fairly and efficiently as possible.

About the author
Kirk Lair has nearly 30 years’ experience in workers’ compensation insurance. He started his career with Travelers Insurance in 1986 and joined Texas Mutual Insurance Company in 1993. Kirk currently serves as a senior hearings specialist. He holds a bachelor’s in business from Texas Tech University.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: