Carrier Correctly Disputed Division’s Denial of its SIBs BRC Request
On June 9, 2015 the Division of Workers’ Compensation appeals panel issued a new decision that construes the waiver provisions associated with disputing a Division determination regarding SIBs entitlement. The decision has been designated as a “significant decision.”
In Texas Division of Workers’ Compensation Appeals Panel Decision No. 150499-s, the hearing officer determined that the carrier had waived its right to contest the claimant’s entitlement to 11th quarter SIBs on the basis that the carrier’s DWC-45 had been denied and because a complete DWC-45 had not been filed within 10 days after receiving the claimant’s 11th quarter SIBs application. The carrier argued that it had appealed the Division’s denial of its DWC-45 in a manner that was authorized by Rule 141.1(g). That rule provides two methods under which a party may pursue a disagreement with the Division’s denial: a party may request an expedited CCH in accordance with Rule 140.3, or a party may pursue an administrative appeal of the Division’s denial in accordance with Chapter 142 relating to Dispute Resolution.
The appeals panel wrote that the hearing officer had correctly observed that the carrier did not request an expedited CCH in accordance with Rule 140.3 regarding the Division’s denial of the carrier’s DWC-45. It wrote, however, that that finding alone did not necessarily establish that the carrier failed to avail itself of its ability to challenge the Division’s denial under Rule 141.1(g). The appeals panel concluded that the carrier had pursued an administrative appeal of the Division’s denial of the carrier’s DWC-45 under Chapter 142 relating to Dispute Resolution. Therefore, the panel held that the carrier had appropriately appealed the Division’s denial of its DWC-45 under Rule 141.1(g).
The appeals panel explicitly held that the hearing officer erred in failing to determine whether or not the carrier filed a complete DWC-45 in compliance with Rule 141.1(d). accordingly, the panel reversed the hearing officer’s determination that the claimant was entitled to 11th quarter SIBs because of waiver and remanded the issues of whether the carrier waived the right to contest the claimant’s entitlement to 11th quarter SIBs and whether the claimant is entitled to 11th quarter SIBs for further action consistent with its decision.
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