Follow These Rules When Attending a Benefit Review Conference or Contested Case Hearing
Believe it or not, some workers' compensation claims go very well for the claimants. The employer reports their injury immediately, the insurance company responds and pays all medical and income benefits in a timely manner, and the worker is back on the job site within a few weeks or months. It would be great if all claims worked out this way, but unfortunately - in a large number of cases - conflicts arise with the insurance company, and when they do there is a good chance you are going to end up in a Benefit Review Conference (BRC) or Contested Case Hearing (CCH).
BRCs and CCHs are events that are held before officials who represent the State of Texas. Their purpose is to attempt to resolve the case either informally (BRCs) or through a contested hearing where evidence is presented (CCHs). They are both critical steps in your workers' compensation case, and if you aren't careful about what you do and say at these events, things can go badly for you and very well for the insurance company. Here are a few rules to follow when attending these events:
Rule 1: Find Representation or Bring an Ombudsman
The insurance company is going to be represented by an attorney or an adjuster who is experienced in handling these types of situations. If you don't get your own assistance, then you are at a serious disadvantage. The best type of representation you can have at a CCH or BRC is an experienced attorney. However, if you are unable to find an attorney for your case, you should at least seek out the assistance of the Office of Injured Employee Counsel (OIEC), which can provide an Ombudsman who will help you at your event. Ombudsmen are not attorneys, but they do understand the process in some detail, and they can help point you in the right direction. You can contact the OIEC here.
Rule 2: Be On Time
It can make a bad impression on the officials who are handling your case if you are late or if you don't show up to your BRC or CCH. You should show up for your event at least 10 to 15 minutes early.
Rule 3: Be Sure to Exchange
You are required to exchange documentary evidence with the insurance company several days before a BRC or CCH takes place. Make sure that your attorney or ombudsman has all relevant medical records and other documents relating to your case, so that they can be exchanged with the insurance company. And if you decide to represent yourself (which you shouldn't - see Rule 1), make sure you send those documents to the insurance company within the required time limits. If you don't exchange documents, you might not be able to introduce them as evidence in your CCH.
Rule 4: Be Courteous
Events like these can be frustrating. Often, the attorneys that represent the insurance company do not understand your side of the case, and they will say things that are misleading. Sometimes your employer will show up and try to make it more difficult for you to prove your case. In those situations, it can be very easy to let the anger and frustration that you are feeling about your situation boil over, but don't. Losing your temper in a BRC or a CCH will always hurt you more than it helps. It makes a bad impression on the people who are overseeing the hearing, and it gives the insurance company insight into ways that you can be manipulated in the future in a way that will help your case.
Rule 5: Be Prepared
Before you go to your event, make sure you understand what issues will arise during the hearing, and organize whatever documents you have in a way where you can easily and quickly access them. When possible, be ready to counter any incorrect information provided by the insurance company with solid documentation.
Rule 6: Ask for Help
If you get to a point where you feel like you are over your head, ask if you can be given some time to find an attorney. At a CCH, this may or may not be allowed, but at the BRC level you will almost always be allowed time to find an attorney if you need to do so. Don't assume that you have to go through the entire process alone. You can and should try to ask for some time to locate an attorney to help you.
The bottom line is - don't go through the process alone and keep your cool, regardless of the circumstances. Follow these guidelines and you'll have a much better chance for a successful outcome in your case.