Title: 

APD 012295

Significant Decision

Date: 

November 15, 2001

Issues: 

Existence of Compensable Inj

Table of Contents

APD 012295

This appeal arises pursuant to the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing was held on September 6, 2001. With respect to the single issue before him, the hearing officer determined that the claimant sustained a compensable injury on __________. In its appeal, the appellant (self-insured) argues that the hearing officer’s injury determination is against the great weight of the evidence. The respondent (sub-claimant), the claimant’s treating doctor, did not respond to the self-insured’s appeal. The claimant did not appear at the hearing or respond to the self-insured’s appeal.

DECISION

Affirmed.

The hearing officer did not err in determining that the claimant sustained a compensable injury on __________. In this case the sub-claimant, the treating doctor, had the burden to prove that the claimant sustained a compensable injury. The sub-claimant did not offer any documentary evidence; however, he testified at the hearing. Inexplicably, the self-insured offered the Employee’s Notice of Injury or Occupational Disease and Claim for Compensation (TWCC-41), which is signed by the claimant and dated November 6, 2000. In that document, the claimant states that he was injured restraining a student when the student kicked him, causing him to fall. In the TWCC-41, the claimant lists the parts of the body injured as head, neck, back, knees, and wrist. The sub-claimant testified that he examined the claimant; that he talked to the claimant and took history at the claimant’s initial appointment; that the claimant told him that on __________, a student kicked him in the groin at school, causing him to fall forward; and that the claimant’s injuries were consistent with the mechanism of injury he described. The sub-claimant’s testimony and the TWCC-41 provide sufficient evidentiary support for the hearing officer’s determination that the claimant sustained a compensable injury on __________. Our review of the record does not demonstrate that the hearing officer’s injury determination is so against the great weight of the evidence as to be clearly wrong or manifestly unjust. Therefore, no sound basis exists for us to reverse that determination on appeal. Pool v. Ford Motor Co., 715 S.W.2d 629, 635 (Tex. 1986); Cain v. Bain, 709 S.W.2d 175, 176 (Tex. 1986).

We find no merit in the self-insured’s assertion that the hearing officer’s decision is “inadequate on its face” because it does not include a “specific finding concerning what injury was allegedly suffered by the Claimant while in the employ of the self-insured.” The only issue before the hearing officer was whether the claimant sustained a compensable injury; thus, that is the only issue he could properly resolve. As the hearing officer noted, there was no issue as to the nature and extent of the injury before the hearing officer and, as such, the hearing officer did not err in not resolving such an issue. If a dispute remains as to the nature of the injury, such issues can be resolved through the dispute resolution process. In addition, if questions exist as to whether specific treatment provided by the sub-claimant was reasonable and necessary treatment for the compensable injury, those disputes can be pursued through the Texas Workers’ Compensation Commission’s medical dispute resolution process.

The hearing officer’s decision and order are affirmed.

The true corporate name of the self-insured is (SELF-INSURED) and the name and address of its registered agent for service of process is

SUPERINTENDENT

(ADDRESS)

(CITY), TEXAS (ZIP CODE).

Elaine M. Chaney – Appeals Judge

CONCUR:

Thomas A. Knapp – Appeals Judge

Philip F. O’Neill – Appeals Judge