Benefit Review Conference (BRC) Information for Injured Employees
When the insurance carrier challenges whether an injury is related to the injured employee's employment, the injured employee must show that he had a work-related injury. This dispute may involve the original injury as a whole, or whether another injury/diagnosis is a result of the original injury. The insurance carrier may also dispute whether the injury occurred while the injured employee was performing duties related to his/her employment. A party should be prepared to discuss the following information at a BRC on a compensability dispute.
- DWC Form-041, Claim for Compensation for a Work-Related Injury or Occupational Disease, filed by the injured employee.
- DWC Form-045, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC)
- DWCForm-150, Notice of Representation or Withdrawal of Representation, if the injured employee is represented by an attorney
Parties to a dispute are also required to provide pertinent information to Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) not later than 14 days before the scheduled benefit review conference, but should NOT attach this information to the Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC) (DWC Form-045).
Pertinent information includes:
- Medical Records:
- Emergency room reports;
- Medical narratives from a doctor to establish an injury and the relationship between the claimed injury/disease and the injured employee's employment;
- A list of doctor's names that treated the injured employee, if more than one;
- Doctor's narrative resulting from a required medical examination, if any;
- For an occupational disease, there must be medical information that establishes the relationship between the disease and the injured worker's employment;
- For a repetitive trauma injury, there must be information that shows the duration, frequency, and nature of the activities alleged to be traumatic and medical to show the relationship between the injury and the employment;
- For a mental trauma injury, there must be information to show that the mental trauma is traceable to a definite time, place and cause;
- For a heart attack, there must be medical information to show that the work rather than the natural progression of a preexisting heart condition or disease was a substantial contributing factor of the heart attack;
- Requests for a designated doctor exam:
- letters of clarification to a designated doctor and responses from the designated doctor, and
- treating doctor's response to a designated doctor's opinion;
- Witness Statements - while not all injuries are witnessed, it is beneficial to present the names and/or statement of any co-workers who might have seen or heard the incident;
- Any information that will show that the injured employee timely reported the injury to the employer;
- Copy of a police report (if any); and
- Any information that would show the injured employee was directed by or on a special assignment for the employer.
Exchange of Information
Pertinent information must be exchanged in accordance with Texas Administrative Code §141.4.
- Disputing party must exchange all documents in their possession with the other party before requesting a BRC.
- Opposing party must exchange documents within 10 working days after receiving the request for a BRC (DWC Form-045).
- Any additional documents that come into a party's possession after the initial timeframes must be exchanged no later than 14 days before the BRC (5 days if the BRC is expedited).
- All documents must be submitted to the TDI-DWC no later than 14 days before the BRC (5 days if the BRC is expedited).
- Any documents obtained after the exchange deadline should be brought to the BRC with sufficient copies for both the other party and the TDI-DWC.
"Injury" means damage or harm to the body, including infections from the injury. See Texas Labor Code §401.011(26).
"Compensable Injury" means an injury in the course and scope of employment. See Texas Labor Code §401.011(10).
"Course and Scope of Employment" means an activity performed by the injured employee originating in the work of the employer. See §401.011(12).
"Occupational Disease" means a disease or repetitious trauma arising from the injured employee's employment. See Texas Labor Code §401.011(34).
"Repetitive Trauma Injury" means damage to the body from repetitious activities related to the injured employee's employment. See Texas Labor Code §401.011(36).
"Mental Trauma" may be compensable if it is traceable to a traumatic event in the injured employee's employment. See Texas Labor Code §408.006.
"Heart Attack" may be compensable if it occurred at a definite time and place in the course and scope of employment. See Texas Labor Code §408.008.
"Required Medical Examination" is an exam required by the TDI-DWC to address the appropriateness of health care or other similar issues. See Texas Labor Code §408.004.
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Last updated: 10/19/2015