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(1)The appeal must be filed no later than 20 days from the date the party received the IRO decision. (2)The party appealing the IRO decision shall deliver a copy of its written request for a hearing to all other parties involved in the dispute. (3)The commission shall file the request for hearing with SOAH. (4)The hearing shall be conducted by the State Office of Administrative Hearings within 90 days of receipt of a request for a hearing in the manner provided for a contested case under Chapter 2001, Government Code (the administrative procedure law). (5)The parties to the dispute must represent themselves before SOAH, and the IRO is not required to participate in the SOAH hearing. (6)A party who has exhausted the party's administrative remedies under this subtitle and who is aggrieved by a final decision of the State Office of Administrative Hearings may seek judicial review of the decision. Judicial review under this subsection shall be conducted in the manner provided for judicial review of contested cases under Subchapter G, Chapter 2001, Government Code. (7)The commission shall post the SOAH decision on the commission website after confidential information has been redacted. (u)Spinal Surgery Appeal. A party to a prospective necessity dispute regarding spinal surgery may appeal the IRO decision by requesting a Contested Case Hearing ("CCH"). (1)the written appeal must be filed with the commission Chief Clerk of Proceedings, Division of Hearings, within 10 days after receipt of the IRO decision and must be filed in compliance with §142.5(c) of this title (relating to Sequence of Proceedings to Resolve Benefit Disputes). (2)the CCH will be scheduled and held within 20 days of commission receipt of the request for a CCH. (3)the hearing and further appeals shall be conducted in accordance with Chapters 140, 142, and 143 of this title (relating to Dispute Resolution/General Provisions, Benefit Contested Case Hearing, and Review by the Appeals Panel). (4)the party appealing the IRO decision shall deliver a copy of its written request for a hearing to all other parties involved in the dispute; the IRO is not required to participate in the CCH or any appeal. (v)In all appeals from reviews of prospective or retrospective necessity disputes, the IRO decision has presumptive weight. (w)The commission is entitled to review, inspect, copy, and/or compel production of documents or other information as necessary to carry out the commission's duties and responsibilities under this rule, the Act, and other applicable statutes. (x)If the commission believes that any person is in violation of the Act or this rule, the commission may initiate appropriate compliance and enforcement action. If the commission believes that any person is in violation of the Insurance Code or TDI rules, the commission may initiate appropriate action in accordance with any Memorandum of Understanding between the Texas Department of Insurance and the commission. Nothing in this rule modifies or limits the authority of the department or the commission.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on December 13, 2001
TRD-200107878 Susan Cory
General Counsel
Texas Workers' Compensation Commission
Effective date: January 2, 2002
Proposal publication date: November 2, 2001
For further information, please call: (512) 804-4287
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