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Information for Participants in a Benefit Review Conference

Información para los Participantes en una Conferencia para Revisión de Beneficios (BRC, por sus siglas en inglés) - Información en español.

If a dispute arises about a workers' compensation claim, the parties are required to make efforts to resolve the dispute prior to requesting a Benefit Review Conference. If the dispute cannot be resolved, a party to the dispute may request a Benefit Review Conference using 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.

The party requesting a Benefit Review Conference is required to provide pertinent information to the opposing party before requesting a Benefit Review Conference.

The following categories represent most of the issues discussed at a Benefit Review Conference. Necessary information has been provided for each category as it relates to each participant in a Benefit Review Conference. Some Benefit Review Conferences may involve more than one category (i.e., a compensability dispute and an income benefit dispute). To view the information related to a certain category, click on the information for your participant status in the workers' compensation claim (i.e., injured employee, insurance carrier, employer, beneficiary, or subclaimant).

I. Compensability Issues:

Compensability is an issue when the insurance carrier challenges whether an injury is related to the injured employee's employment. This dispute may be over 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, or whether the injured employee's death was the result of the injury.

II. Liability Issues:

Liability is an issue when the insurance company disputes whether the injured employee was intoxicated at the time of the injury, or if the injured employee's injury was the result of horseplay, his/her intention to injure his/herself or another person, another person intending to injure the injured employee, an off-duty (recreational/social/athletic) activity, or an act of God. ("Exceptions" listed under Texas Labor Code §406.032).

III. Income Benefit Issues:

Income Benefits are an issue when the insurance carrier disputes the injured employee's entitlement to or amount of income benefits. Income benefits include temporary income benefits (TIBs), impairment income benefits (IIBs), supplemental income benefits (SIBs), and lifetime income benefits (LIBs).

For Maximum Medical Improvement and/or Impairment Ratings (See IIBs for Injured Employees or Insurance Carriers)

IV. Average Weekly Wage Issues (AWW):

Average weekly wage is an issue when the insurance carrier, the injured employee or their beneficiaries dispute the wages or method used to calculate an injured employee's average weekly wage. Income and death benefits are based on an injured employee's average weekly wage.

V. Death/Burial Benefit Disputes:

An insurance carrier may dispute a beneficiary's entitlement to receive death benefits. An issue may also arise over the reasonable cost of burial benefits and/or transportation costs incurred on behalf of the deceased injured employee (Death and Burial Benefits).

VI. Appeal of a Medical Fee Dispute Decision:

A party may request a BRC using DWC Form-045M, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (BRC-MFD), to appeal a medical fee dispute decision on a fee dispute filed with the TDI-DWC on or after June 1, 2012. A party seeking review of a medical fee dispute decision must request a BRC within 20 days from the date of the party's receipt of the decision. A party requesting a BRC must include in the request a copy of the medical fee dispute decision. First responders' requests for a BRC must be accelerated by the TDI-DWC and given priority. First responders must provide notice to the TDI-DWC that the case involves a first responder.

Contact the local Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) field office handling your claim for additional information or assistance on the above disputed issues or for disputed issues not reflected above.

Last updated: 4/19/2017