2023 Laws of Puerto Rico › TITLE ELEVEN - Workmen’s Compensation (§§ 1 — 268) › Chapter 1 - Workmen’s Accident Compensation (§§ 1 — 42) › § 11 - Appeal from the Administrator’s decision

If the worker, or employee, or his/her beneficiaries are not satisfied with the decision rendered by the Administrator of the State Insurance Fund Corporation in their case, he/she may appeal before the Industrial Commission within a term of thirty (30) days after a copy of the decision of the Administrator has been served to them, and the case shall be referred to an Examining Official. In the cases of uninsured employers, the worker as well as the employer may appeal to the Industrial Commission once the employer is declared uninsured by the Administrator. The employer shall have thirty (30) days to appeal the decision of the Administrator.
Once an injured worker has filed an appeal involving a medical matter, he/she shall be examined at a medical hearing to determine whether the appellant requires additional medical treatment, to be examined by a specialist, or if the decision on disability requires revision. Said hearing shall be held jointly by physicians of the State Insurance Fund Corporation and the Industrial Commission, and by the physician the worker may see proper to bring, whose fees and travel expenses shall be compensated by the Industrial Commission in the manner set forth by regulation, under the charge and control of the physician representing the Commission. The appellant may be represented by an attorney.
The physicians in charge of the medical hearing shall render a report to the Commission regarding the medical evaluation and the steps taken regarding the condition, medical treatment of the appellant, and the decisions on disability, if any. The Commission shall issue the required decision, and shall notify the appellant. If the appellant is unsatisfied with the Commission’s decision, he/she may request that a public hearing be held within a term of thirty (30) days. When the worker designates his/her own physician to assist him/her in the appeal, the fees and travel expenses of said physician shall be paid by the Industrial Commission as established by regulations.
The Chair shall designate a Corps of Examining Officials whose duty shall be to collaborate in the adjudication duties of the Commission by conducting investigations and presiding over public hearings of a quasi-judicial nature held at the Commission. They shall hold office in the career service within the Commission and have the authority to:
(1) Take oaths and statements;
(2) issue summonses, require the presentation of reports, books, papers and documents deemed necessary for the exercise of their functions;
(3) receive pertinent evidence and to pass judgment thereon;
(4) take depositions, or have them taken;
(5) hold public hearings and regulate the course thereof;
(6) hold and preside [at] preliminary conferences for the clarification and simplification of matters in dispute;
(7) dispose of procedural processes or similar matters;
(8) recommend decisions to the Industrial Commission, and
(9) carry out delegated authority adjudication functions; the work of these Examining Officials shall be valid with the signature of one Commissioner.
The Commission shall set forth by means of regulation the procedures that shall govern the holding of medical and public hearings, pursuant to the provisions set forth in §§ 2101 et seq. of Title 3, as amended. The public hearings shall be public, except when the appellant has demonstrated the existence of irreparable damage, as set forth by regulation, for the holding of the same. Minutes shall be kept of all medical and public hearings held. The resolutions issued by the official examiners or the Commissioners shall contain a summary of all the evidence submitted, a statement on the burden of proof, issues of fact and conclusions of law that illustrate the law and the applicable case laws.
History —Apr. 18, 1935, No. 45, p. 250, § 10; Apr. 22, 1942, No. 43, p. 454, § 1; May 2, 1952, No. 185, p. 384, § 1; June 10, 1974, No. 63, Part 1, p. 257, § 1; Aug. 9, 1974, No. 15, Part 2, p. 621; renumbered as § 9 and amended on July 1, 1996, No. 63, § 2; Mar. 25, 2003, No. 94, § 3; Aug. 28, 2003, No. 224, § 1; Nov. 16, 2009, No. 141, § 3.