Appeals Panel Reverses ALJ in Late Filing Case

The Appeals Panel has reversed an ALJ’s Decision and Order and rendered a Decision in favor of the carrier in a claim involving the 1-year filing obligation. The Decision, Texas Division of Workers’ Compensation Appeals Panel Decision No. 190183, was filed March 21, 2019. The Decision found that the ALJ erred by finding that the injured worker sustained a “compensable injury” when he failed to file a claim for compensation within the one-year filing deadline.

The claimant testified that he
was injured when he either missed a step or slipped as he was getting out of
his truck and fell to the ground. The ALJ found that the claimant suffered harm
to the physical structure of his body in the course and scope of his
employment. This finding was not appealed. The ALJ also determined that the
carrier was relieved from liability under Section 409.004 because of the
claimant’s failure to timely file a claim for compensation with the Division
within one year of the injury as required by Section 409.003. The ALJ’s
late-filing determination was not appealed by the claimant and became final
pursuant to Section 410.169.

The carrier appealed the ALJ’s
conclusion that the claimant had sustained a compensable injury because that
conclusion was inconsistent with the ALJ’s determination that the carrier was
relieved from liability because of the late filing defense. The appeals panel
agreed with the carrier.

We hold that the ALJ erred in concluding the claimant sustained a compensable injury on (date of injury), because the carrier is relieved of liability under Section 409.004 based on the claimant’s failure to timely file a claim for compensation with the Division within one year of the injury as required by Section 409.003. Section 401.011(10) defines “compensable injury” as “an injury that arises out of and in the course and scope of employment for which compensation is payable under this subtitle.” See Appeals Panel Decision (APD) 060779, decided June 19, 2006; APD 070532, decided May 22, 2007.

The Appeals Panel reversed the ALJ’s determination that the claimant sustained a compensable injury and rendered a new decision that the claimant did not sustain a compensable injury because the carrier was relieved from liability under Section 409.004 due to the claimant’s failure to timely file a claim for compensation with the Division within one year of the injury as required by Section 409.003.