| (a) Prior Notification. Before requesting a benefit
review conference, a disputing party must notify the other parties
of the nature of the dispute and attempt to resolve the dispute.
(b) Who May Request. A request for a benefit review
conference may be made by an injured employee, a subclaimant, or an
insurance carrier. An employer may request a benefit review conference
to contest compensability when the insurance carrier has accepted
the claim as compensable.
(c) Subclaimant. A request for a benefit review conference
made by a subclaimant under Labor Code §409.009 must also comply
with the requirements of §140.6 of this title (relating to Subclaimant
Status: Establishment, Rights, and Procedures).
(d) Request for Benefit Review Conference. A request
for a benefit review conference must be made in the form and manner
required by the division. The request must:
(1) identify and describe the disputed issues;
(2) provide details and supporting documentation of
efforts made by the requesting party to resolve the disputed issues,
including, but not limited to, copies of the notification provided
in accordance with subsection (a) of this section, correspondence,
emails, faxes, records of telephone contacts, or summaries of meetings
or telephone conversations. For the purposes of this subsection, copies
of the notification provided under subsection (a) of this section,
correspondence, emails, faxes, records of telephone contacts, or summaries
of meetings or telephone conversations should not include all attachments
of pertinent information exchanged with the opposing parties as required
by §141.4 of this title (relating to Sending and Exchanging Pertinent
Information);
(3) contain the requesting party's signature to show
that the party made reasonable efforts to resolve the disputed issues
before requesting a benefit review conference, and provide any pertinent
information in their possession to the other parties as required by §141.4(c)
of this title; and
(4) send the request to the division and opposing parties.
(e) Complete Request. A request that meets the requirements
of subsection (d) of this section is a complete request for a benefit
review conference. The division will schedule a benefit review conference
if the request is complete and otherwise appropriate for a benefit
review conference.
(f) Incomplete Request. A request for a benefit review
conference that does not meet the requirements of subsection (d) of
this section is an incomplete request. The division will deny an incomplete
request.
(1) A denied request for a benefit review conference
does not constitute a dispute proceeding, except as provided by subsection
(g) of this section.
(2) If the division denies a request, it will provide
notice to the parties and state the reasons for the denial.
(3) On notice from the division, the requesting party
may submit a new request for a benefit review conference that meets
the requirements of this section.
(g) Incomplete Request Denials. If a party disagrees
with the division's determination that the request was incomplete,
or if a party has good cause for failing to meet the requirements
of subsection (d) of this section, the party may pursue an administrative
appeal of the division's determination under Chapter 142 of this title
(relating to Dispute Resolution--Benefit Contested Case Hearing).
The party may also request an expedited contested case hearing under §140.3
of this title (relating to Expedited Proceedings).
(h) Setting. If a request meets the standards of subsection
(e) of this section, the division will schedule a benefit review conference:
(1) within 40 days after the division received the
request; and
(2) within 20 days after the division received the
request, if the division determines that an expedited setting is needed.
(i) Notice. After setting the benefit review conference,
the division must provide, by first class mail, electronic transmission,
or personal delivery, written notice of the date, time, and location
to the parties and the employer.
(j) Method for Conducting. The benefit review conference
will be conducted by telephone or videoconference, unless the division
determines that good cause exists for conducting the benefit review
conference in person. Unless the division determines that good cause
exists for the selection of a different location, an in-person benefit
review conference will be conducted at a site no more than 75 miles
from the injured employee's residence at the time of injury.
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| Source Note: The provisions of this §141.1 adopted to be effective June 7, 1991, 16 TexReg 2876; amended to be effective October 1, 2010, 35 TexReg 7430; amended to be effective December 9, 2021, 46 TexReg 8258 |
