It’s hard being an injured worker in Texas. In 1991, the Texas Legislature took away the injured workers’ right to file a law suit for damages against your employer (if they are a subscriber). In 2005, they created medical networks for treatment took away the injured workers’ ability to treat with their own doctor. Now with decisions like City of Larado v. Garza, and Transcontinental Ins. Co. v. Crump, the Division of Workers Compensation is placing a greater burden on injured workers’ when establishing the extent of their injuries.
The burden of proof work Texas Workers Compensation cases is a “Preponderance of the Evidence” which means the great weight of the evidence or more convincing then the evidence the opposes it. The burden basically means more likely than not.
However, on injuries beyond a sprain/strain, there now must be medical evidence establishing that the injury was a substantial factor in bringing about the injury, without which the injury would not have occurred. The “Substantial Factor” language is new even though the work related accident does not need to be the sole factor, but only one of the producing causes of the condition.
If your insurance carrier is disputing the extent of your workers compensation injury, make sure that you have a causation letter establishing your injuries to the work related accident. You must have this prior to the Benefit Contested Case Hearing. When you are in the Benefit Contested Case Hearing let them know that your burden is still only a preponderance of the evidence and not a greater one.