CHAPTER 410. ADJUDICATION OF DISPUTES
LABOR CODE
TITLE 5. WORKERS' COMPENSATION
SUBTITLE A. TEXAS WORKERS' COMPENSATION ACT
CHAPTER 410. ADJUDICATION OF DISPUTES
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 410.002. LAW GOVERNING LIABILITY PROCEEDINGS. A proceeding
before the division to determine the liability of an insurance
carrier for compensation for an injury or death under this
subtitle is governed by this chapter.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.150, eff. September 1, 2005.
Sec. 410.003. APPLICATION OF ADMINISTRATIVE PROCEDURE AND TEXAS
REGISTER ACT. Except as otherwise provided by this chapter,
Chapter 2001, Government Code does not apply to a proceeding
under this chapter.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff.
Sept. 1, 1995.
Sec. 410.005. VENUE FOR ADMINISTRATIVE PROCEEDINGS. (a) Unless
the division determines that good cause exists for the selection
of a different location, a benefit review conference or a
contested case hearing may not be conducted at a site more than
75 miles from the claimant's residence at the time of the injury.
(b) Unless the assigned arbitrator determines that good cause
exists for the selection of a different location, arbitration may
not be conducted at a site more than 75 miles from the claimant's
residence at the time of the injury.
(c) All appeals panel proceedings shall be conducted in Travis
County.
(d) Notwithstanding Subsection (a), the division may conduct a
benefit review conference telephonically on agreement by the
injured employee.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.151, eff. September 1, 2005.
Sec. 410.006. REPRESENTATION AT ADMINISTRATIVE PROCEEDINGS. (a)
A claimant may be represented at a benefit review conference, a
contested case hearing, or arbitration by an attorney or may be
assisted by an individual of the claimant's choice who does not
work for an attorney or receive a fee. An employee of an attorney
may represent a claimant if that employee:
(1) is a relative of the claimant; and
(2) does not receive a fee.
(b) An insurance carrier may be represented by an attorney or
adjuster.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.007. INFORMATION LIST. (a) The division shall
determine the type of information that is most useful to parties
to help resolve disputes regarding income benefits. That
information may include:
(1) reports regarding the compensable injury;
(2) medical information regarding the injured employee; and
(3) wage records.
(b) The division shall publish a list developed from the
information described under Subsection (a) in appropriate media,
including the division's Internet website, to provide guidance to
a party to a dispute regarding the type of information the party
should have available at a benefit review conference or a
contested case hearing.
(c) At the time a benefit review conference or contested case
hearing is scheduled, the division shall make available a copy of
the list developed under Subsection (b) to each party to the
dispute.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 3.152, eff. September 1, 2005.
SUBCHAPTER B. BENEFIT REVIEW CONFERENCE
Sec. 410.021. PURPOSE. A benefit review conference is a
nonadversarial, informal dispute resolution proceeding designed
to:
(1) explain, orally and in writing, the rights of the respective
parties to a workers' compensation claim and the procedures
necessary to protect those rights;
(2) discuss the facts of the claim, review available information
in order to evaluate the claim, and delineate the disputed
issues; and
(3) mediate and resolve disputed issues by agreement of the
parties in accordance with this subtitle and the policies of the
division.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.153, eff. September 1, 2005.
Sec. 410.022. BENEFIT REVIEW OFFICERS; QUALIFICATIONS. (a) A
benefit review officer shall conduct a benefit review conference.
(b) A benefit review officer must:
(1) be an employee of the division;
(2) be trained in the principles and procedures of dispute
mediation; and
(3) have documentation satisfactory to the commissioner that
evidences the completion by the officer of at least 40 classroom
hours of training in dispute resolution techniques from an
alternative dispute resolution organization recognized by the
commissioner.
(c) The division shall institute and maintain an education and
training program for benefit review officers and shall consult or
contract with the Federal Mediation and Conciliation Service or
other appropriate organizations for this purpose.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.154, eff. September 1, 2005.
Sec. 410.023. REQUEST FOR BENEFIT REVIEW CONFERENCE. (a) On
receipt of a request from a party or on its own motion, the
division may direct the parties to a disputed workers'
compensation claim to meet in a benefit review conference to
attempt to reach agreement on disputed issues involved in the
claim.
(b) The division shall require the party requesting the benefit
review conference to provide documentation of efforts made to
resolve the disputed issues before the request was submitted.
The commissioner by rule shall adopt guidelines regarding the
type of information necessary to satisfy this requirement.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.155, eff. September 1, 2005.
Sec. 410.024. BENEFIT REVIEW CONFERENCE AS PREREQUISITE TO
FURTHER PROCEEDINGS ON CERTAIN CLAIMS. (a) Except as otherwise
provided by law or commissioner rule, the parties to a disputed
compensation claim are not entitled to a contested case hearing
or arbitration on the claim unless a benefit review conference is
conducted as provided by this subchapter.
(b) The commissioner by rule shall adopt guidelines relating to
claims that do not require a benefit review conference and may
proceed directly to a contested case hearing or arbitration.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.156, eff. September 1, 2005.
Sec. 410.025. SCHEDULING OF BENEFIT REVIEW CONFERENCE; NOTICE.
(a) The commissioner by rule shall prescribe the time within
which a benefit review conference must be scheduled.
(b) The division shall schedule a contested case hearing to be
held not later than the 60th day after the date of the benefit
review conference if the disputed issues are not resolved at the
benefit review conference.
(c) The division shall send written notice of the benefit review
conference to the parties to the claim and the employer.
(d) The commissioner by rule shall provide for expedited
proceedings in cases in which compensability or liability for
essential medical treatment is in dispute.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.157, eff. September 1, 2005.
Sec. 410.026. POWERS AND DUTIES OF BENEFIT REVIEW OFFICER. (a)
A benefit review officer shall:
(1) mediate disputes between the parties and assist in the
adjustment of the claim consistent with this subtitle and the
policies of the division;
(2) thoroughly inform all parties of their rights and
responsibilities under this subtitle, especially in a case in
which the employee is not represented by an attorney or other
representative;
(3) ensure that all documents and information relating to the
employee's wages, medical condition, and any other information
pertinent to the resolution of disputed issues are contained in
the claim file at the conference, especially in a case in which
the employee is not represented by an attorney or other
representative; and
(4) prepare a written report that details each issue that is not
resolved at the benefit review conference, as required under
Section 410.031, including any issue raised for the first time at
the conclusion of an additional benefit review conference
conducted under Subsection (b).
(b) A benefit review officer may schedule an additional benefit
review conference if:
(1) the benefit review officer determines that any available
information pertinent to the resolution of disputed issues was
not produced at the initial benefit review conference; and
(2) a second benefit review conference has not already been
conducted.
(c) A benefit review officer may not take testimony but may
direct questions to an employee, an employer, or a representative
of an insurance carrier to supplement or clarify information in a
claim file.
(d) A benefit review officer may not make a formal record.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.158, eff. September 1, 2005.
Sec. 410.027. RULES. (a) The commissioner shall adopt rules
for conducting benefit review conferences.
(b) A benefit review conference is not subject to common law or
statutory rules of evidence or procedure.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.159, eff. September 1, 2005.
Sec. 410.028. FAILURE TO ATTEND; ADMINISTRATIVE VIOLATION. (a)
A scheduled benefit review conference shall be conducted even
though a party fails to attend unless the benefit review officer
determines that good cause exists to reschedule the conference.
(b) A party commits an administrative violation if the party
fails to attend a benefit review conference without good cause as
determined by the benefit review officer.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.160, eff. September 1, 2005.
Sec. 410.029. RESOLUTION AT BENEFIT REVIEW CONFERENCE; WRITTEN
AGREEMENT. (a) A dispute may be resolved either in whole or in
part at a benefit review conference.
(b) If the conference results in the resolution of some disputed
issues by agreement or in a settlement, the benefit review
officer shall reduce the agreement or the settlement to writing.
The benefit review officer and each party or the designated
representative of the party shall sign the agreement or
settlement.
(c) A settlement takes effect on the date it is approved by the
director in accordance with Section 408.005.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.030. BINDING EFFECT OF AGREEMENT. (a) An agreement
signed in accordance with Section 410.029 is binding on the
insurance carrier through the conclusion of all matters relating
to the claim, unless the division or a court, on a finding of
fraud, newly discovered evidence, or other good and sufficient
cause, relieves the insurance carrier of the effect of the
agreement.
(b) The agreement is binding on the claimant, if represented by
an attorney, to the same extent as on the insurance carrier. If
the claimant is not represented by an attorney, the agreement is
binding on the claimant through the conclusion of all matters
relating to the claim while the claim is pending before the
division, unless the commissioner for good cause relieves the
claimant of the effect of the agreement.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.161, eff. September 1, 2005.
Sec. 410.031. INCOMPLETE RESOLUTION; REPORT. (a) If a dispute
is not entirely resolved at a benefit review conference, the
benefit review officer shall prepare a written report that
details each issue that is not resolved at the conference.
(b) The report must also include:
(1) a statement of each resolved issue;
(2) a statement of each issue raised but not resolved;
(3) a statement of the position of the parties regarding each
unresolved issue;
(4) a statement of the procedures required to request a
contested case hearing or arbitration and a complete explanation
of the differences in those proceedings and the rights of the
parties to subsequent review of the determinations made in those
proceedings; and
(5) the date of the contested case hearing scheduled in
accordance with Section 410.025(b).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.162, eff. September 1, 2005.
Text of section as amended by Acts 2007, 80th Leg., R.S., Ch.
1177, Sec. 1
For text of section as amended by Acts 2007, 80th Leg., R.S., Ch.
1150, Sec. 4, see other Sec. 410.032.
Sec. 410.032. PAYMENT OF BENEFITS UNDER INTERLOCUTORY ORDER. (a)
The benefit review officer who presides at the benefit review
conference shall consider a request for an interlocutory order
and shall give the opposing party the opportunity to respond
before issuing an interlocutory order.
(b) The interlocutory order may address the payment or
suspension of accrued benefits, future benefits, or both accrued
benefits and future benefits.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1999, 76th Leg., ch. 955, Sec. 2, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.162, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
1177, Sec. 1, eff. September 1, 2007.
Text of section as amended by Acts 2007, 80th Leg., R.S., Ch.
1150, Sec. 4
For text of section as amended by Acts 2007, 80th Leg., R.S., Ch.
1177, Sec. 1, see other Sec. 410.032.
Sec. 410.032. PAYMENT OF BENEFITS UNDER INTERLOCUTORY ORDER.
(a) The benefit review officer who presides at the benefit
review conference shall:
(1) consider a written or verbal request for an interlocutory
order for the payment of benefits; and
(2) if the benefit review officer determines that issuance of an
interlocutory order is appropriate, issue the interlocutory order
not later than the third day after the date of receipt of the
request under Subdivision (1).
(b) The interlocutory order may address accrued benefits, future
benefits, or both accrued benefits and future benefits.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1999, 76th Leg., ch. 955, Sec. 2, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.162, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
1150, Sec. 4, eff. September 1, 2007.
Sec. 410.033. MULTIPLE CARRIERS. (a) If there is a dispute as
to which of two or more insurance carriers is liable for
compensation for one or more compensable injuries, the
commissioner may issue an interlocutory order directing each
insurance carrier to pay a proportionate share of benefits due
pending a final decision on liability. The proportionate share
is computed by dividing the compensation due by the number of
insurance carriers involved.
(b) On final determination of liability, an insurance carrier
determined to be not liable for the payment of benefits is
entitled to reimbursement for the share paid by the insurance
carrier from any insurance carrier determined to be liable.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.163, eff. September 1, 2005.
Sec. 410.034. FILING OF AGREEMENT AND REPORT. (a) The benefit
review officer shall file the signed agreement and the report
with the division.
(b) The commissioner by rule shall prescribe the times within
which the agreement and report must be filed.
(c) The division shall furnish a copy of the file-stamped report
to:
(1) the claimant;
(2) the employer; and
(3) the insurance carrier.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.164, eff. September 1, 2005.
SUBCHAPTER C. ARBITRATION
Sec. 410.101. PURPOSE. The purpose of arbitration is to:
(1) enter into formal, binding stipulations on issues on which
the parties agree;
(2) resolve issues on which the parties disagree; and
(3) render a final award with respect to all issues in dispute.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.102. ARBITRATORS; QUALIFICATIONS. (a) An arbitrator
must be an employee of the division, except that the division may
contract with qualified arbitrators on a determination of special
need.
(b) An arbitrator must:
(1) be a member of the National Academy of Arbitrators;
(2) be on an approved list of the American Arbitration
Association or Federal Mediation and Conciliation Service; or
(3) meet qualifications established by the commissioner by rule.
(c) The division shall require that each arbitrator have
appropriate training in the workers' compensation laws of this
state. The commissioner shall establish procedures to carry out
this subsection.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.165, eff. September 1, 2005.
Sec. 410.103. DUTIES OF ARBITRATOR. An arbitrator shall:
(1) protect the interests of all parties;
(2) ensure that all relevant evidence has been disclosed to the
arbitrator and to all parties; and
(3) render an award consistent with this subtitle and the
policies of the division.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.166, eff. September 1, 2005.
Sec. 410.104. ELECTION OF ARBITRATION; EFFECT. (a) If issues
remain unresolved after a benefit review conference, the parties,
by agreement, may elect to engage in arbitration in the manner
provided by this subchapter. Arbitration may be used only to
resolve disputed benefit issues and is an alternative to a
contested case hearing. A contested case hearing scheduled under
Section 410.025(b) is canceled by an election under this
subchapter.
(b) To elect arbitration, the parties must file the election
with the division not later than the 20th day after the last day
of the benefit review conference. The commissioner shall
prescribe a form for that purpose.
(c) An election to engage in arbitration under this subchapter
is irrevocable and binding on all parties for the resolution of
all disputes arising out of the claims that are under the
jurisdiction of the division.
(d) An agreement to elect arbitration binds the parties to the
provisions of Chapter 408 relating to benefits, and any award,
agreement, or settlement after arbitration is elected must comply
with that chapter.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.167, eff. September 1, 2005.
Sec. 410.105. LISTS OF ARBITRATORS. (a) The division shall
establish regional lists of arbitrators who meet the
qualifications prescribed under Sections 410.102(a) and (b).
Each regional list shall be initially prepared in a random name
order, and subsequent additions to a list shall be added
chronologically.
(b) The commissioner shall review the lists of arbitrators
annually and determine if each arbitrator is fair and impartial
and makes awards that are consistent with and in accordance with
this subtitle and the rules of the commissioner. The
commissioner shall remove an arbitrator if, after the review, the
commissioner determines that the arbitrator is not fair and
impartial or does not make awards consistent with this subtitle
and commissioner rules.
(c) The division's lists are confidential and are not subject to
disclosure under Chapter 552, Government Code. The lists may not
be revealed by any division employee to any person who is not a
division employee. The lists are exempt from discovery in civil
litigation unless the party seeking the discovery establishes
reasonable cause to believe that a violation of the requirements
of this section or Section 410.106, 410.107, 410.108, or
410.109(b) occurred and that the violation is relevant to the
issues in dispute.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(88), eff.
Sept. 1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.168, eff. September 1, 2005.
Sec. 410.106. SELECTION OF ARBITRATOR. The division shall
assign the arbitrator for a particular case by selecting the next
name after the previous case's selection in consecutive order.
The division may not change the order of names once the order is
established under this subchapter, except that once each
arbitrator on the list has been assigned to a case, the names
shall be randomly reordered.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.169, eff. September 1, 2005.
Sec. 410.107. ASSIGNMENT OF ARBITRATOR. (a) The division shall
assign an arbitrator to a pending case not later than the 30th
day after the date on which the election for arbitration is filed
with the division.
(b) When an arbitrator has been assigned to a case under
Subsection (a), the parties shall be notified immediately.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.170, eff. September 1, 2005.
Sec. 410.108. REJECTION OF ARBITRATOR. (a) Each party is
entitled, in its sole discretion, to one rejection of the
arbitrator in each case. If a party rejects the arbitrator, the
division shall assign another arbitrator as provided by Section
410.106.
(b) A rejection must be made not later than the third day after
the date of notification of the arbitrator's assignment.
(c) When all parties have exercised their right of rejection or
if no rejection is registered, the assignment is final.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.171, eff. September 1, 2005.
Sec. 410.109. SCHEDULING OF ARBITRATION. (a) The arbitrator
shall schedule arbitration to be held not later than the 30th day
after the date of the arbitrator's assignment and shall notify
the parties and the division of the scheduled date.
(b) If an arbitrator is unable to schedule arbitration in
accordance with Subsection (a), the division shall appoint the
next arbitrator on the applicable list. Each party is entitled
to reject the arbitrator appointed under this subsection in the
manner provided under Section 410.108.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.172, eff. September 1, 2005.
Sec. 410.110. CONTINUANCE. (a) A request by a party for a
continuance of the arbitration to another date must be directed
to the director. The director may grant a continuance only if the
director determines, giving due regard to the availability of the
arbitrator, that good cause for the continuance exists.
(b) If the director grants a continuance under this section, the
rescheduled date may not be later than the 30th day after the
original date of the arbitration.
(c) Without regard to whether good cause exists, the director
may not grant more than one continuance to each party.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.111. RULES. The commissioner shall adopt rules for
arbitration consistent with generally recognized arbitration
principles and procedures.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.173, eff. September 1, 2005.
Sec. 410.112. EXCHANGE AND FILING OF INFORMATION; ADMINISTRATIVE
VIOLATION. (a) Not later than the seventh day before the first
day of arbitration, the parties shall exchange and file with the
arbitrator:
(1) all medical reports and other documentary evidence not
previously exchanged or filed that are pertinent to the
resolution of the claim; and
(2) information relating to their proposed resolution of the
disputed issues.
(b) A party commits an administrative violation if the party,
without good cause as determined by the arbitrator, fails to
comply with Subsection (a).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.174, eff. September 1, 2005.
Sec. 410.113. DUTIES OF PARTIES AT ARBITRATION; ATTENDANCE;
ADMINISTRATIVE VIOLATION. (a) Each party shall attend the
arbitration prepared to set forth in detail its position on
unresolved issues and the issues on which it is prepared to
stipulate.
(b) A party commits an administrative violation if the party
does not attend the arbitration unless the arbitrator determines
that the party had good cause not to attend.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.175, eff. September 1, 2005.
Sec. 410.114. TESTIMONY; RECORD. (a) The arbitrator may
require witnesses to testify under oath and shall require
testimony under oath if requested by a party.
(b) The division shall make an electronic recording of the
proceeding.
(c) An official stenographic record is not required, but any
party may at the party's expense make a stenographic record of
the proceeding.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.176, eff. September 1, 2005.
Sec. 410.115. EVIDENCE. (a) The parties may offer evidence as
they desire and shall produce additional evidence as the
arbitrator considers necessary to an understanding and
determination of the dispute.
(b) The arbitrator is the judge of the relevance and materiality
of the evidence offered. Conformity to legal rules of evidence is
not required.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.116. CLOSING STATEMENTS; BRIEFS. The parties may
present closing statements as they desire, but the record may not
remain open for written briefs unless requested by the
arbitrator.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.117. EX PARTE CONTACTS PROHIBITED. A party and an
arbitrator may not communicate outside the arbitration unless the
communication is in writing with copies provided to all parties
or relates to procedural matters.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.118. AWARD. (a) The arbitrator shall enter the
arbitrator's award not later than the seventh day after the last
day of arbitration.
(b) The arbitrator shall base the award on the facts established
at arbitration, including stipulations of the parties, and on the
law as properly applied to those facts.
(c) The award must:
(1) be in writing;
(2) be signed and dated by the arbitrator; and
(3) include a statement of the arbitrator's decision on the
contested issues and the parties' stipulations on uncontested
issues.
(d) The arbitrator shall file a copy of the award as part of the
permanent claim file at the division and shall notify the parties
in writing of the decision.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.177, eff. September 1, 2005.
Sec. 410.119. EFFECT OF AWARD. (a) An arbitrator's award is
final and binding on all parties. Except as provided by Section
410.121, there is no right to appeal.
(b) An arbitrator's award is a final order of the division.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.178, eff. September 1, 2005.
Sec. 410.120. CLERICAL ERROR. For the purpose of correcting a
clerical error, an arbitrator retains jurisdiction of the award
for 20 days after the date of the award.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.121. COURT VACATING AWARD. (a) On application of an
aggrieved party, a court of competent jurisdiction shall vacate
an arbitrator's award on a finding that:
(1) the award was procured by corruption, fraud, or
misrepresentation;
(2) the decision of the arbitrator was arbitrary and capricious;
or
(3) the award was outside the jurisdiction of the division.
(b) If an award is vacated, the case shall be remanded to the
division for another arbitration proceeding.
(c) A suit to vacate an award must be filed not later than the
30th day after:
(1) the date of the award; or
(2) the date the appealing party knew or should have known of a
basis for suit under this section, but in no event later than 12
months after an order denying compensation or after the
expiration of the income or death benefit period.
(d) Venue for a suit to vacate an award is in the county in
which the arbitration was conducted.
(e) In a suit to vacate an arbitrator's award, only the court
may make determinations, including findings of fact or
conclusions of law.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.179, eff. September 1, 2005.
SUBCHAPTER D. CONTESTED CASE HEARING
Sec. 410.151. CONTESTED CASE HEARING; SCOPE. (a) If
arbitration is not elected under Section 410.104, a party to a
claim for which a benefit review conference is held or a party
eligible to proceed directly to a contested case hearing as
provided by Section 410.024 is entitled to a contested case
hearing.
(b) An issue that was not raised at a benefit review conference
or that was resolved at a benefit review conference may not be
considered unless:
(1) the parties consent; or
(2) if the issue was not raised, the commissioner determines
that good cause existed for not raising the issue at the
conference.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.180, eff. September 1, 2005.
Sec. 410.152. HEARING OFFICERS; QUALIFICATIONS. (a) A hearing
officer shall conduct a contested case hearing.
(b) A hearing officer must be licensed to practice law in this
state.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.153. APPLICATION OF ADMINISTRATIVE PROCEDURE ACT.
Chapter 2001, Government Code, applies to a contested case
hearing to the extent that the commissioner finds appropriate,
except that the following do not apply:
(1) Section 2001.054;
(2) Sections 2001.061 and 2001.062;
(3) Section 2001.202; and
(4) Subchapters F, G, I, and Z, except for Section 2001.141(c).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.93, eff. Sept. 1,
1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.181, eff. September 1, 2005.
Sec. 410.154. SCHEDULING OF HEARING. The division shall
schedule a contested case hearing in accordance with Section
410.024 or 410.025(b).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.182, eff. September 1, 2005.
Sec. 410.155. CONTINUANCE. (a) A written request by a party
for a continuance of a contested case hearing to another date
must be directed to the division.
(b) The division may grant a continuance only if the division
determines that there is good cause for the continuance.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.183, eff. September 1, 2005.
Sec. 410.156. ATTENDANCE REQUIRED; ADMINISTRATIVE VIOLATION.
(a) Each party shall attend a contested case hearing.
(b) A party commits an administrative violation if the party,
without good cause as determined by the hearing officer, does not
attend a contested case hearing.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.184, eff. September 1, 2005.
Sec. 410.157. RULES. The commissioner shall adopt rules
governing procedures under which contested case hearings are
conducted.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.185, eff. September 1, 2005.
Sec. 410.158. DISCOVERY. (a) Except as provided by Section
410.162, discovery is limited to:
(1) depositions on written questions to any health care
provider;
(2) depositions of other witnesses as permitted by the hearing
officer for good cause shown; and
(3) interrogatories as prescribed by the commissioner.
(b) Discovery under Subsection (a) may not seek information that
may readily be derived from documentary evidence described in
Section 410.160. Answers to discovery under Subsection (a) need
not duplicate information that may readily be derived from
documentary evidence described in Section 410.160.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.186, eff. September 1, 2005.
Sec. 410.159. STANDARD INTERROGATORIES. (a) The commissioner
by rule shall prescribe standard form sets of interrogatories to
elicit information from claimants and insurance carriers.
(b) Standard interrogatories shall be answered by each party and
served on the opposing party within the time prescribed by
commissioner rule, unless the parties agree otherwise.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.187, eff. September 1, 2005.
Sec. 410.160. EXCHANGE OF INFORMATION. Within the time
prescribed by commissioner rule, the parties shall exchange:
(1) all medical reports and reports of expert witnesses who will
be called to testify at the hearing;
(2) all medical records;
(3) any witness statements;
(4) the identity and location of any witness known to the
parties to have knowledge of relevant facts; and
(5) all photographs or other documents that a party intends to
offer into evidence at the hearing.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.188, eff. September 1, 2005.
Sec. 410.161. FAILURE TO DISCLOSE INFORMATION. A party who
fails to disclose information known to the party or documents
that are in the party's possession, custody, or control at the
time disclosure is required by Sections 410.158-410.160 may not
introduce the evidence at any subsequent proceeding before the
division or in court on the claim unless good cause is shown for
not having disclosed the information or documents under those
sections.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.189, eff. September 1, 2005.
Sec. 410.162. ADDITIONAL DISCOVERY. For good cause shown, a
party may obtain permission from the hearing officer to conduct
additional discovery as necessary.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.163. POWERS AND DUTIES OF HEARING OFFICER. (a) At a
contested case hearing the hearing officer shall:
(1) swear witnesses;
(2) receive testimony;
(3) allow examination and cross-examination of witnesses;
(4) accept documents and other tangible evidence; and
(5) allow the presentation of evidence by affidavit.
(b) A hearing officer shall ensure the preservation of the
rights of the parties and the full development of facts required
for the determinations to be made. A hearing officer may permit
the use of summary procedures, if appropriate, including witness
statements, summaries, and similar measures to expedite the
proceedings.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.164. RECORD. (a) The proceedings of a contested case
hearing shall be recorded electronically. A party may request a
transcript of the proceeding and shall pay the reasonable cost of
the transcription.
(b) A party may request that the proceedings of the contested
case hearing be recorded by a court reporter. The party making
the request shall bear the cost.
(c) At each contested case hearing, as applicable, the insurance
carrier shall file with the hearing officer and shall deliver to
the claimant a single document stating the true corporate name of
the insurance carrier and the name and address of the insurance
carrier's registered agent for service of process. The document
is part of the record of the contested case hearing.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 11.01, eff. June
17, 2001.
Sec. 410.165. EVIDENCE. (a) The hearing officer is the sole
judge of the relevance and materiality of the evidence offered
and of the weight and credibility to be given to the evidence.
Conformity to legal rules of evidence is not necessary.
(b) A hearing officer may accept a written statement signed by a
witness and shall accept all written reports signed by a health
care provider.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.166. STIPULATIONS. A written stipulation or agreement
of the parties that is filed in the record or an oral stipulation
or agreement of the parties that is preserved in the record is
final and binding.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.167. EX PARTE CONTACTS PROHIBITED. A party and a
hearing officer may not communicate outside the contested case
hearing unless the communication is in writing with copies
provided to all parties or relates to procedural matters.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.168. DECISION. (a) The hearing officer shall issue a
written decision that includes:
(1) findings of fact and conclusions of law;
(2) a determination of whether benefits are due; and
(3) an award of benefits due.
(b) The decision may address accrued benefits, future benefits,
or both accrued benefits and future benefits.
(c) The hearing officer may enter an interlocutory order for the
payment of all or part of medical benefits or income benefits.
The order may address accrued benefits, future benefits, or both
accrued benefits and future benefits. The order is binding during
the pendency of an appeal to the appeals panel.
(d) On a form that the commissioner by rule prescribes, the
hearing officer shall issue a separate written decision regarding
attorney's fees and any matter related to attorney's fees. The
decision regarding attorney's fees and the form may not be made
known to a jury in a judicial review of an award, including an
appeal.
(e) The commissioner by rule shall prescribe the times within
which the hearing officer must file the decisions with the
division.
(f) The division shall send a copy of the decision to each
party.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1999, 76th Leg., ch. 955, Sec. 3, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.190, eff. September 1, 2005.
Sec. 410.169. EFFECT OF DECISION. A decision of a hearing
officer regarding benefits is final in the absence of a timely
appeal by a party and is binding during the pendency of an appeal
to the appeals panel.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
SUBCHAPTER E. APPEALS PANEL
Sec. 410.201. APPEALS JUDGES; QUALIFICATIONS. (a) Appeals
judges, in a three-member panel, shall conduct administrative
appeals proceedings.
(b) An appeals judge must be licensed to practice law in this
state.
(c) An appeals judge may not conduct a benefit review conference
or a contested case hearing.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.191, eff. September 1, 2005.
Sec. 410.202. REQUEST FOR APPEAL; RESPONSE. (a) To appeal the
decision of a hearing officer, a party shall file a written
request for appeal with the appeals panel not later than the 15th
day after the date on which the decision of the hearing officer
is received from the division and shall on the same date serve a
copy of the request for appeal on the other party.
(b) The respondent shall file a written response with the
appeals panel not later than the 15th day after the date on which
the copy of the request for appeal is served and shall on the
same date serve a copy of the response on the appellant.
(c) A request for appeal or a response must clearly and
concisely rebut or support the decision of the hearing officer on
each issue on which review is sought.
(d) Saturdays and Sundays and holidays listed in Section
662.003, Government Code, are not included in the computation of
the time in which a request for an appeal under Subsection (a) or
a response under Subsection (b) must be filed.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 12.01, eff. June
17, 2001.
Sec. 410.203. POWERS AND DUTIES OF APPEALS PANEL; PRIORITY OF
HEARING ON REMAND. (a) The appeals panel shall consider:
(1) the record developed at the contested case hearing; and
(2) the written request for appeal and response filed with the
appeals panel.
(b) The appeals panel may:
(1) reverse the decision of the hearings officer and render a
new decision; or
(2) reverse the decision of the hearings officer and remand the
case to the hearing officer for further consideration and
development of evidence.
(c) The appeals panel may not remand a case under Subsection
(b)(2) more than once.
(d) A hearing on remand shall be accelerated and the
commissioner shall adopt rules to give priority to the hearing
over other proceedings.
(e) The appeals panel shall issue and maintain a precedent
manual. The precedent manual shall be composed of
precedent-establishing decisions and may include other
information as identified by the appeals panel.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.192, eff. September 1, 2005.
Sec. 410.204. DECISION. (a) The appeals panel shall review
each request and issue a written decision on each reversed or
remanded case. The decision must be in writing and shall be
issued not later than the 45th day after the date on which the
written response to the request for appeal is filed. The appeals
panel shall file a copy of the decision with the commissioner.
(b) A copy of the decision of the appeals panel shall be sent to
each party not later than the seventh day after the date the
decision is filed with the division.
(c) If the appeals panel does not issue a decision in accordance
with this section, the decision of the hearing officer becomes
final and is the final decision of the appeals panel.
(d) Each final decision of the appeals panel shall conclude with
a separate paragraph stating: "The true corporate name of the
insurance carrier is (NAME IN BOLD PRINT) and the name and
address of its registered agent for service of process is (NAME
AND ADDRESS IN BOLD PRINT)."
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 11.02, eff. June
17, 2001.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.193, eff. September 1, 2005.
Sec. 410.205. EFFECT OF DECISION. (a) A decision of the
appeals panel regarding benefits is final in the absence of a
timely appeal for judicial review.
(b) The decision of the appeals panel regarding benefits is
binding during the pendency of an appeal under Subchapter F or G.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1999, 76th Leg., ch. 955, Sec. 4, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.194, eff. September 1, 2005.
Sec. 410.206. CLERICAL ERROR. The division may revise a
decision in a contested case hearing on a finding of clerical
error.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.195, eff. September 1, 2005.
Sec. 410.207. CONTINUATION OF DIVISION JURISDICTION. During
judicial review of the appeals panel decision on any disputed
issue relating to a workers' compensation claim, the division
retains jurisdiction of all other issues related to the claim.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.196, eff. September 1, 2005.
Sec. 410.208. JUDICIAL ENFORCEMENT OF ORDER OR DECISION;
ADMINISTRATIVE VIOLATION. (a) If a person refuses or fails to
comply with an interlocutory order, final order, or decision of
the commissioner, the division may bring suit in Travis County to
enforce the order or decision.
(b) If an insurance carrier refuses or fails to comply with an
interlocutory order, a final order, or a decision of the
commissioner, the claimant may bring suit in the county of the
claimant's residence at the time of the injury, or death if the
employee is deceased, or, in the case of an occupational disease,
in the county in which the employee resided on the date
disability began or any county agreed to by the parties.
(c) If the division brings suit to enforce an interlocutory
order, final order, or decision of the commissioner, the division
is entitled to reasonable attorney's fees and costs for the
prosecution and collection of the claim, in addition to a
judgment enforcing the order or decision and any other remedy
provided by law.
(d) A claimant who brings suit to enforce an interlocutory
order, final order, or decision of the commissioner is entitled
to a penalty equal to 12 percent of the amount of benefits
recovered in the judgment, interest, and reasonable attorney's
fees for the prosecution and collection of the claim, in addition
to a judgment enforcing the order or decision.
(e) A person commits an administrative violation if the person
fails or refuses to comply with an interlocutory order, final
order, or decision of the commissioner within 20 days after the
date the order or decision becomes final.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2003, 78th Leg., ch. 397, Sec. 1, eff. Sept. 1,
2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.197, eff. September 1, 2005.
Sec. 410.209. REIMBURSEMENT FOR OVERPAYMENT. The subsequent
injury fund shall reimburse an insurance carrier for any
overpayments of benefits made under an interlocutory order or
decision if that order or decision is reversed or modified by
final arbitration, order, or decision of the commissioner or a
court. The commissioner shall adopt rules to provide for a
periodic reimbursement schedule, providing for reimbursement at
least annually.
Added by Acts 1999, 76th Leg., ch. 955, Sec. 5, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.198, eff. September 1, 2005.
SUBCHAPTER F. JUDICIAL REVIEW--GENERAL PROVISIONS
Sec. 410.251. EXHAUSTION OF REMEDIES. A party that has
exhausted its administrative remedies under this subtitle and
that is aggrieved by a final decision of the appeals panel may
seek judicial review under this subchapter and Subchapter G, if
applicable.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.252. TIME FOR FILING PETITION; VENUE. (a) A party may
seek judicial review by filing suit not later than the 45th day
after the date on which the division mailed the party the
decision of the appeals panel. For purposes of this section, the
mailing date is considered to be the fifth day after the date the
decision of the appeals panel was filed with the division.
(b) The party bringing suit to appeal the decision must file a
petition with the appropriate court in:
(1) the county where the employee resided at the time of the
injury or death, if the employee is deceased; or
(2) in the case of an occupational disease, in the county where
the employee resided on the date disability began or any county
agreed to by the parties.
(c) If a suit under this section is filed in a county other than
the county described by Subsection (b), the court, on determining
that it does not have jurisdiction to render judgment on the
merits of the suit, shall transfer the case to a proper court in
a county described by Subsection (b). Notice of the transfer of a
suit shall be given to the parties. A suit transferred under this
subsection shall be considered for all purposes the same as if
originally filed in the court to which it is transferred.
(d) If a suit is initially filed within the 40-day period in
Subsection (a), and is transferred under Subsection (c), the suit
is considered to be timely filed in the court to which it is
transferred.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2003, 78th Leg., ch. 663, Sec. 1, eff. Sept. 1,
2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch.
1200, Sec. 1, eff. September 1, 2009.
Sec. 410.253. SERVICE; NOTICE. (a) A party seeking judicial
review shall simultaneously:
(1) file a copy of the party's petition with the court;
(2) serve any opposing party to the suit; and
(3) provide written notice of the suit or notice of appeal to
the division.
(b) A party may not seek judicial review under Section 410.251
unless the party has provided written notice of the suit to the
division as required by this section.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2003, 78th Leg., ch. 397, Sec. 2, eff. Sept. 1,
2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.199, eff. September 1, 2005.
Sec. 410.254. INTERVENTION. On timely motion initiated by the
commissioner, the division shall be permitted to intervene in any
judicial proceeding under this subchapter or Subchapter G.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.200, eff. September 1, 2005.
Sec. 410.255. JUDICIAL REVIEW OF ISSUES OTHER THAN
COMPENSABILITY OR INCOME OR DEATH BENEFITS. (a) For all issues
other than those covered under Section 410.301(a), judicial
review shall be conducted in the manner provided for judicial
review of a contested case under Subchapter G, Chapter 2001,
Government Code.
(b) Judicial review conducted under this section is governed by
the substantial evidence rule.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(53), eff.
Sept. 1, 1995.
Sec. 410.256. COURT APPROVAL OF SETTLEMENT. (a) A claim or
issue may not be settled contrary to the provisions of the
appeals panel decision issued on the claim or issue unless a
party to the proceeding has filed for judicial review under this
subchapter or Subchapter G. The trial court must approve a
settlement made by the parties after judicial review of an award
is sought and before the court enters judgment.
(b) The court may not approve a settlement except on a finding
that:
(1) the settlement accurately reflects the agreement between the
parties;
(2) the settlement adheres to all appropriate provisions of the
law; and
(3) under the law and facts, the settlement is in the best
interest of the claimant.
(c) A settlement may not provide for:
(1) payment of any benefits in a lump sum except as provided by
Section 408.128; or
(2) limitation or termination of the claimant's right to medical
benefits under Section 408.021.
(d) A settlement or agreement that resolves an issue of
impairment may not be made before the claimant reaches maximum
medical improvement and must adopt one of the impairment ratings
under Subchapter G, Chapter 408.
(e) A party proposing a settlement before judgment is entered by
the trial court may petition the court orally or in writing for
approval of the settlement.
(f) Settlement of a claim or issue under this section does not
constitute a modification or reversal of the decision awarding
benefits for the purpose of Section 410.209.
(g) Settlement of a claim or issue must be in compliance with
all appropriate provisions of the law, including this section and
Section 410.258 of this subchapter. A settlement which on its
face does not comply with this section is void.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1997, 75th Leg., ch. 1267, Sec. 1, eff. Sept. 1,
1997; Acts 2003, 78th Leg., ch. 397, Sec. 3, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.2001, eff. September 1, 2005.
Sec. 410.257. JUDGMENT AFTER JUDICIAL REVIEW. (a) A judgment
entered by a court on judicial review of the appeals panel
decision under this subchapter or Subchapter G must comply with
all appropriate provisions of the law.
(b) A judgment under this section may not provide for:
(1) payment of benefits in a lump sum except as provided by
Section 408.128; or
(2) the limitation or termination of the claimant's right to
medical benefits under Section 408.021.
(c) A judgment that resolves an issue of impairment may not be
entered before the date the claimant reaches maximum medical
improvement. The judgment must adopt an impairment rating under
Subchapter G, Chapter 408, except to the extent Section 410.307
applies.
(d) A judgment under this section may not order reimbursement
from the subsequent injury fund.
(e) A judgment under this section based on default or on an
agreement of the parties does not constitute a modification or
reversal of a decision awarding benefits for the purpose of
Section 410. 209.
(f) A judgment that on its face does not comply with this
section is void.
Added by Acts 1997, 75th Leg., ch. 1267, Sec. 2, eff. Sept. 1,
1997. Amended by Acts 2003, 78th Leg., ch. 397, Sec. 4, eff.
Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.2002, eff. September 1, 2005.
Sec. 410.258. NOTIFICATION OF DIVISION OF PROPOSED JUDGMENTS AND
SETTLEMENTS; RIGHT TO INTERVENE. (a) The party who initiated a
proceeding under this subchapter or Subchapter G must file any
proposed judgment or settlement made by the parties to the
proceeding, including a proposed default judgment, with the
division not later than the 30th day before the date on which the
court is scheduled to enter the judgment or approve the
settlement. The proposed judgment or settlement must be mailed
to the division by certified mail, return receipt requested.
(b) The division may intervene in a proceeding under Subsection
(a) not later than the 30th day after the date of receipt of the
proposed judgment or settlement.
(c) The commissioner shall review the proposed judgment or
settlement to determine compliance with all appropriate
provisions of the law. If the commissioner determines that the
proposal is not in compliance with the law, the division may
intervene as a matter of right in the proceeding not later than
the 30th day after the date of receipt of the proposed judgment
or settlement. The court may limit the extent of the division's
intervention to providing the information described by Subsection
(e).
(d) If the division does not intervene before the 31st day after
the date of receipt of the proposed judgment or settlement, the
court shall enter the judgment or approve the settlement if the
court determines that the proposed judgment or settlement is in
compliance with all appropriate provisions of the law.
(e) If the division intervenes in the proceeding, the
commissioner shall inform the court of each reason the
commissioner believes the proposed judgment or settlement is not
in compliance with the law. The court shall give full
consideration to the information provided by the commissioner
before entering a judgment or approving a settlement.
(f) A judgment entered or settlement approved without complying
with the requirements of this section is void.
Added by Acts 1997, 75th Leg., ch. 1267, Sec. 2, eff. Sept. 1,
1997.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.201, eff. September 1, 2005.
Acts 2005, 79th Leg., Ch.
265, Sec. 3.202, eff. September 1, 2005.
SUBCHAPTER G. JUDICIAL REVIEW OF ISSUES REGARDING COMPENSABILITY
OR INCOME OR DEATH BENEFITS
Sec. 410.301. JUDICIAL REVIEW OF ISSUES REGARDING COMPENSABILITY
OR INCOME OR DEATH BENEFITS. (a) Judicial review of a final
decision of the appeals panel regarding compensability or
eligibility for or the amount of income or death benefits shall
be conducted as provided by this subchapter.
(b) A determination of benefits before a court shall be in
accordance with this subtitle.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.203, eff. September 1, 2005.
Sec. 410.302. ADMISSIBILITY OF RECORDS; LIMITATION OF ISSUES.
(a) The records of a contested case hearing conducted under this
chapter are admissible in a trial under this subchapter in
accordance with the Texas Rules of Evidence.
(b) A trial under this subchapter is limited to issues decided
by the appeals panel and on which judicial review is sought. The
pleadings must specifically set forth the determinations of the
appeals panel by which the party is aggrieved.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.204, eff. September 1, 2005.
Sec. 410.303. BURDEN OF PROOF. The party appealing the decision
on an issue described in Section 410.301(a) has the burden of
proof by a preponderance of the evidence.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.304. CONSIDERATION OF APPEALS PANEL DECISION. (a) In
a jury trial, the court, before submitting the case to the jury,
shall inform the jury in the court's instructions, charge, or
questions to the jury of the appeals panel decision on each
disputed issue described by Section 410.301(a) that is submitted
to the jury.
(b) In a trial to the court without a jury, the court in
rendering its judgment on an issue described by Section
410.301(a) shall consider the decision of the appeals panel.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.205, eff. September 1, 2005.
Sec. 410.305. CONFLICT WITH RULES OF CIVIL PROCEDURE. (a) To
the extent that this subchapter conflicts with the Texas Rules of
Civil Procedure or any other rules adopted by the supreme court,
this subchapter controls.
(b) Notwithstanding Section 22.004, Government Code, or any
other law, the supreme court may not adopt rules in conflict with
or inconsistent with this subchapter.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 410.306. EVIDENCE. (a) Evidence shall be adduced as in
other civil trials.
(b) The division on payment of a reasonable fee shall make
available to the parties a certified copy of the division's
record. All facts and evidence the record contains are
admissible to the extent allowed under the Texas Rules of
Evidence.
(c) Except as provided by Section 410.307, evidence of extent of
impairment shall be limited to that presented to the division.
The court or jury, in its determination of the extent of
impairment