Texas Workers' Compensation

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§ 141.1. Requesting and Setting a Benefit Review Conference

(a) Prior Notification. Prior to requesting a benefit review conference, a disputing party must notify the other party or 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 shall be made in the form and manner required by the division. The request shall:

(1) identify and describe the disputed issue or 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, e-mails, facsimiles, records of telephone contacts, or summaries of meetings or telephone conversations. For the purposes of this subsection, copies of the notification provided in accordance with subsection (a) of this section, correspondence, e-mails, facsimiles, records of telephone contacts, or summaries of meetings or telephone conversations should not include all attachments of pertinent information exchanged with the opposing party or parties as required by § 141.4 of this title (relating to Sending and Exchanging Pertinent Information);

(3) contain a signature by the requesting party attesting that reasonable efforts have been made to resolve the disputed issue(s) prior to requesting a benefit review conference, and that any pertinent information in their possession has been provided to the other parties as required by § 141.4(c) of this title; and

(4) be sent to the division and opposing party or parties.

(e) Complete Request. A request that meets the requirements of subsection (d) of this section is a complete request for a benefit review conference. The division will schedule a benefit review conference if the request is complete and otherwise appropriate for a benefit review conference.

(f) Incomplete Request. A request for a benefit review conference that does not meet the requirements of subsection (d) of this section is an incomplete request and will be denied.

(1) A denied request for a benefit review conference does not constitute a dispute proceeding, except as provided by subsection (g) of this section.

(2) The division will notify the parties if a request is denied and state the reasons for the denial.

(3) Upon notice from the division, the requesting party may submit a new request for a benefit review conference that meets the requirements of this section.

(g) Incomplete Request Denials. If a party disagrees with the division’s determination that the request was incomplete, or, if a party has good cause for failing to meet the requirements of subsection (d) of this section, the party may pursue an administrative appeal of the division’s determination in accordance with Chapter 142 of this title (relating to Dispute Resolution–Benefit Contested Case Hearing). The party may also request an expedited contested case hearing in accordance with § 140.3 of this title (relating to Expedited Proceedings).

(h) Setting. If a request meets the standards of subsection (e) of this section, the division will schedule a benefit review conference within 40 days after the request was received by the division and within 20 days after the request was received by the division, if the division determines that an expedited setting is needed.

(i) Notice. After setting the benefit review conference, the division shall provide, by first class mail, electronic transmission, or personal delivery, written notice of the date, time, and location to the parties and to the employer.

(j) Site. The benefit review conference will be conducted at a site no more than 75 miles from the injured employee’s residence at the time of injury, unless the division determines that good cause exists for selecting another site.

(k) Effective date. The effective date of this section is October 1, 2010.

The provisions of this §141.1 adopted to be effective June 7, 1991, 16 TexReg 2876; amended to be effective October 1, 2010, 35 TexReg 7430.

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At a Glance:

Title:

§ 141.1. Requesting and Setting a Benefit Review Conference

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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