My Texas workers' comp insurance carrier disagrees with me about benefits. What are the steps?

Workers’ compAppealTexasChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Texas Department of Insurance · Dispute resolution for injured employees View original ↗

In short

First talk to your attorney or ombudsman, if you have one.
Then talk to the insurance carrier's adjuster.
If that fails, ask for a benefit review conference.

What this means

The Texas Department of Insurance says most disputes are about two things. One is whether an injured worker can get medical or income benefits. The other is how much will be paid [1]. First, talk to your attorney or ombudsman, if you have one. Then talk to the insurance carrier. You, your ombudsman, or your attorney should call the adjuster. If you cannot work it out, you can ask for a benefit review conference. That starts the state's dispute process [1]. The Office of Injured Employee Counsel says there are two kinds of requests. Medical Dispute Resolution is for medical benefits. Indemnity (Income) Dispute Resolution is for income benefits [2].

Your next step

Call the adjuster and write down what was said. If it is not solved, request a benefit review conference with DWC (form DWC-045 is linked on the TDI page). The sources give no deadline for requesting it: "Don't know yet".

Check it yourself

The TDI page shows only the first steps in the text saved here; later steps are on the same page and not quoted. The leaflet is marked REV. 06/2012.

Where this comes from (2)

[1] Texas Department of Insurance · Dispute resolution for injured employees · checked 2026-11-06
Most disputes are about whether an injured employee can get medical or income benefits and the amount to be paid. … Step 1 – Talk with your attorney or ombudsman. If you don’t agree with the insurance carrier about something, talk to your attorney or ombudsman, if you have one. Step 2 – Talk to the insurance carrier about the dispute. You, your ombudsman, or attorney, if you have one, should call the adjuster about t…
[2] Texas Office of Injured Employee Counsel · Injured employee rights and responsibilities (leaflet REV. 06/2012) · checked 2026-11-06
You may request Medical Dispute Resolution if you disagree with the insurance carrier regarding medical benefits. You may request Indemnity (Income) Dispute Resolution if you disagree with the insurance carrier regarding income benefits.

How we found this

We matched your question to 2 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

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Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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