2023 Laws of Puerto Rico › TITLE ELEVEN - Workmen’s Compensation (§§ 1 — 268) › Chapter 9 - Temporary Disability Benefits (§§ 201 — 212) › § 204 - Determinations, notices and appeals

(a) Written notice of determination and appeal.— Written notice of a determination of eligibility or ineligibility shall be remitted to every claimant after he/she files a request for benefits. The Director shall remit every determination by certified mail or personal service to the last known address of the claimant. In the event the person insured or his/her beneficiaries, or any person who claims to be entitled to the benefits provided by this chapter, disagrees with the Director’s determination, he/she may request a reconsideration thereof in writing, within twenty (20) days following the date of notice. In the absence of such request for reconsideration, the determination shall be deemed final and binding.
(b) Reconsideration.— The determination in reconsideration that is issued by the Director, and is adverse to the claimant party, can be appealed through a motion before the Secretary of Labor and Human Resources within a term of twenty (20) days counted from the date the Director’s determination on reconsideration was filed in the registry. The Secretary shall appoint an examining official to hear the appeal. Said appeal shall be considered within fifteen (15) days after the motion has been filed. The Director shall submit to the Secretary a record with the complete investigation and the results thereof, and the conclusions and recommendations in law.
The examining official shall hold a hearing and shall give full recognition of the rights inherent to due process of law in favor of the appellant. In said hearing, the appellant shall have the right to examine and cross-examine witnesses, attend, accompanied by his/her counsel or defense, and present the necessary evidence in his/her behalf.
The examining official shall preside over the hearing and shall submit a report to the Secretary including a statement of the facts and conclusions of law, as well as his/her recommendations in each case.
The Secretary shall issue the final decision from which a reconsideration can be requested within a term of twenty (20) days after the notice of the order or resolution was filed. The Secretary shall consider said motion. If the Secretary rejects the motion for[th]with and does not act within the following fifteen (15) days, the term to request a review shall begin again from the date said denial is notified, or when such fifteen (15) days expire, as the case may be. If any determination is made in its consideration, the term to request a revision shall begin on the date a copy of the notice of the resolution that definitely resolves the motion is filed in the registry, which resolution shall be issued and filed in the registry within ninety (90) days following the filing of the motion.
If the Secretary fails to take any action with regard to the motion for reconsideration within ninety (90) days after having filed the motion to be resolved, he/she shall forfeit jurisdiction on the same and the term to request judicial review shall begin as of the expiration date of said term of ninety (90) days, unless the court, for just cause, authorizes an extension to the Department of Labor and Human Resources to resolve the motion within a reasonable period of time. The motion for reconsideration shall be jurisdictional, thus judicial revision may be requested.
(c) Notice of the Secretary’s decision and judicial review— The party adversely affected by an order or final resolution of the Secretary may file an application for appeal before the Circuit Court of Appeals with competent jurisdiction within the following thirty (30) days as of the date of filing of the copy of the notice of the Secretary’s order or final resolution.
(d) Writ of certiorari.— Any of the parties adversely affected by the resolution of the Circuit Court of Appeals may request a review thereof through the filing of a writ of certiorari before the Supreme Court.
(e) Interested party.— The claimant shall be the interested party in everything concerning his/her right to receive benefits. An employer shall be an interested party in a determination or redetermination only with regard to his/her obligation to pay contributions according to the provisions of § 208 of this title. However, an employer who has a private plan, or an insurance company authorized up to the limit of its liability, or a board of trustees, union or association which administers a private plan, shall be an interested party in everything concerning a determination or redetermination with regard to any benefit claim under the private plan.
(f) Conclusive nature of final determination and decisions.— Except insofar as there is a redetermination under subsection (c) of this section, all final determinations and decisions shall be conclusive with regard to the employing units that have been notified thereof, as well as the Secretary and the claimant. No final determination or decision with regard to benefit rights shall be subject to collateral attack by an employing unit regardless of whether or not there has been a notice thereof. The Secretary or the Director shall reopen a determination or decision or revoke permission to desist from an appeal if:
(1) He/she finds that a worker or employer has been defrauded or coerced to act by illegal means in connection with a determination, or decision, or to desist from the appeal, and
(2) the defrauded or coerced person informs the official or body of the fraud or coercion within sixty (60) days after he/she has become aware of the fraud or within sixty (60) days after the coercion has ceased.
(g) Limitation of fees.— Neither the Director, nor the Secretary nor any court shall impose the payment of any kind of fees or costs on a claimant, except that a court may impose costs against said claimant if it determines that the proceedings on judicial review have been unreasonably instituted or continued.
(h) Representation of claimant.— Any claimant in any proceeding before the Secretary or his/her duly authorized representative, may be represented by counsel. Said counsel shall not charge or receive a greater sum than the amount approved by the Secretary for such services.
(i) Counsel fees for claimants on appeals before the courts and the Secretary.— Counsel for a claimant on appeal shall be entitled to the payment of fees, as well as the payment of costs accrued. Such counsel fees, costs and any other disbursement shall be paid by the Secretary of the Disability Benefit Fund, or by the Administrator of a private insurance plan or a self-insured employer, in each of the following cases:
(1) Any appeal of an administrative or judicial decision which has favored the claimant in whole or in part;
(2) any appeal requested by a claimant of a decision which reverses another decision issued in his/her favor in whole or in part, or
(3) any appeal as a result of which the claimant is awarded benefits.
(j) Rules on decisions and certification to the Secretary.— The final decisions of the Secretary and the rules of law invoked in support thereof shall be binding in all subsequent proceedings which involve similar matters unless they are expressly or implicitly revoked by a subsequent decision of the Secretary or of a court of competent jurisdiction. The final decisions of the Secretary and the rules of law brought forward in support thereof shall be binding with regard to the Director and shall, likewise, serve as a persuasive authority in subsequent proceedings. If in any subsequent proceeding the Director has serious doubts with regard to the legality of any rules previously expounded by the Secretary, then the findings of fact and the issues of law involved in said case may be certified to the Secretary.
History —June 26, 1968, No. 139, p. 354, § 4; May 30, 1970, No. 83, p. 205, § 4; Nov. 12, 1975, No. 24, p. 828, § 3; July 26, 1979, No. 191, p. 527, § 3; July 1, 1988, No. 51, p. 237, § 4; Dec. 30, 1995, No. 262, § 3.