Appeals Panel Finds Carrier Waived its Right to Contest Compensability in Subsequent PLN Filing
The Appeals Panel has affirmed the decision of a Hearing Officer who concluded that that a carrier waived its right to contest compensability by withdrawing a timely-filed PLN-1. The decision is a rare published affirmance of a Hearing Officer’s ruling. Most published Appeals Panel decisions are reversals of Hearing Officer actions.
The case, in Appeals Panel Decision Number 160249, decided April 4, 2016, involved a claim where the Hearing Officer resolved the disputed issues by deciding that: (1) the carrier waived the right to contest compensability of the claimed injury by not timely contesting the injury in accordance with Section 409.021; (2) the claimant sustained a compensable injury through carrier waiver; and (3) the claimant had disability, resulting from the compensable injury. The carrier appealed the Hearing Officer’s determinations, contending the evidence did not establish that the claimant sustained a compensable injury through carrier waiver and that, accordingly, there was no evidence of any disability.
The opinion states that the carrier received notice of the claimed injury on May 15, 2015. The 60th day after May 15, 2015, is July 14, 2015. It was undisputed that the carrier filed a Plain Language Notice on July 8, 2015, in which the carrier noted that “[t]he claimant[’s] injury did not arise [out] of or in the course and scope of employment for the employer; therefore . . . the carrier denies that the claimant has a work related injury and denies compensability.” The Hearing Officer found in an unappealed finding of fact that the carrier denied compensability of the claimed injury in the July 8, 2015, PLN. On August 3, 2015, the carrier filed another Plain Language Notice stating that the “[c]arrier [is] no longer disputing . . . compensability as of [July 8, 2015].”
The Appeals Panel rejected the carrier’s appeal, in which it argued that it had not waived its right to contest the compensability of the claim.
The Hearing Officer, citing Appeals Panel Decision (APD) 982975, decided February 3, 1999, determined that the carrier waived the right to contest compensability of the claimed injury by not timely contesting the injury in accordance with Section 409.021. We agree. In APD 982975, the carrier first received written notice of injury on May 20, 1998, and on May 26, 1998, filed a Payment of Compensation or Notice of Refused or Disputed Claim Interim (TWCC-21) contesting compensability. The carrier then filed another TWCC-21 on August 25, 1998, which was after the 60-day period, accepting liability. The Appeals Panel stated that “[b]y accepting liability, the carrier effectively withdrew its prior dispute,” citing APD 970713, decided June 4, 1997. The Appeals Panel “[rejected] the carrier’s contention that its first TWCC-21 forever preserved a ‘timely’ dispute for the purposes of Section 409.021(c), especially in light of [the] carrier’s later acceptance of the claim.”
In the case on appeal the carrier contested compensability of the claimed injury in the July 8, 2015, [Plain Language Notice], which was within the 60-day period. However, just as in APD 982975, supra, the carrier then filed a [Plain Language Notice]accepting the claim. We hold in this case, as we did in APD 982975, that by accepting liability in the [Plain Language Notice] filed on August 3, 2015, the carrier effectively withdrew its prior July 8, 2015, dispute. As noted above, the 60-day period in this case was May 15 through July 14, 2015. There is no other PLN in evidence from the carrier denying compensability within the 60-day period. Accordingly, we affirm the Hearing Officer’s determination that the carrier waived the right to contest compensability of the claimed injury by not timely contesting the injury in accordance with Section 409.021.
Because the Appeals Panel affirmed the Hearing Officer’s carrier waiver determination, it also affirmed the Hearing Officer’s determination that the claimant sustained a compensable injury through carrier waiver.
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