(a) Statement of disputes. The statement of disputes
is a written description of the benefit dispute or disputes to be
considered by the administrative law judge. A dispute not expressly
included in the statement of disputes will not be considered by the
administrative law judge.
(b) Statement of disputes after a benefit review conference.
The statement of disputes for a hearing held after a benefit review
conference includes:
(1) the benefit review officer's report, identifying
the disputes remaining unresolved at the close of the benefit review
conference;
(2) the parties' responses, if any;
(3) additional disputes by unanimous consent, as provided
by subsection (c) of this section; and
(4) additional disputes presented by a party, as provided
by subsections (d) and (e) of this section, if the administrative
law judge determines that the party has good cause.
(c) Party response to the benefit review officer's
report. A party may submit a response to the disputes identified as
unresolved in the benefit review officer's report. The response shall:
(1) be in writing;
(2) describe and explain the party's position on the
unresolved dispute or disputes;
(3) be sent to the division no later than 20 days after
receiving the benefit review officer's report; and
(4) be delivered to all other parties, as provided
by §142.4 of this title (relating to Delivery of Copies to All
Parties).
(d) Additional disputes by unanimous consent. Parties
may, by unanimous consent, submit for inclusion in the statement of
disputes one or more disputes not identified as unresolved in the
benefit review officer's report. Additional disputes submitted by
consent shall:
(1) be made in writing;
(2) identify the dispute and explain the party's position
on it;
(3) be signed by all parties;
(4) be sent to the division no later than 10 days before
the hearing; and
(5) explain why the issue was not raised earlier.
(e) Additional disputes by permission of the administrative
law judge. A party may request the administrative law judge to include
in the statement of disputes one or more disputes not identified as
unresolved in the benefit review officer's report. The administrative
law judge will allow such amendment only on a determination of good
cause.
(1) If the requester is a carrier, carrier representative,
claimant represented by an attorney, or claimant assisted by OIEC,
the request shall:
(A) be made in writing;
(B) identify and describe the dispute or disputes;
(C) state the reason for the request;
(D) be sent to the division no later than 15 days before
the hearing; and
(E) be delivered to all other parties, as provided
by §142.4 of this title (relating to Delivery of Copies to All
Parties).
(2) A claimant who is neither represented by an attorney
nor assisted by OIEC may request additional disputes to be included
in the statement of disputes by contacting the division in any manner
no later than 15 days before the hearing.
(3) The administrative law judge will rule on the request,
and notify the parties of the ruling.
(f) Statement of disputes without prior benefit review
conference. The statement of disputes for a hearing held without a
prior benefit review conference includes:
(1) the request for hearing, as described in §142.5(c)
of this title (relating to Sequence of Proceedings To Resolve Benefit
Disputes); and
(2) the other party's response, as described in §142.5(e)
of this title (relating to Sequence of Proceedings To Resolve Benefit
Disputes), if any.
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