This appeal arises pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 401.001 et seq. (1989 Act). A contested case hearing (CCH) was held on April 10, 2025, with the record closing on May 1, 2025, in (city), Texas, with (administrative law judge) presiding as the administrative law judge (ALJ). The ALJ resolved the disputed issues by deciding that the appellant (claimant) reached maximum medical improvement (MMI) on August 8, 2024, with a four percent impairment rating (IR). The claimant did not attend the CCH held on April 10, 2025, nor did she respond to a 10-day letter dated that same date. The claimant appealed, disputing the ALJ’s determinations and requested the case be remanded to the ALJ to allow the claimant an opportunity to present evidence on the disputed issues. The respondent (self-insured) responded, urging affirmance of the ALJ’s determinations and contended that the claimant did not have good cause for failing to appear at the April 10, 2025, CCH.
DECISION
Reversed and remanded.
The claimant states in her appeal that she has been living in a rehabilitation facility since December 2024, due to spine surgery, and she did not receive the 10-day letter within the timeframe to respond.
In Appeals Panel Decision (APD) 042634, decided November 29, 2004, the Appeals Panel noted that the purpose of the 10-day letter process is to give the non-appearing party the opportunity to meaningfully participate in the dispute resolution process. In APD 020273, decided March 29, 2002, the claimant made a number of factual allegations in her appeal regarding good cause for failing to attend the CCH and her attempts to respond to the 10-day letter, and the Appeals Panel stated that it was not in a position to evaluate the credibility of the claimant in regard to those matters and thus, remanded the case to the ALJ to take evidence concerning the claimant’s allegations and to permit the claimant to present evidence on the merits of her claim at the CCH on remand. See also APD 220552, decided May 31, 2022.
28 Tex. Admin. Code § 142.11 (Rule 142.11) regarding the failure to attend a CCH was amended to be effective January 7, 2019. Rule 142.11(c) provides, in part, that if the ALJ determines that good cause exists for the failure to attend, the hearing will be rescheduled.
In this case the claimant makes factual allegations that, if true, could constitute a basis for good cause for the claimant’s failure to respond to the 10-day letter and explain why she did not appear at the April 10, 2025, CCH. See APD 020273, supra. The case is remanded to the ALJ to consider whether the claimant had good cause for failing to attend the CCH. If good cause is found, the ALJ is to permit the parties to present evidence on the merits of the claim at the CCH on remand.
Pending resolution of the remand, a final decision has not been made in this case. However, since reversal and remand necessitate the issuance of a new decision and order by the ALJ, a party who wishes to appeal from such new decision must file a request for review not later than 15 days after the date on which such new decision is received from the Division, pursuant to Section 410.202 which was amended June 17, 2001, to exclude Saturdays and Sundays and holidays listed in Section 662.003 of the Texas Government Code in the computation of the 15-day appeal and response periods. See APD 060721, decided June 12, 2006.
The true corporate name of the insurance carrier is (a self-insured governmental entity) and the name and address of its registered agent for service of process is
(NAME)
(SELF INSURED)
(ADDRESS)
(CITY), TEXAS (ZIP CODE).
Carisa Space-Beam
Appeals Judge
CONCUR:
Cristina Beceiro
Appeals Judge
Margaret L. Turner
Appeals Judge