Dispute resolution for injured employees

Información sobre la resolución de disputas en español

Disputes are disagreements between participants in a workers’ compensation claim. Most disputes are about whether an injured employee can get medical or income benefits and the amount to be paid. Learn more about the different kinds of disputes in the Texas workers’ compensation system. 

Below are the steps to dispute resolution. DWC can help you with many of these steps.

Step 1 – Talk with your attorney or ombudsman.

If you don’t agree with the insurance carrier about something, talk to your attorney or ombudsman, if you have one.

Step 2 – Talk to the insurance carrier about the dispute.

You, your ombudsman, or attorney, if you have one, should call the adjuster about the dispute. If you can’t work out the dispute with the insurance carrier, then you can begin the DWC dispute resolution process by requesting a benefit review conference.

Step 3 – Attend a benefit review conference

A benefit review conference is an informal meeting. You and your attorney or ombudsman meet with someone from the insurance carrier and a DWC benefit review officer to talk about your dispute. If the dispute is resolved, an agreement will be written and signed by the parties and the benefit review officer. If you don’t reach an agreement, the parties may go to a more formal meeting called a contested case hearing.

Learn more about:

• requesting a benefit review conference
• practices and procedures for benefit review conferences
• how to attend a virtual benefit review conference
• injured employee forms 
• how to exchange your information
• when and what kind of information to share

Step 4 – Attend a contested case hearing

If you did not resolve your dispute at the benefit review conference, you may attend a contested case hearing. This is a formal hearing held by a DWC administrative law judge. After the hearing, the judge will issue a decision. DWC will mail you a copy. The decision may be appealed. Instead of a hearing, the parties can choose to go to arbitration.

Learn more about:

• practices and procedures for contested case hearings
• how to attend a virtual hearing
• request a hearing without a benefit review conference
• how to exchange your information
• when and what kind of information to share

Step 5 – Appeal a hearing decision or respond to an appeal

If any party disagrees with the hearing decision, they may ask the Appeals Panel to review it. The parties submit written statements describing their position. The Appeals Panel will review the statements, the hearing decision, and the hearing record. Then the Appeals Panel issues a written decision.

Learn more about the appeal process.

Step 6 – Judicial review

The Appeals Panel is the last step in DWC's dispute resolution process, but the decision may be appealed to an appropriate court. This is called requesting judicial review.

Learn more about judicial review: Texas Labor Code  §§410.208 and 410.251 through 410.308.