Challenging a Workers' Compensation Cutoff Based on Surveillance

Attorney Answer

A carrier can stop paying benefits, but it does not get the last word. Texas workers' compensation has an administrative dispute process, and a decision made on the strength of surveillance video is exactly the kind that gets contested — so the important thing is to challenge it properly rather than wait it out.

The rules that govern how a carrier suspends or disputes benefits, and the steps and deadlines for challenging that decision, run through the Texas Division of Workers' Compensation. That process exists, it is administrative rather than a lawsuit, and its deadlines are short — which is why this is a call to make this week, not next month.

The same goes for the footage. Whether surveillance of you was lawfully obtained, and what effect that has on the carrier's decision, depends on where and how it was recorded and on Texas law that is not in these sources. Do not assume that calling it illegal ends the matter, and do not assume it is beyond challenge either.

What I can tell you with citations is the part that stays constant. The filing duties in a Texas comp claim belong to the worker: Tex. Lab. Code § 409.001(a) requires an employee, or a person acting on the employee's behalf, to notify the employer of an injury not later than the 30th day after the date the injury occurs, and Tex. Lab. Code § 409.003 requires that a claim be filed with the Division of Workers' Compensation not later than one year after the date the injury occurred. Tex. Lab. Code §§ 409.002 and 409.004 preserve a late notice or claim where the employer or carrier had actual knowledge of the injury, where the division determines good cause exists, or where the claim is not contested. Confirm that your own claim is properly on file before you fight about anything else.

And if it is your employer, rather than the insurance carrier, that has acted against you since you filed, Tex. Lab. Code § 451.001 provides that a person may not discharge or in any other manner discriminate against an employee because the employee has filed a workers' compensation claim in good faith, hired a lawyer to represent the employee in a claim, instituted or caused to be instituted in good faith a proceeding under the subtitle, or testified or is about to testify in such a proceeding. Section 451.002 provides for reasonable damages and reinstatement, with the burden of proof on the employee.

What you can do

1. Ask the carrier in writing for its written explanation of why benefits stopped, and for a copy of everything it relied on, including the footage. Keep the request and the response.

2. Keep every medical appointment your doctors have set and follow the restrictions you have been given. A gap in treatment becomes the carrier's next argument, whatever the video shows.

3. Ask your treating doctor to put your current restrictions and functional limits in writing, dated.

4. Contact the Texas Division of Workers' Compensation, tell them your benefits were stopped, and ask what the dispute process is and what its deadline is in your situation. Ask that question now — the answer is time-sensitive.

5. Keep a dated log of every contact from the carrier, an adjuster or an investigator. Do not give a recorded statement about your daily activities before you have talked to a lawyer.

6. Ask a Texas workers' compensation lawyer to take the dispute from here. Contested benefit terminations are argued on medical evidence and procedure, and that is not a fair fight to take on alone.

Most lawyers offer a brief initial call at no cost, and a few minutes on your specific facts is worth more than any general guidance, including this page.

⏱ Time limits apply. Tex. Lab. Code § 409.001(a) sets 30 days to notify the employer and § 409.003 sets one year to file the claim with the division, and the process for disputing a carrier's decision to stop benefits carries its own separate and much shorter deadlines that depend on what the carrier filed and when. Have a Texas attorney or the division confirm those dates for your claim immediately — do not calculate them yourself, and do not let them pass while you wait for the carrier to reconsider.