This appeal arises pursuant to the Texas Workers’ Compensation Act, Texas Labor Code Section 401.001 et seq. (1989 Act). A contested case hearing (CCH) was held on September 12, 2024, in (city), Texas, with (administrative law judge) presiding as the administrative law judge (ALJ). The ALJ resolved the disputed issues by deciding that: (1) the appellant/cross-respondent (claimant) is entitled to supplemental income benefits (SIBs) for the first quarter, June 18, 2024, through September 16, 2024; (2) the issue of whether the respondent/cross-appellant (carrier) waived its right to contest the claimant’s entitlement of SIBs for the first quarter is moot because the ALJ does not have jurisdiction to determine whether the Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (DWC-45) met the requirements of 28 Tex. Admin. Code Section 141.1(d) (Rule 141.1(d)); (3) the Texas Department of Insurance, Division of Workers’ Compensation (Division) does not have jurisdiction to determine whether the approved DWC-45 received on June 12, 2024, met the requirements of Rule 141.1(d) for the purpose of scheduling a benefit review conference (BRC); and (4) because the ALJ does not have jurisdiction to determine whether the DWC-45 met the requirements of Rule 141.1(d), the issue of whether the Division abused its discretion in approving the DWC-45 received on June 12, 2024, is moot.
The claimant appealed, disputing the ALJ’s determinations that were adverse to him. The carrier responded, urging affirmance of the appealed determinations, and cross-appealed the ALJ’s determination that the claimant is entitled to the first quarter of SIBs. The appeal file does not contain a response from the claimant to the carrier’s cross-appeal.
DECISION
Affirmed in part, affirmed as clarified in part, and reversed and rendered in part.
SIBS
The ALJ’s determination that the claimant is entitled to SIBs for the first quarter, June 18, 2024, through September 16, 2024, is supported by sufficient evidence and is affirmed.
JURISDICTION
The Division received a DWC-45 on June 12, 2024, and scheduled a BRC. The claimant argued the ALJ had jurisdiction to review the Division’s previous determination to approve the DWC-45. We disagree.
Rule 141.1 provides, in pertinent part:
(e) Complete Request. A request that meets the requirements of subsection (d) of this section is a complete request for a BRC. The Division will schedule a BRC if the request is complete and otherwise appropriate for a BRC.
(f) Incomplete Request. A request for a BRC 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 BRC 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 BRC 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 CCH). The party may also request an expedited CCH under §140.3 of this title (relating to Expedited Proceedings).
(Emphasis added.)
Rule 141.1 does not give parties an avenue to dispute or appeal the Division’s approval of a DWC-45. Rule 141.1(g) limits appeals to situations where the Division has denied a DWC-45. In this case, the claimant asked the ALJ to preside over an administrative appeal of a Division determination that approved a request for a BRC.
The Division had jurisdiction to determine whether the DWC-45 received on June 12, 2024, met the requirements of Rule 141.1(d) for the purpose of scheduling a BRC. The Division acted on the request and issued an order setting a BRC. However, there is no provision allowing an ALJ to review a previously approved DWC-45. Therefore, we decline to interpret Rule 141.1 to allow a party to request further review of a DWC-45 approved by the Division, and we decline to follow any prior cases, including Appeals Panel Decision 220504, decided May 20, 2022, that may have read such an interpretation.
We note the ALJ stated in Conclusion of Law No. 5 and her decision, “[t]he Division does not have jurisdiction to determine whether the [DWC-45] received on June 12, 2024, met the requirements of Rule 141.1(d) for the purpose of scheduling a [BRC].” However, it is clear from the ALJ’s discussion that she decided the Division has jurisdiction to determine whether the DWC-45 received on June 12, 2024, met the requirements of Rule 141.1(d) for the purpose of scheduling a BRC. The ALJ correctly explained in her decision that an ALJ only has authority to overturn a commissioner’s order if the commissioner has authorized the action through rulemaking or delegation. Therefore, while the Division has jurisdiction to determine whether a DWC-45 meets the requirements of Rule 141.1(d) for purposes of scheduling a BRC, an ALJ does not have the authority to determine whether an approved DWC-45 meets the requirements of Rule 141.1(d).
We further note that the ALJ referenced in her decision that she did not have jurisdiction to determine whether the DWC-45 received on June 12, 2024, met the requirements of Rule 141.1(d); however, it is more proper to characterize that the ALJ did not have any authority granted by the commissioner to make that determination. Therefore, we affirm the ALJ’s final determinations on abuse of discretion and waiver, with the clarification in terminology.
We reverse the ALJ’s determination that the Division does not have jurisdiction to determine whether the DWC-45 received on June 12, 2024, met the requirements of Rule 141.1(d) for the purpose of scheduling a BRC. We render a new decision that the Division does have jurisdiction to determine whether the DWC-45 received on June 12, 2024, met the requirements of Rule 141.1(d) for the purpose of scheduling a BRC.
The true corporate name of the insurance carrier is TEXAS MUTUAL INSURANCE COMPANY, and the name and address of its registered agent for service of process is
JEANETTE WARD, PRESIDENT & CEO
2200 ALDRICH STREET
AUSTIN, TEXAS 78723.
Amanda Barlow – Appeals Judge
CONCUR:
Cristina Beceiro – Appeals Judge
Carisa Space-Beam – Appeals Judge