APD 251478
After remand, the Appeals Panel held that the self-insured’s April 22, 2024, PLN-1 was sufficiently specific under §409.022 and Rule 124.2(f), and therefore the self-insured properly contested compensability. The Panel also found that the later October 18, 2024, PLN-1, raising the recreational-activity defense under §406.032(1)(D), was not based on newly discovered evidence, meaning the self-insured could not rely on that affirmative defense. Because the ALJ’s denial of compensability was based on that barred recreational-activity defense, the Appeals Panel reversed and rendered, holding that the claimant did sustain a compensable injury while participating in the employer’s anniversary event.
APD 251337
The Appeals Panel reversed the ALJ’s decision and held that the claimant was on a special mission when injured in a motor vehicle accident traveling to a mandatory orientation in a different city, making the injury compensable. The Panel struck findings that exceeded the scope of the issues but determined that the claimant did have disability from the date of injury through May 26, 2025.
APD 250174
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determination that the self-insured did not waive its right to contest compensability by failing to timely contest the injury. However, it reversed the ALJ’s finding that the self-insured specifically contested compensability under Section 409.022 and Rule 124.2(f), because the defense under Section 406.032(1)(D) was raised for the first time in a supplemental denial and not shown to be based on newly discovered evidence. The case was remanded for the ALJ to determine whether the newly raised defense qualifies as newly discovered evidence, and to reconsider whether the claimant sustained a compensable injury in light of that determination.
APD 241728
The Appeals Panel reversed the decision because the Administrative Law Judge incorrectly found that the Employee-Decedent’s parents were not proper beneficiaries because they failed to prove they were dependents. The Appeals Panel noted that there is no requirement for eligible parents to show dependent status.
APD 231750
The Appeals Panel reversed the Administrative Law Judge’s decision regarding the sufficiency of the carrier’s dispute. The Appeals Panel noted that “was riding a co-workers motorcycle recklessly” was sufficient for the horseplay defense.
APD 230665
The Appeals Panel reversed the Administrative Law Judge’s decision that the claimant’s injury did not arise out of voluntary participation. The Appeals Panel noted that the claimant’s participation in an agility test, the injury event, was not mandatory but for consideration for transfer or promotion to another position.
APD 230503
The Appeals Panel reversed the administrative law judge’s decision that the insurance carrier waived its right to contest compensability. The Appeals Panel noted that, although the claimant filed two different dates for the same injury, the carrier’s PLN-1 for the second date of injury contained sufficient claim-specific information to inform the claimant of the carrier’s denial of the first date of injury.
APD 230145
The Appeals Panel reversed the Administrative Law Judge’s decision regarding whether short-term disability payments were considered post-injury earnings. The Appeals Panel found that, because the short-term disability benefits were funded by the employer, they were post-injury earnings.
APD 211335
The Appeals Panel reversed the Administrative Law Judge’s decision regarding compensability. The Appeals Panel reasoned that, where the Administrative Law Judge found the insurance carrier waived its right to contest compensability and failed to appeal that determination, the injury must be deemed a compensable injury.
APD 210517
The Appeals Panel reversed the Administrative Law Judge’s decision that the insurance carrier was liable for payment of accrued benefits pursuant to rule 124.3. The Appeals Panel noted that rule 124.3 does not apply in a case where the insurance carrier does not file a dispute of compensability or liability.