Texas Workers' Compensation

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§ 53.35. Notice of Suspension of Compensation

(a) In every instance in which an insurance carrier has paid compensation to a claimant, the carrier shall report to the board and to the claimant or his attorney on Form A-2 (notice of suspension of compensation payments) within 10 calendar days from the date of last payment. The reasons for suspension of payment shall be stated fully on the notice. When Form A-2 is filed stating compensation suspended because case settled with third party, the carrier shall accompany the notice with a copy of the judgment(s) or settlement papers.

(b) If a carrier suspends or stops the payments of indemnity compensation or medical benefits, and notifies the board in writing thereof pursuant to Texas Civil Statutes, Article 8306, § 18a(b), and Article 8307, § 11, such notice shall state fully the reason(s) for suspending or stopping such payments. This statement must contain sufficient substantive information to enable the board to evaluate the carrier’s position on the claim. It is insufficient to simply state the carrier’s position with such phrases as abandoned medical treatment, disability in dispute, etc. When a carrier files an insufficient statement of reasons for suspension of payment of benefits, the board will issue a complaint report to the carrier through its designated Austin Industrial Accident Board representative. The carrier will have 30 days from the date of receipt of the complaint report to respond in writing to the charge. The board will evaluate the carrier’s response. If a majority of the board members determine that a violation has occurred, the violation may be used to establish a record of general business practice, in accordance with Texas Civil Statutes, Article 8306, § 18a(d). A failure to respond to the complaint report within 30 days will constitute an automatic violation.

The provisions of this § 53.35 adopted to be effective November 11, 1983, 8 TexReg 4495; amended to be effective July 20, 1983, 9 TexReg 3733; amended to be effective October 1, 1985, 10 TexReg 3507.

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At a Glance:

Title:

§ 53.35. Notice of Suspension of Compensation

Title:

Title 28. Insurance

Status:

Current

Usage:

Old Law Rule

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