AP Clarifies the Rule on Payment of Accrued Benefits due to Failure to Timely Dispute Compensability within 15 days of Notice of Injury
In APD 230302, decided April 20, 2023, the ALJ below concluded that: (1) Claimant had disability from August 14, 2021, through April 4, 2022, resulting from the compensable injury; (2) the claimant’s average weekly wage (AWW) is $908.46; and (3) Carrier is liable for the payment of accrued benefits through December 27, 2021, pursuant to DWC Rule 124.3 resulting from its failure to dispute or initiate payment of benefits within 15 days of the date it received written notice of the injury.
The ALJ noted in his discussion that Carrier received written notice of the claimed injury on August 17, 2021, and that Carrier filed a Notice of Disputed Issue(s) and Refusal to Pay Benefits (PLN-11) with the Division on December 27, 2021. The ALJ found the carrier’s PLN-11 disputing disability on December 27, 2021, was not timely under Rule 124.3, and therefore determined the Carrier is liable for payment of accrued benefits through December 27, 2021, pursuant to Rule 124.3 resulting from its failure to dispute or initiate the payment of benefits within 15 days of the date it received written notice of the injury.
Carrier contended on appeal that it has never disputed the compensability of the Claimant’s injury, and had in fact accepted compensability of that injury. In evidence was the PLN-11 dated December 21, 2021, in which Carrier stated it did not agree the “[claimant’s] work-related injury…stops [him] from getting or keeping a job that pays what [he] earned before [his] injury (existence, duration, or extent of disability).” Carrier did not state in the PLN-11 that it was disputing compensability or liability of the injury, and the evidence does not contain a PLN-1 from Carrier denying compensability or liability of the injury.
The AP cited APD 072002-s, decided December 20, 2007, in which the AP noted that the “preamble to Rule 124.3 states a dispute of benefit entitlement, i.e.[,] disability and entitlement to [temporary income benefits], is not a dispute of compensability/liability. . . .” Carrier’s PLN-11 filed on December 27, 2021, was a dispute of benefit entitlement, not a dispute of compensability or liability of the injury. The evidence did not establish that Carrier had filed a dispute of compensability or liability of that injury, and as noted above, the parties stipulated at the CCH that the claimant sustained a compensable injury.
The Appeals Panel reversed the ALJ’s determination that Carrier is liable for payment of accrued benefits pursuant to Rule 124.3, resulting from its failure to dispute or initiate the payment of benefits within 15 days of the date it received written notice of the injury. It did hold that Carrier was otherwise liable for benefits as the ALJ’s determination on the disability issue was upheld.
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