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(C)A party must file the request for a benefit review
conference in accordance with Chapter 141 of this title and must include
in the request a copy of the MFDR decision. Providing a copy of the
MFDR decision satisfies the documentation requirements in §141.1(d)
of this title. A first responder's request for a benefit review conference
must be accelerated by the division and given priority in accordance
with Labor Code §504.055. The first responder must provide notice
to the division that the contested case involves a first responder.
(2)If the medical fee dispute remains unresolved after
a benefit review conference, the parties may request arbitration as
provided in Labor Code, Chapter 410, Subchapter C and Chapter 144
of this title (relating to Dispute Resolution). If arbitration is
not elected, the party may appeal the MFDR decision by requesting
a contested case hearing before the State Office of Administrative
Hearings. A first responder's request for arbitration by the division
or a contested case hearing before the State Office of Administrative
Hearings must be accelerated by the division and given priority in
accordance with Labor Code §504.055. The first responder must
provide notice to the division that the contested case involves a
first responder.
(A)To request a contested case hearing before State
Office of Administrative Hearings, a party shall file a written request
for a State Office of Administrative Hearings hearing with the Division's
Chief Clerk of Proceedings not later than 20 days after conclusion
of the benefit review conference in accordance with §148.3 of
this title (relating to Requesting a Hearing).
(B)The party seeking review of the MFDR decision shall
deliver a copy of its written request for a hearing to all other parties
involved in the dispute at the same time the request for hearing is
filed with the division.
(3)A party to a medical fee dispute who has exhausted
all administrative remedies may seek judicial review of the decision
of the Administrative Law Judge at the State Office of Administrative
Hearings. The division and the department are not considered to be
parties to the medical dispute pursuant to Labor Code §413.031(k-2)
and §413.0312(f). Judicial review under this paragraph shall
be conducted in the manner provided for judicial review of contested
cases under Chapter 2001, Subchapter G Government Code, except that
in the case of a medical fee dispute the party seeking judicial review
must file suit not later than the 45th day after the date on which
the State Office of Administrative Hearings mailed the party the notification
of the decision. The mailing date is considered to be the fifth day
after the date the decision was issued by the State Office of Administrative
Hearings. A party seeking judicial review of the decision of the administrative
law judge shall at the time the petition for judicial review is filed
with the district court file a copy of the petition with the division's
chief clerk of proceedings.
(h)Billing of the non-prevailing party. Except as
otherwise provided by Labor Code §413.0312, the non-prevailing
party shall reimburse the division for the costs for services provided
by the State Office of Administrative Hearings and any interest required
by law.
(1)The non-prevailing party shall remit payment to
the division not later than the 30th day after the date of receiving
a bill or statement from the division.
(2)In the event of a dismissal, the party requesting
the hearing, other than the injured employee, shall reimburse the
division for the costs for services provided by the State Office of
Administrative Hearings unless otherwise agreed by the parties.
(3)If the injured employee is the non-prevailing party,
the insurance carrier shall reimburse the division for the costs for
services provided by the State Office of Administrative Hearings.
The agency certifies that legal counsel has
reviewed the adoption and found it to be a valid exercise of the agency's
legal authority.
Filed with the Office
of the Secretary of State on January 15, 2021
TRD-202100232 Kara Mace
Deputy Commissioner of Legal Services
Texas Department of Insurance, Division of Workers’ Compensation
Effective date: February 22, 2021
Proposal publication date: October 9, 2020
For further information, please call: (512) 804-4703
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