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 February 24, 2025, with the record closing on March 5, 2025, 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 compensable injury of (date of injury), does not extend to concussion without loss of consciousness; (2) the appellant (claimant) reached maximum medical improvement (MMI) on April 9, 2024; and (3) the claimant’s impairment rating (IR) is zero percent. The claimant appealed, disputing the ALJ’s determinations. The claimant did not attend the CCH, but he did respond to a 10-day letter. The claimant contends on appeal that he did not receive the set notice informing him about the CCH before the hearing date because the address it was sent to was missing his apartment number. The respondent (carrier) responded, urging affirmance of the disputed issues.
DECISION
Reversed and remanded.
The evidence reflects the claimant was injured on (date of injury), when he hit his head on a large screw. The parties present stipulated, in part, that the claimant sustained a compensable injury on (date of injury), that extends to at least a head contusion.
Initially, a CCH was set for February 5, 2025, and the set notice for this CCH was sent to the claimant’s complete, correct address of (address). The CCH was then reset to February 24, 2025. The new set notice, which was included in the claimant’s appeal, reflects the address it was sent to was incomplete because it was missing the claimant’s apartment number. The claimant did not appear at the CCH, and a 10-day letter dated February 24, 2025, was sent to the claimant at his complete, correct address. The claimant responded to the 10-day letter on March 4, 2025, stating that the CCH set notice was delivered to him on February 26, 2025, which was after the CCH date. He further explained that he was not home on that date but was informed of its delivery by his roommate. On March 5, 2025, the ALJ issued an order stating that the hearing would not be rescheduled because the claimant did not have good cause for failing to appear at the February 24, 2025, CCH.
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. 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.
The review of rulings on good cause for the failure to attend a CCH is under the abuse of discretion standard. In determining whether there has been an abuse of discretion, the Appeals Panel looks to see whether the ALJ acted without reference to any guiding rules or principles. See Appeals Panel Decision (APD) 051705, decided September 1, 2005.
The evidence is unclear why the set notice for the February 24, 2025, CCH was not mailed to the claimant’s complete address when that address was used on the set notice for the February 5, 2025, hearing. Under the circumstances in this case, we find it was an abuse of discretion to hold that the claimant did not have good cause for missing the February 24, 2025, CCH because it was the Division that failed to send the set notice for the CCH on February 24, 2025, to the claimant’s complete, correct address. Therefore, we remand this case to the ALJ to permit the parties to present evidence on the merits of the claim at the CCH on remand.
Accordingly, we reverse the ALJ’s determinations that the compensable injury of (date of injury), does not extend to concussion without loss of consciousness; the claimant reached MMI on April 9, 2024; and the claimant’s IR is zero percent. We remand this case to the ALJ to allow for the presentation of evidence on the merits of the claim. The ALJ is then to make determinations on the disputed issues of extent of injury, MMI, and IR that are supported by the evidence.
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 the new decision must file a request for review not later than 15 days after the date on which the new decision is received from the Texas Department of Insurance, Division of Workers’ Compensation, 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 SENTRY CASUALTY COMPANY and the name and address of its registered agent for service of process is
CT CORPORATION SYSTEM
1999 BRYAN STREET, SUITE 900
DALLAS, TEXAS 75201.
Cristina Beceiro
Appeals Judge
CONCURRED:
Carisa Space-Beam
Appeals Judge
Margaret L. Turner
Appeals Judge