What Happens If Your Texas Workers’ Comp Claim Is Denied?

Common reasons include late reporting, employer disputes, lack of medical evidence, delayed treatment, pre‑existing conditions, or inconsistent statements in medical records. Many of these denials can be overturned.

Keep getting medical treatment, gather documentation, and file a dispute with the DWC. The denial letter will outline your appeal rights and deadlines.

You’re not required to have one, but the insurance company will have lawyers. Having legal representation significantly increases your chances of overturning the denial.

A DWC officer meets with you and the insurance company to try to resolve the dispute. Evidence is reviewed, and settlement options may be discussed.

Your case moves to a Contested Case Hearing (CCH), where a judge reviews evidence, hears testimony, and issues a written decision.

Yes. You should continue treatment. Your medical records are essential evidence for overturning the denial. 

Your claim cannot be “denied” because there is no workers’ comp system involved. Instead, you may be able to file a personal injury lawsuit for full damages.  This type of employer is called a nonsubscriber.

No. Texas law prohibits firing someone because they filed a workers’ comp claim. However, employers often try to disguise retaliation as something else.

Fortunately, there is no deadline to appeal a totally denied claim.  Once you receive the denial form in the mail, it is time to gather the right evidence and request a Benefit Review Conference.

Medical records, diagnostic tests, witness statements, photos or videos, employer communications, and documentation of unsafe conditions all strengthen your appeal.

This is one of the most common denial tactics. You can challenge it with medical evidence, witness statements, and legal representation.  You will have to request a Benefit Review Conference to start the litigation process.