Texas Workers' Compensation

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§ 148.3. Requesting a Hearing

(a) Hearings Requested by the Division. The division may request a hearing before SOAH as permitted by the APA, the Act, and division rules.

(b) Requests for Hearing by Other Parties. Other Parties may file requests for hearings before SOAH as permitted by the APA, the Act, and division rules. The request for hearing must be in writing. The request for hearing must be filed with the Chief Clerk of Proceedings.

(c) Date Deemed Filed or Received. When a request for a hearing is addressed to the Chief Clerk of Proceedings but is sent to an office other than the Chief Clerk of Proceedings, the date filed or received shall be the date the request is received by the division. The request for hearing will be forwarded to the division’s Chief Clerk of Proceedings, but this may result in delay of processing the request. When a request for a hearing is not addressed to the Chief Clerk of Proceedings, it will not be considered filed or received by the division unless it is actually received by the Chief Clerk of Proceedings. Otherwise, a request for a hearing is deemed filed as of the date of the division date stamp placed on the document or other evidence of receipt.

(d) Deadlines for Filing. A request for hearing before SOAH must be filed with the Chief Clerk of Proceedings within the following time periods:

(1) medical fee dispute under Labor Code § 413.031 and § 413.0312: 20 days after the conclusion of the benefit review conference under Chapter 141 of this title (concerning Dispute Resolution–Benefit Review Conference);

(2) administrative violation: 20 days after receipt of a notice of possible administrative violation under Labor Code § 415.032 and § 180.8 of this title (concerning Notices of Violation; Notices of Hearing; Default Judgments);

(3) interlocutory order: 20 days after receipt of an interlocutory order for payment under Labor Code § 413.055;

(4) emergency cease and desist order: not later than the 30th day after the date the affected person receives the order;

(5) division audit or review: 20 days after receipt of a division refund order issued pursuant to a division audit or review; or

(6) requests for hearing not specified in this subsection: the time for filing a request for hearing before SOAH is 20 days after receipt of a notice of the action that the party is requesting a hearing on, unless specified in other law.

(e) Requests for Hearing Under Labor Code § 413.031 and § 413.0312. If the request for hearing is based on Labor Code § 413.031 and § 413.0312, the request must be in the form and manner specified by the division and must:

(1) contain a statement indicating that it is a request for hearing;

(2) include a copy of the findings and decision on which a hearing is being requested;

(3) include verification of the date of the conclusion of the Benefit Review Conference;

(4) be signed by a requestor or respondent as defined by § 133.305 of this title (concerning MDR–General), or its representative; and

(5) include a certificate of service demonstrating that the request has been sent to the other party in accordance with the requirements of § 133.307 of this title (concerning MDR of Fee Disputes), in substance as follows: “I hereby certify that I have on this ___ day of ___________, 20 __, served a copy of the attached instrument on (state the name of the other parties on whom a copy was served) by (state the manner of service.)”

(f) Notice of Violation.

(1) If a person receives a notice of violation, the person charged must file an answer not later than the 20th day after the date of receipt of the notice. The answer must either:

(A) remit the amount of the sanction to the division or otherwise consent to the imposed sanction; or

(B) request a hearing.

(2) If the person charged does not file an answer to the notice of violation, the division shall schedule a hearing at SOAH, pursuant to § 180.8(c) of this title (concerning Notices of Violation; Notices of Hearing; Default Judgments).

(g) Dismissal of Late Filings. The division, or the ALJ pursuant to paragraph (3) of this subsection, shall dismiss a request for hearing filed later than the deadline date. This subsection does not apply to requests for hearing submitted in response to a Notice of Violation pursuant to § 180.8 of this title.

(1) The division shall send a letter to the requestor informing the requestor that the untimely request will be dismissed unless the requestor provides information about timely filing or good cause for untimely filing within 10 working days of the date of the letter.

(2) If the requestor responds with information about timely filing or good cause, the Chief Clerk of Proceedings will send the request for hearing and the additional filing or good cause information to SOAH.

(3) The SOAH ALJ will dismiss a request for hearing that the ALJ determines to be filed later than the deadline date without good cause.

(h) Division Delivery of Request for Hearing to SOAH. The Chief Clerk of Proceedings shall send the request for a hearing to SOAH within 20 working days of receipt, unless:

(1) the decision has been withdrawn under the provisions contained in § 148.8 of this title (concerning Withdrawal of Hearing Request);

(2) the request for hearing has been dismissed under subsection (g) of this section;

(3) the division has notified the parties of a proposed clerical correction to the order or decision; or

(4) a party has requested a correction of clerical error with the division.

The provisions of this §148.3 adopted to be effective July 27, 2014, 39 TexReg 5608.

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At a Glance:

Title:

§ 148.3. Requesting a Hearing

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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