If there is a dispute about a workers' compensation claim, the parties must try to resolve the dispute before asking for a benefit review conference (BRC). If the dispute cannot be resolved, a party may ask for a BRC using DWC Form-045, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference. They must submit proof that they tried to resolve the dispute on their own.
The party requesting a BRC must send information about the dispute (pertinent information) to the other party before requesting a BRC.
Here are the most common disputes discussed at a BRC.
Need help?
- Call DWC Customer Service at 800-252-7031, Monday through Friday, 8 a.m. to 5 p.m., Central time;
- The Office of Injured Employee Counsel (OIEC) is a state agency that offers injured employees free help with workers’ compensation claims. If you do not have an attorney and want help from an ombudsman, contact OIEC at 866-393-6432, ext. 44186;
- If you want an attorney and need help finding one, contact the State Bar of Texas at 800-252-9690.
Compensability disputes
Compensability may be an issue if the insurance carrier disputes whether an injury, illness, or condition is related to the injured employee's job. Here are examples of disputes about compensability:
- Course and scope of employment – whether the injury, illness, condition, or death was caused by the injured employee’s work activities.
- Extent of injury – whether a new injury, illness, or medical condition was caused by the original work injury.
Learn more about compensability disputes for:
Exceptions to liability disputes
These kinds of disputes happen if the insurance carrier believes there is a reason the injury should not be covered, such as:
- the injured employee was intoxicated at the time of the injury;
- the injury happened during horseplay;
- the injury happened when the injured employee tried to harm themself or another person;
- the injury happened when another person tried to harm the injured employee;
- the injury happened during an off-duty (recreational/social/athletic) activity; or
- the injury was caused by an act of God (such as weather).
More about exceptions to liability can be found in Texas Labor Code §406.032.
Learn more about exceptions to liability disputes for:
Income benefit disputes
Income benefits issues may happen if the insurance carrier disputes the injured employee's right to or amount of income benefits. Income benefits include:
- temporary income benefits
- impairment income benefits
- supplemental income benefits
- lifetime income benefits
Learn more about income benefit disputes for:
Average Weekly Wage (AWW) disputes
Average weekly wage may be an issue if 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.
Learn more about AWW disputes for:
Death and burial benefit disputes
An insurance carrier may dispute a beneficiary's right to receive death benefits. Disputes may also arise over the reasonable cost of burial benefits and transportation costs for the deceased injured employee.
Disputes of medical fee decisions
If the parties have a dispute about fees charged for the injured employee’s medical care, the dispute will go to DWC Medical Fee Dispute Resolution for a decision. If the parties disagree with that decision, they may ask for a BRC to appeal the decision.
Learn more about medical fee dispute resolution and how to appeal a decision for: