Up to 80% of disputes in Texas Workers’ Compensation claims include an extent of injury issue. Over the past few years it has become more difficult for injured workers to prevail at the Texas Department of Insurance, Division of Workers’ Compensation when an insurance carrier disputes disputes any conditions beyond a contusion or a sprain/strain injury.
Most conditions beyond a sprain/strain or contusion require a medical provider to present a “letter of causation” to establish the diagnosis as related to the compensable injury.
However, getting a “letter of causation” is not as simple as it sounds. Texas has now allowed employers to elect to be part of a care network. Injured workers whose employers are in a network may only treat with doctors in the network. Most of the networks are very restrictive on which doctors are allowed to enter the network and those who are in the network can be removed at the discretion of the insurance carrier. Therefore, some doctors in the networks refuse to provide “letters of causation” when the insurance carrier has denied a diagnosis.
Even when a worker gets a “letter of causation”, the insurance carrier can have the worker examined by their selection of doctor to rebut the letter. Some insurance carriers even hire doctors to testify at hearings who have never examined the worker; nor have they provided a report which the injured worker may have reviewed by a doctor.
In summary, if you are looking at a dispute of your Texas Workers’ Compensation claim make sure you have the evidence you need to establish the disputed condition.
Daniel L Morris, The Morris Firm, firstname.lastname@example.org, (214)357=1782