If a worker happens to be injured in the workplace or is suddenly struck down by a work-related illness, there is usually workers’ compensation available, which covers the financial costs of such a life-changing event. Such unexpected occurrences can cause financial hardship especially if the injured victim provides the highest proportion of the income of a household. Most employers carry workers’ comp. cover with a business like Texas Mutual, but now and again a claim may be denied and help from a workers’ comp. attorney can attempt to correct any errors made on the claim form that has resulted in a denial. Texas Mutual: Company Profile Texas leading provider for workers’ compensation insurance is the Texas Mutual Insurance Company. It insures 40 percent of the workers’ comp. market in Texas which includes 62,000 businesses and 1.3 million workers. It also provides the best possible medical care after an accident at work and attempts to ensure injured or sick workers are back on their feet and back at work as soon as possible. In 2016, Texas Mutual handled $1.1 billion in premiums according to the company itself. It provides for Texas employers consistent, competitive, workers' compensation insurance. It also acts as the insurer when someone can’t get insurance cover from anyone else. It is active in helping to prevent workplace illnesses and injuries while minimizing their consequences. Tips to Help You Make a Decision After a Workers’ Comp. Claim Has Been Rejected There will be a genuine reason why your workers’ comp. claim has been rejected, and you will be informed by letter what they are. The types of explanations that are given are usually fairly easy to put straight; however, a letter written by you is not always good enough. You will have to lodge an appeal, preferably with help from an experienced workers’ comp attorney. Tip #1: Check carefully the facts that have been laid out in your denial letter to ensure you know exactly what the denial is all about. You typically will need to calculate what you should have included but may have accidentally omitted. If you aren’t sure which way to turn next talk to a workers’ comp. attorney who will point you in the right direction and help you appeal the decision if that’s best for you. Tip #2: One thing you should scrutinize carefully and that is if the claim denial was to do with something your employer or insurer failed to do. It could even be down to a simple typo or the omission of some key information on the part of your employer or insurer. Often mistakes like this are easy to sort out. Tip #3: If you know you lodged your claim before the set deadline and your employer and insurance company knew all about it and you can’t find any mistakes on the workers’ comp claim form, it’s important to talk to a workers’ comp. attorney to sort out the matter. If you don’t you may never receive the workers’ comp. you deserve. At this point you should ask your attorney about the possibility of filing an appeal which may at this stage be your only option. Tip #4: Your attorney may go back to the actual time and date of the accident and find some more details that may help to give more support to your workers’ comp. claim. You may need some more conclusive evidence proving that the accident definitely took place in the workplace. Sometimes, an employer may cover up a workplace accident making it just about impossible to file a workers’ comp. claim because the evidence could not be found. Tip #5: Once you have filed an appeal you will be issued with a date for an administrative hearing. A judge will be present who will listen intently to your grounds for requesting a reversal of the workers’ comp. claim decision and will carefully scrutinize any new evidence that supports your claim. Use an Experienced WC Attorney if You Intend to Appeal a Denied Claim One would think that being awarded a claim is just a routine matter. However, your state’s workers’ comp. board doesn’t want to see any element of doubt when examining your claim. If there is even a sentence in a document that’s difficult to read or comprehend your claim may be denied. However, with the help of a workers’ comp. attorney these issues can be ironed out and an appeal will help to get your workers’ comp. claim back on track. *The content of this article serves only to provide information and should not be construed as legal advice. If you file a claim against Texas Mutual, or any other company, you may not be entitled to any compensation.
