Texas Workers' Compensation

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§ 144.5. Statement of Disputes

(a) Statement of disputes. The statement of disputes is a written description of the dispute(s) to be considered by the arbitrator. A dispute not expressly included in the statement of disputes will not be considered by the arbitrator.

(b) Statement of disputes after a benefit review conference. The statement of disputes for an arbitration proceeding conducted 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 to the benefit review officer’s report, if any; and

(3) additional disputes by unanimous consent, as provided by subsections (c) and (d) of this section.

(c) Additional disputes by unanimous consent. Parties may, by unanimous consent, submit for inclusion in the statement of disputes one or more disputes not identified as unresolved in the benefit review officer’s report. Additional disputes submitted by consent shall:

(1) be made in writing;

(2) identify the dispute and explain each party’s position on it;

(3) be signed by all parties;

(4) be sent to the division’s chief clerk of proceedings no later than 10 days before the arbitration proceeding; and

(5) explain why the issue was not raised earlier.

(d) The statement of dispute in the arbitration of a medical fee dispute may not include a dispute regarding compensability, extent of injury, liability, or medical necessity for the same service for which there is a medical fee dispute. Chapter 133, Subchapter D of this title (relating to Dispute of Medical Bills) requires parties to resolve such disputes prior to requesting medical fee dispute resolution by the division. If a party provides the arbitrator with documentation listed in § 133.307(d)(2)(H) or (I) of this title (relating to MDR of Fee Disputes) that shows unresolved issues regarding compensability, extent of injury, liability, or medical necessity for the same service subject to the fee dispute, then the arbitrator shall abate the arbitration proceedings until those issues have been resolved.

The provisions of this §144.5 adopted to be effective December 31, 1991, 16 TexReg 7358; amended to be effective May 31, 2012, 37 TexReg 3856.

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At a Glance:

Title:

§ 144.5. Statement of Disputes

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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