reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 137 - DISABILITY MANAGEMENT › Subchapter C - TREATMENT GUIDELINES › Section 137.100 - Treatment Guidelines

Current through Reg. 49, No. 28; July 12, 2024
(a) Health care
				  providers shall provide treatment in accordance with the current edition of the
Official Disability Guidelines - Treatment in Workers' Comp,
excluding the return to work pathways, (ODG), published by Work Loss Data
				  Institute (Division treatment guidelines), unless the treatment(s) or
				  service(s) require(s) preauthorization in accordance with §
										134.600
				  of this title (relating to Preauthorization, Concurrent Review and Voluntary
				  Certification of Health Care) or § 137.300 of this title (relating to
				  Required Treatment Planning).
(b)
				  Information on how to obtain or inspect copies of the Division treatment
				  guidelines may be found on the Division's website:
www.tdi.state.tx.us.
(c) Health care provided in accordance with
				  the Division treatment guidelines is presumed reasonable as specified in Labor
				  Code §
										413.017,
				  and is also presumed to be health care reasonably required as defined by Labor
				  Code §
										401.011(22-a).
(d) The insurance carrier is not liable for
				  the costs of treatments or services provided in excess of the Division
				  treatment guidelines unless:
(1) the
				  treatment(s) or service(s) were provided in a medical emergency; or
(2) the treatment(s) or service(s) were
				  preauthorized in accordance with §
											134.600
				  or § 137.300 of this title.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.1 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this part, shall
				  have the following meanings, unless the context clearly indicates
				  otherwise.
(1) Benefit dispute--A
				disputed issue arising under the Texas Workers' Compensation Act (Act) in a
				workers' compensation claim regarding compensability or eligibility for, or the
				amount of, income or death benefits.
(2) Benefit proceeding--A proceeding pursuant
				to the Act, Chapter 410, conducted by a presiding officer to resolve one or
				more benefit disputes. Benefit proceedings include benefit review conferences,
				benefit contested case hearings, appeals, and, after January 1, 1992,
				arbitration.
(3) Party to a
				proceeding--A person entitled to take part in a proceeding because of a direct
				legal interest in the outcome.
(4)
				Presiding officer--The division employee, or independent arbitrator, assigned
				to conduct a proceeding. Presiding officers include benefit review officers,
				administrative law judges, appeals panel judges, and arbitrators.
(5) Special accommodations--Individuals and
				equipment necessary to allow an individual who does not speak English or who
				has a physical, mental, or developmental handicap to participate in a
				proceeding. The term includes spoken language translators and sign language
				translators.
(6) Stipulation--A
				voluntary accord between parties to a benefit contested case hearing regarding
				any matter relating to the hearing that does not constitute an agreement, as
				defined by the Act, §401.011(3), or a settlement, as defined by the Act,
				§401.011(40).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.2 - Special Accommodations

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				commission, on its own motion or upon request, will provide special
				accommodations to an individual who intends to participate in a proceeding and
				who does not speak English, or who has a physical, mental, or developmental
				handicap.
(b) A request for special
				accommodations may be made by the individual desiring them, the carrier, or
				anyone knowing of the need.
(c) The
				request:
(1) may be made in any
				manner;
(2) should describe the
				special accommodations needed; and
(3) should be sent to the commission no later
				than 10 days before the date of the proceeding.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.3 - Expedited Proceedings

Current through Reg. 49, No. 28; July 12, 2024
In addition to expedited proceedings provided by any other
				  commission rule, the commission may provide expedited benefit review
				  conferences and benefit contested case hearings for resolution of disputes
				  involving compensability, liability for essential medical treatment, or any
				  type of issue as defined by commission policy for which the executive director
				  or delegate determines an expedited proceeding will serve the best interests of
				  the workers' compensation system or its participants.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.4 - Conduct and Decorum

Current through Reg. 49, No. 28; July 12, 2024
(a) The presiding
				officer may at the beginning of any proceeding and during the course of that
				proceeding establish rules of decorum to be followed during the proceeding. The
				presiding officer may also establish times for beginning the proceeding, for
				recesses, and for ending the proceeding.
(b) Parties and participants in a proceeding
				shall conduct themselves with dignity, shall show courtesy and respect for one
				another and for the presiding officer, shall follow the decorum prescribed by
				the presiding officer at the proceeding, and shall adhere to the beginning
				times of the proceeding, and to the times established for each recess and for
				ending the proceeding.
(c) To
				maintain and enforce proper conduct and decorum at a proceeding, and to enforce
				promptness at a proceeding, the presiding officer may take appropriate action,
				including, but not limited to:
(1) issuing a
				warning;
(2) excluding any person
				from the proceeding;
(3) recessing
				the proceeding; and
(4) referring
				an action for possible enforcement as an administrative violation.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.5 - Correction of Clerical Error

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				executive director or the executive director's designee may at any time revise
				an order or decision to correct clerical error:
(1) at the joint written request of the
				parties;
(2) at the request of a
				party affected by the order or decision; or
(3) on his or her own motion.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.6 - Subclaimant Status: Establishment, Rights, and Procedures

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability. This section is applicable
				to a subclaim pursued under Labor Code §
									409.009, including a
				subclaim pursued by a health care insurer.
(b) Party status. A subclaimant as described
				in §409.009 is a party to a claim concerning workers' compensation
				benefits.
(c) Rights in Relation to
				the Injured Employee.
(1) A subclaimant may
				file and pursue a claim for reimbursement of a benefit that has been provided
				to an injured employee, and is entitled to appropriate dispute resolution in
				accordance with the Texas Workers' Compensation Act (Act) and Division of
				Workers' Compensation (Division) rules.
(2) A subclaimant may pursue a claim for
				reimbursement of a benefit that has been provided to an injured employee and
				participate in the dispute resolution process without the participation of the
				injured employee if:
(A) there is no prior
				written agreement between the injured employee and the workers' compensation
				insurance carrier or no final decision by the Division on the issue in
				dispute;
(B) the workers'
				compensation insurance carrier has denied the entitlement to benefits under the
				Act and Division rules;
(C) the
				injured employee is not pursuing dispute resolution to establish the injured
				employee's entitlement to benefits with reasonable diligence; and
(D) the subclaimant has provided the injured
				employee with written notice of:
(i)
				subclaimant's intent to pursue a claim for reimbursement of a
				benefit;
(ii) warning that a
				decision rendered may be binding against the injured employee; and
(iii) contact information for the Office of
				the Injured Employee Counsel.
(3) At a contested case hearing without the
				participation of the injured employee, the subclaimant must show, in addition
				to other facts:
(A) subclaimant provided
				written notice to the injured employee as specified in paragraph (2)(D) of this
				subsection;
(B) it has contacted
				the injured employee and the injured employee is not pursuing the dispute with
				reasonable diligence; or
(C) it has
				been unable to contact the injured employee through the exercise of reasonable
				diligence.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.7 - Health Care Insurer Reimbursement under Labor Code Section

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability.
				This section applies only to subclaims by a health care insurer based on
				information received under Labor Code §
									402.084(c-3).
(b) Health care insurer. "Health care
				insurer" means an insurance carrier and an authorized representative of an
				insurance carrier, as described by Labor Code §
									402.084(c-1).
(c) Reimbursement of Health Care Insurers. A
				health care insurer may be reimbursed for medical benefits provided to or paid
				on behalf of an injured employee with a compensable workers' compensation claim
				in accordance with Labor Code §
									409.0091,
				the procedures of §
									140.8
				of this title (relating to Procedures for Health Care Insurers to Pursue
				Reimbursement of Medical Benefits under Labor Code §
									409.0091),
				and this section.
(d) Certain
				Defenses Not Allowed. A workers' compensation insurance carrier shall not deny
				a reimbursement request under Labor Code §
									409.0091
				from a health care insurer because:
(1) the
				health care insurer has not sought reimbursement from the health care provider
				or the health care insurer's insured;
(2) the health care insurer or the health
				care provider did not request preauthorization under §
										134.600
				of this title (relating to Preauthorization, Concurrent Review, and Voluntary
				Certification of Health Care) or Labor Code §
										413.014;
				or
(3) the health care provider did
				not bill the workers' compensation insurance carrier, as provided by Labor Code
				§
										408.027,
				before the 95th day after the date the health care for which the health care
				insurer paid was provided.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.8 - Procedures for Health Care Insurers to Pursue Reimbursement of Medical Benefits under Labor Code Section 409.0091

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Applicability. This section applies only to subclaims by a health care insurer
				based on information received under Labor Code §
									402.084(c-3).
(b) Health care insurer. "Health care
				insurer" means an insurance carrier and an authorized representative of an
				insurance carrier, as described by Labor Code §
									402.084(c-1).
(c) Request to Workers' Compensation
				Insurance Carrier. A health care insurer seeking reimbursement must first file
				a reimbursement request with the workers' compensation insurance carrier.
(1) Form. The request must be in the
				form/format and manner prescribed by the Division of Workers' Compensation
				(Division) and must contain all the required elements listed on the
				form.
(2) Notice. The health care
				insurer must give notice of the request to the injured employee and the health
				care provider that performed the services that are the subject of the
				reimbursement request. The notice shall include a copy of the reimbursement
				request and an explanation that the health care insurer is seeking
				reimbursement for medical care costs.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 140 - DISPUTE RESOLUTION-GENERAL PROVISIONS › Section 140.9 - Requests by Parties

Current through Reg. 49, No. 28; July 12, 2024
(a) This subsection
				applies to carriers, carrier representatives, claimants represented by an
				attorney, and claimants assisted by the Office of Injured Employee Counsel
				(OIEC). The parties shall work collaboratively to reach any agreement
				reasonably necessary for the efficient disposition of a case. Unless presented
				during a proceeding, all requests to presiding officers, including rescheduling
				and continuance requests, discovery requests, and other requests, must be in
				writing and include a signed statement that the requester made reasonable
				efforts to confer with the other party or parties about the request. If the
				requester was unable to confer with the other party or parties, the statement
				must summarize the efforts made to confer. If the parties conferred, the
				statement must:
(1) include whether the other
				party or parties oppose the request; and
(2) for a request to reschedule or continue a proceeding, propose
				a date and time the parties are available for the rescheduled proceeding that
				has been coordinated with the division's docketing section.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 141 - DISPUTE RESOLUTION-BENEFIT REVIEW CONFERENCE › Section 141.1 - Requesting and Setting a Benefit Review Conference

Current through Reg. 49, No. 28; July 12, 2024
(a) Prior Notification. Before requesting a
				benefit review conference, a disputing party must notify the other parties of
				the nature of the dispute and attempt to resolve the dispute.
(b) Who May Request. A request for a benefit
				review conference may be made by an injured employee, a subclaimant, or an
				insurance carrier. An employer may request a benefit review conference to
				contest compensability when the insurance carrier has accepted the claim as
				compensable.
(c) Subclaimant. A
				request for a benefit review conference made by a subclaimant under Labor Code
				§
									409.009 must also
				comply with the requirements of §
									140.6
				of this title (relating to Subclaimant Status: Establishment, Rights, and
				Procedures).
(d) Request for
				Benefit Review Conference. A request for a benefit review conference must be
				made in the form and manner required by the division. The request must:
(1) identify and describe the disputed
				issues;
(2) provide details and
				supporting documentation of efforts made by the requesting party to resolve the
				disputed issues, including, but not limited to, copies of the notification
				provided in accordance with subsection (a) of this section, correspondence,
				emails, faxes, records of telephone contacts, or summaries of meetings or
				telephone conversations. For the purposes of this subsection, copies of the
				notification provided under subsection (a) of this section, correspondence,
				emails, faxes, records of telephone contacts, or summaries of meetings or
				telephone conversations should not include all attachments of pertinent
				information exchanged with the opposing parties as required by §
										141.4
				of this title (relating to Sending and Exchanging Pertinent
				Information);
(3) contain the
				requesting party's signature to show that the party made reasonable efforts to
				resolve the disputed issues before requesting a benefit review conference, and
				provide any pertinent information in their possession to the other parties as
				required by §
										141.4(c)
				of this title; and
(4) send the
				request to the division and opposing parties.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 141 - DISPUTE RESOLUTION-BENEFIT REVIEW CONFERENCE › Section 141.2 - Canceling or Rescheduling a Benefit Review Conference

Current through Reg. 49, No. 28; July 12, 2024
(a) In this subsection, "good cause" will be
				determined at the discretion of the benefit review officer on a case-by-case
				basis, including consideration of prejudice to parties, and means:
(1) objective facts beyond the control of a
				party, which reasonably:
(A) prevent a party
				from attending the benefit review conference; or
(B) would prevent the benefit review
				conference from accomplishing its purpose, such as the need for a reasonable
				amount of additional time to secure necessary evidence for the dispute;
				or
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 141 - DISPUTE RESOLUTION-BENEFIT REVIEW CONFERENCE › Section 141.3 - Failure to Attend a Benefit Review Conference

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability. This subsection applies to
				a benefit review conference that is requested before December 1, 2011.
(1) When a party fails to attend a benefit
				review conference without good cause, as determined by the benefit review
				officer, the benefit review officer:
(A)
				shall hold the conference as scheduled; and
(B) may recommend the issuance of an
				administrative violation.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 141 - DISPUTE RESOLUTION-BENEFIT REVIEW CONFERENCE › Section 141.4 - Sending and Exchanging Pertinent Information

Current through Reg. 49, No. 28; July 12, 2024
(a) As used in this chapter "pertinent
				information" means all information relevant to the resolution of the disputed
				issue or issues to be addressed at the benefit review conference, including but
				not limited to:
(1) reports regarding the
				compensable injury;
(2) the injured
				employee's wage records; and
(3)
				the injured employee's medical records.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 141 - DISPUTE RESOLUTION-BENEFIT REVIEW CONFERENCE › Section 141.5 - Description of the Benefit Review Conference

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions. As used in this section,
				"participant" means an individual entitled or permitted to attend and take part
				in a benefit review conference. Participants include:
(1) the parties;
(2) the parties' representatives;
(3) the employer exercising the right to
				present evidence relevant to the disputed issue or issues; and
(4) any other individual, at the discretion
				of the benefit review officer.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 141 - DISPUTE RESOLUTION-BENEFIT REVIEW CONFERENCE › Section 141.7 - Division Actions After a Benefit Review Conference

Current through Reg. 49, No. 28; July 12, 2024
(a) All Issues Resolved. Division actions if
				all issues are resolved at the benefit review conference.
(1) If all issues in dispute are resolved at
				the benefit review conference by agreement or settlement, the agreement or
				settlement must be reduced to writing and signed by each party and their
				designated representative, if any, and the benefit review officer.
(2) The benefit review officer shall make the
				agreement part of the claim file. If all issues in dispute are resolved at the
				benefit review conference by settlement, the benefit review officer shall
				submit the signed settlement to the commissioner or commissioner's designee for
				handling as provided by Chapter 147 of this title (relating to Dispute
				Resolution--Agreements, Settlements, Commutations). If the commissioner or
				commissioner's designee rejects the settlement, the parties may request:
(A) a second benefit review conference, if a
				second benefit review conference has not already been held; or
(B) a contested case hearing.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.1 - Application of the Administrative Procedure Act

Current through Reg. 49, No. 28; July 12, 2024
The following sections of the Government Code, apply to
				  benefit contested case hearings: §2001.201, relating to enforcement of
				  subpoenas.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.2 - Authority of the Administrative Law Judge

Current through Reg. 49, No. 28; July 12, 2024
The administrative law judge is authorized to:
(1) issue subpoenas;
(2) rule on requests;
(3) issue orders, including interlocutory
				orders;
(4) use summary procedures
				as provided by §
									142.8 of this
				chapter (relating to Summary Procedures);
(5) direct parties to appear at a prehearing
				conference to resolve evidentiary and procedural issues;
(6) establish time limits for conducting a
				hearing;
(7) administer
				oaths;
(8) rule on the
				admissibility of evidence;
(9)
				determine the relevancy, materiality, weight, and credibility of
				evidence;
(10) request additional
				evidence;
(11) take official notice
				of the law of Texas and other jurisdictions, Texas city and county ordinances,
				the contents of the
Texas Register,
the rule of state
				agencies, facts that are judicially cognizable, and generally recognized facts
				within the division's specialized knowledge;
(12) examine parties and witnesses, and
				permit examination and cross-examination of parties and witnesses;
(13) recess, postpone, or dismiss a hearing;
				and
(14) take any other action as
				authorized by law, or as may facilitate the orderly conduct and disposition of
				the hearing.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.3 - Ex Parte Communications

Current through Reg. 49, No. 28; July 12, 2024
(a) No person,
				except as otherwise provided in subsection (c) of this section, may
				communicate, either directly or indirectly, with the administrative law judge
				regarding any facts, issues, law or rules relating to the benefit contested
				case hearing after the hearing has been set, and until all administrative and
				judicial remedies have been exhausted, unless all parties to the hearing are
				present, except where the communication is:
(1) written; and
(2) delivered to all parties, as provided by
				§
										142.4
				of this title (relating to Delivery of Copies to All Parties).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.4 - Delivery of Copies to all Parties

Current through Reg. 49, No. 28; July 12, 2024
A party who sends a document relating to a benefit contested
				  case hearing to the division shall also deliver copies of the document to all
				  other parties as provided in § 140.9 of this title (Requests by Parties).
				  Delivery shall be accomplished by presenting in person, mailing by first class
				  mail, facsimile, or electronic transmission. The document sent to the division
				  shall contain a statement certifying delivery. The following statement of
				  certification shall be used: "I hereby certify that I have on this _____ day of
				  __________, _____, delivered a copy of the attached document to (state the
				  names of all parties to whom a copy was delivered) by (state the manner of
				  delivery)."
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.5 - Sequence of Proceedings to Resolve Benefit Disputes

Current through Reg. 49, No. 28; July 12, 2024
(a) Usual sequence. Except as provided in
				this section, parties to a benefit dispute are required to attempt to resolve
				the dispute by mediation at a benefit review conference before proceeding to a
				contested case hearing or to arbitration by mutual election.
(b) Guidelines for proceeding directly to a
				benefit contested case hearing. Parties may proceed directly to a contested
				case hearing without attending a benefit review conference if the division
				determines that:
(1) mediation would not
				prove effective to resolve the dispute;
(2) necessary evidence cannot be obtained
				without subpoena; or
(3) the
				situation of the parties or the nature of the facts or law of the case is such
				that the overall policy of the Act would be advanced by proceeding directly to
				a contested case hearing.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.6 - Setting a Benefit Contested Case Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) Setting with prior benefit review
				conference. The commission shall set a benefit contested case hearing to be
				held:
(1) no later than 60 days from the date
				of the benefit review conference; or
(2) if the commission determines that an
				expedited setting is appropriate, as provided by §
										140.3 of
				this title (relating to Expedited Hearings), no later than 30 days from the
				date of the benefit review conference.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.7 - Statement of Disputes

Current through Reg. 49, No. 28; July 12, 2024
(a) Statement of
				disputes. The statement of disputes is a written description of the benefit
				dispute or disputes to be considered by the administrative law judge. A dispute
				not expressly included in the statement of disputes will not be considered by
				the administrative law judge.
(b)
				Statement of disputes after a benefit review conference. The statement of
				disputes for a hearing held after a benefit review conference includes:
(1) the benefit review officer's report,
				identifying the disputes remaining unresolved at the close of the benefit
				review conference;
(2) the parties'
				responses, if any;
(3) additional
				disputes by unanimous consent, as provided by subsection (c) of this section;
				and
(4) additional disputes
				presented by a party, as provided by subsections (d) and (e) of this section,
				if the administrative law judge determines that the party has good
				cause.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.8 - Summary Procedures

Current through Reg. 49, No. 28; July 12, 2024
(a) In order to
				expedite the presentation of a case, the administrative law judge may allow
				summary procedures, including, but not limited to, the use of:
(1) sworn witness statements;
(2) summaries of evidence;
(3) medical reports;
(4) agreements; and
(5) stipulations.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.9 - Stipulations, Agreements, and Settlements

Current through Reg. 49, No. 28; July 12, 2024
(a) At any time before or during the hearing,
				parties may:
(1) enter into stipulations, as
				provided by §
										140.1 of
				this title (relating to Definitions);
(2) resolve one or more benefit disputes by
				agreement; or
(3) resolve all
				benefit disputes by settlement.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.10 - Continuance

Current through Reg. 49, No. 28; July 12, 2024
(a) As used in this chapter, continuance
				means postponing a hearing from the time or date set and rescheduling it on a
				later time or date.
(b) The
				division may continue a hearing:
(1) on its
				own motion; or
(2) at the request
				of a party, if the administrative law judge determines the party has good
				cause.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.11 - Failure To Attend a Benefit Contested Case Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) When a party fails to attend a scheduled
				contested case hearing for which proper notice was provided, the administrative
				law judge shall proceed with the scheduled hearing. Following the close of
				evidence, the administrative law judge shall send written notice that the
				non-attending party has ten days from the date of receipt of the notice to
				respond in writing and show good cause for the party's failure to
				attend.
(b) Other parties to the
				proceeding may reply, in writing, to the non-attending party's response within
				three days of receipt of the response.
(c) The administrative law judge shall issue
				a written ruling based on the filings allowed under subsections (a) and (b) of
				this section. If the administrative law judge determines that good cause exists
				for the failure to attend, the hearing will be rescheduled. If good cause is
				not found, or if the non-attending party does not respond to the notice, the
				administrative law judge shall issue a decision based on the evidence presented
				at the hearing and may recommend the issuance of an administrative
				violation.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.12 - Subpoena

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions. The following words and
				terms, as used in this chapter, shall have the following meanings, unless the
				context clearly indicates otherwise:
(1)
				Evidence - Testimony or documents, including books, papers, and tangible
				things.
(2) Service - Delivery of a
				subpoena by an authorized individual to the person to whom it is
				addressed.
(3) Subpoena - A
				division order issued by the administrative law judge requiring a person to
				attend or to produce evidence at a deposition (deposition subpoena) or at a
				hearing (hearing subpoena).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.13 - Discovery

Current through Reg. 49, No. 28; July 12, 2024
(a) Description of discovery. As used in this
				chapter, discovery is the process by which a party may, before the hearing,
				obtain evidence relating to the disputed issue or issues from the other parties
				and witnesses. If the evidence is not produced voluntarily, the party may
				request a subpoena, as provided in §
									142.12 of
				this title (relating to Subpoena). Discovery includes:
(1) parties' exchange of documentary
				evidence;
(2) interrogatories, as
				prescribed by §
										142.19 of
				this title (relating to Interrogatories); and
(3) witness depositions, as follows:
(A) a health care provider may be deposed
				only on written questions; and
(B)
				other witnesses may be deposed within their county of residence or employment,
				orally or on written questions, if the administrative law judge determines the
				party has good cause to request such testimony.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.14 - Permission to Use Court Reporter

Current through Reg. 49, No. 28; July 12, 2024
(a) A party may
				request permission to have the hearing recorded by a court reporter provided by
				the party. The party may select, and must bear the cost of, the court
				reporter.
(b) A request for
				permission to use a court reporter may be made in any manner and at any time
				before the hearing. The administrative law judge will rule on the request and
				notify the parties only if the request is denied.
(c) A copy of the court reporter's audiotape,
				or transcript, if produced, shall be furnished to the division at no
				charge.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.16 - Decision

Current through Reg. 49, No. 28; July 12, 2024
(a) After the record closes, the
				administrative law judge shall issue a decision on benefits. The decision
				shall:
(1) be in writing;
(2) include findings of fact and conclusions
				of law; a determination of whether benefits are due; and, if so, an award of
				benefits due; and
(3) be signed by
				the administrative law judge.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.17 - Transcript or Duplicate of the Hearing Audiotape

Current through Reg. 49, No. 28; July 12, 2024
(a) A party or the employer may submit a
				request to the commission for a transcript of the hearing audiotape. The
				requester shall pay the cost of the transcript, as established by the
				commission.
(b) A party or the
				employer may submit a request to the commission for a duplicate of the hearing
				audiotape. The requester shall pay the cost of the duplication, as established
				by the commission.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.18 - Special Provisions for Cases on Remand from the Appeals Panel

Current through Reg. 49, No. 28; July 12, 2024
(a) Priority setting for case on remand from
				appeals panel. When the appeals panel reverses an administrative law judge's
				decision and remands the case for further consideration, the division shall set
				the hearing to be held within 30 days of the date of the appeals panel's
				decision.
(b) Notice of hearing.
				After setting a hearing under this section, the division shall furnish, by
				first class mail or personal delivery, written notice of the date, time, and
				location to the parties. The notice shall be furnished at least 20 days before
				the hearing.
(c) Statement of
				issues. For cases on remand from the appeals panel, the statement of issues
				includes:
(1) the decision of the appeals
				panel; and
(2) the parties'
				responses, if any.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.19 - Form Interrogatories

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				division has developed standard interrogatories for parties to exchange the
				following information :
(1) the name and
				contact information of the person answering the interrogatories;
(2) the issues in dispute;
(3) any certification of maximum medical
				improvement and impairment rating;
(4) any statement obtained from any person on
				the issues in dispute;
(5) the name
				and contact information for each health care provider the claimant has seen
				since the date of injury, and the conditions the health care provider
				treated;
(6) any recordings,
				photographs, videotapes, or similar material showing the claimant since the
				date of injury;
(7) for each health
				care provider the claimant has seen during the five years before the date of
				injury for treatment of a body part the claimant believes to be part of the
				claim:
(A) the health care provider's name and
				contact information;
(B) the dates
				the health care provider treated the claimant; and
(C) the conditions the health care provider
				treated; and
(8) for
				each expert witness expected to testify:
(A)
				the expert witness' name and contact information;
(B) the subject matter the expert witness may
				or will testify on; and
(C) the
				general substance of the expert witness' opinions and a brief summary of the
				basis for them.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 142 - DISPUTE RESOLUTION-BENEFIT CONTESTED CASE HEARING › Section 142.20 - Interlocutory Orders

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				administrative law judge may enter an interlocutory order to pay all or part of
				income benefits or medical benefits.
(b) An interlocutory order contained in a
				decision supersedes the decision as it pertains to the payment of income
				benefits or medical benefits and remains in effect until:
(1) the decision becomes final in accordance
				with §
										142.16(f)
				of this title (relating to the Decision);
(2) the decision of the appeals panel is
				issued pursuant to the Texas Labor Code, §
										410.204, and Chapter 143
				of this title, if appealed to the appeals panel as provided by the Texas Labor
				Code, §
										410.202,
				and Chapter 143 of this title and the decision and order are affirmed or an
				appeals panel decision reverses the administrative law judge's decision and
				renders a decision;
(3) reversed or
				modified by an agreement or settlement, as provided by §
										147.7
				of this title (relating to Effect on Previously-Entered Decisions and Orders);
				or
(4) reversed or modified by a
				subsequent interlocutory order or decision issued after remand from the appeals
				panel pursuant to the Texas Labor Code, §
										410.203,
				and Chapter143 of this title.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 143 - DISPUTE RESOLUTION REVIEW BY THE APPEALS PANEL › Section 143.1 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
(1) Appellant--A party to a
				benefit contested case hearing who is dissatisfied with the decision of the
				administrative law judge, and files a request for review of that decision by
				the appeals panel.
(2) Request--The
				appellant's written appeal for review of the decision of an administrative law
				judge.
(3) Respondent--The other
				party to a benefit contested case hearing who must file a response to the
				appellant's request.
(4)
				Response--The respondent's written answer to the appellant's request.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 143 - DISPUTE RESOLUTION REVIEW BY THE APPEALS PANEL › Section 143.2 - Description of the Appeal Proceeding

Current through Reg. 49, No. 28; July 12, 2024
(a) To
				review the decision of the administrative law judge, the appeals panel
				considers the appellant's request, the respondent's response, and the record of
				the benefit contested case hearing. The parties do not appear in person before
				the panel.
(b) The appeals panel
				may:
(1) reverse the decision of the
				administrative law judge and render a new decision;
(2) reverse the decision of the
				administrative law judge and remand to the administrative law judge for a
				second benefit contested case hearing, which shall be set as provided by §
										142.18
				of this title (relating to Special Provisions for Cases on Remand from the
				Appeals Panel). The appeals panel may not remand a case more than once;
				or
(3) affirm the decision of an
				administrative law judge in a case as described by Labor Code §
										410.204(a-1).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 143 - DISPUTE RESOLUTION REVIEW BY THE APPEALS PANEL › Section 143.3 - Requesting the Appeals Panel to Review the Decision of the Administrative Law Judge

Current through Reg. 49, No. 28; July 12, 2024
(a) A party to a
				benefit contested case hearing who is dissatisfied with the decision of the
				administrative law judge may request the appeals panel to review that decision.
				The request shall:
(1) be in
				writing;
(2) clearly and concisely
				rebut each issue in the administrative law judge's decision that the appellant
				wants reviewed, and state the relief the appellant wants granted;
(3) be filed with the Chief Clerk of
				Proceedings in the division's central office in Austin not later than the 15th
				day after receipt of the administrative law judge's decision. The
				administrative law judge's decision is deemed to have been received by the
				parties in accordance with §102.5 (relating to General Rules for Written
				Communications To and From the Commission) and §
										102.3(relating
				to Computation of Time) of this title. Requests that are timely submitted to a
				division location other than the Chief Clerk of Proceedings, such as a local
				field office of the division, will be considered timely filed and forwarded to
				the division's appeals panel for consideration, but this may result in delay in
				the processing of the request. Untimely requests, regardless of whether they
				are filed with the Chief Clerk of Proceedings in the division's central office
				or in a different division field office, do not invoke the jurisdiction of the
				appeals panel and will not be reviewed by the appeals panel;
(4) be served on the other party or parties
				on the same day filed with the division; and
(5) contain a statement certifying that a
				copy has been served on the other party or parties in person, mailed by
				certified mail, return receipt requested, or transmitted by verifiable means. A
				certificate in substantially the following form shall be used: "I hereby
				certify that I have on this ____ day of ____________, _____, served a copy of
				the attached request for appeal on _______________________________ (state the
				name of the other party or parties on whom a copy was served) by
				_______________________________ (state the manner of service)."
				_______________________________ Signature
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 143 - DISPUTE RESOLUTION REVIEW BY THE APPEALS PANEL › Section 143.4 - Responding to a Request for Review by the Appeals Panel

Current through Reg. 49, No. 28; July 12, 2024
(a) The other party shall respond to the
				appellant's request. The response shall:
(1)
				be in writing;
(2) clearly and
				concisely support each issue in the administrative law judge's decision that
				the appellant has rebutted in the request, and state why the appellant's relief
				should not be granted;
(3) be filed
				with the Chief Clerk of Proceedings in the division's central office in Austin
				not later than the 15th day after receipt of the appellant's appeal. The
				appellant's appeal is deemed received in accordance with §102.5 (relating
				to General Rules for Written Communications To and From the Commission,
				§102.4 (relating to General Rules for Non-Commission Communications) and
				§
										102.3(relating
				to Computation of Time) of this title. Responses that are timely submitted to a
				division location other than the Chief Clerk of Proceedings, such as a local
				field office of the division, will be considered filed timely and forwarded to
				the division's appeals panel for consideration, but this may result in delay in
				the processing of the response. Untimely responses, regardless of whether they
				are filed with the Chief Clerk of Proceedings or in a different division
				office, will not be reviewed by the appeals panel;
(4) be served on the other party or parties
				on the same day filed with the division; and
(5) contain a statement certifying that a
				copy has been served on the other party or parties in person, mailed by
				certified mail, return receipt requested, or transmitted by verifiable means. A
				certificate in substantially the following form shall be used: "I hereby
				certify that I have on this ____ day of ____________, _____, served a copy of
				the attached response to a request for appeal on
				_______________________________ (state the name of the other party or parties
				on whom a copy was served) by _______________________________ (state the manner
				of service)." _______________________________ Signature