Reporting Injury to Employer (C17)
An IE, or a person acting on the IE’s behalf, must report a work-related injury to the employer within 30 days after the date of injury. TLC Section 409.001 and 28 Texas Administrative Code (TAC) Section 122.1. [Cross references: Date of Injury (C05); Compensability/Injury (C06)]. The purpose of the injury report is to allow the […]
Alcohol Intoxication (C08)
There are two definitions of alcohol intoxication under the Texas Workers’ Compensation Act. Under the first definition, intoxication is defined as having an alcohol concentration to qualify as intoxicated under Penal Code Section 49.01. TLC Section 401.013(a)(1). Sanchez v. State Office of Risk Mgmt., 234 S.W.3d 96, 102 (Tex.App.—El Paso 2007, no pet.) Under the […]
Identity of Legal Beneficiaries (D01)
Death benefits are payable to a legal beneficiary if an employee dies as the result of a compensable injury. TLC Section 408.181(a); APD 000436. A legal beneficiary is a person who is entitled to receive a death benefit under the Act. TLC Section 401.011(29). In deciding whether a person is a proper legal beneficiary for […]
Existence/Duration of Disability Raised by Other Evidence (I03)
Disability is defined as an IE’s inability, because of a compensable injury, to obtain and retain employment at wages equivalent to the IE’s pre-injury wage. TLC Section 401.011(16). Before disability can be established, the IE must first prove they sustained a compensable injury. APD 023210. The ALJ must consider all of the conditions which comprise […]
Other Procedural Issues (P00)
Appearance at CCH/10-Day Letter When a party fails to appear for a CCH, the ALJ will send a letter, known as a 10-day letter, notifying the nonappearing party that they have 10 days from the receipt of the notice to respond in writing to DWC and show good cause for the party’s failure to attend. […]
Reduction/Suspension (IIBs or SIBs) for Contribution from Prior Compensable Injury (I15)
At the request of the IC, the DWC commissioner may order a reduction in IIBs and SIBs in a proportion equal to the proportion of a documented impairment that resulted from prior compensable injuries. TLC Section 408.084(a). In determining whether to allow a reduction, and the amount of the reduction, the commissioner shall consider the […]
Admissibility of Evidence (P01)
The Texas Rules of Evidence do not strictly apply in administrative workers’ compensation proceedings. TLC Section 410.165(a). Given this, whether or not evidence will be admitted or excluded during a CCH is determined under DWC rules, and is generally within the ALJ’s discretion. 18 TAC Section 142.2(8); APD 042176. DWC rules require parties seeking to […]
Drug Intoxication (C09)
[Cross reference. Course and scope (C00)]. Intoxication is defined as not having the normal use of mental or physical faculties resulting from the voluntary introduction into the body of a controlled substance or controlled substance analogue, as defined by Health and Safety Code Section 481.002; a dangerous drug as defined by Health and Safety Code […]
Reduction/Suspension to Recoup Overpayment (I16)
[Cross-references:Reduction/Suspension (IIBs or SIBs) for Contribution from Prior Compensable Injury (I15);Wage Issues (W00-W06)]. Statutory and Rule Provisions Texas Labor Code (TLC) Section 408.0815, enacted as part of House Bill 2089, 82nd Texas Legislature Regular Session (2011), required the commissioner of workers’ compensation to establish by rule a procedure through which an IC could recoup underpayments […]
Compensability/Mental Trauma (C15)
An accidental mental trauma injury may be compensable when there is evidence of an undesigned, untoward event traceable to a definite time, place, and cause. Transportation Ins. Co. v. Maksyn, 580 S.W.2d 334 (Tex. 1979). However, except as provided below, repetitive mental trauma resulting in injury is not compensable, nor is it considered an occupational […]