law-workers-comp-impairment-rating-dispute (adminstrative process)

law-workers-comp-impairment-rating-dispute | impairment-rating of injured worker under worker's comp act |
workers-comp-insured-vs-carrier | administrative dispute of worker impairment rating | workers compensation |
administrative dispute of worker impairment rating | workers compensation appeals | judicial review suits under the Workers
Compensation Act | Houston Workers Comp Cases on Appeal |

HOUSTON CASE LAW ON -
DISPUTING IMPAIRMENT RATING OF WORKER'S COMP CLAIMANT

Disputing Impairment Ratings - Administrative Process

The Workers' Compensation Act vests the Division with exclusive jurisdiction to determine a claimant's
entitlement to medical benefits. In re Liberty Mut. Fire Ins. Co., 295 S.W.3d 327, 328 (Tex. 2009). Under the
"exclusive jurisdiction doctrine," the legislature grants the Division the sole authority to make the initial
determination in a medical benefit dispute. Subaru of Am. v. David McDavid Nissan, 84 S.W.3d 212, 221
(Tex. 2002). If an agency has exclusive jurisdiction, a claimant must exhaust all administrative remedies in the
agency before filing a claim in the trial court. See In re Entergy Corp., 142 S.W.3d 316, 321-22 (Tex. 2004);
Subaru, 84 S.W.3d at 221.

In instances where the parties dispute the impairment rating, the Texas Workers' Compensation Act provides
a three-step administrative process for resolving disputed issues. See Tex. Lab. Code Ann. §§ 410.021-.209
(Vernon 2006 & Vernon Supp. 2009) (first tier: benefit review conference; second tier: contested case
hearing; third tier: review by administrative appeals panel); Tex. Dept. of Ins., Div. of Workers' Comp. v.
Jackson, 225 S.W.3d 734, 736 (Tex. App.--Eastland 2007, no pet). Compliance with each step is a
prerequisite to participation in the next level, and subsequent proceedings are limited by the scope of the
prior proceeding. Jackson, 225 S.W.3d at 736.

The Division's first tier, the benefit review conference, is an informal dispute resolution proceeding. Tex. Lab.
Code Ann. § 410.021. If the conference is unsuccessful, the parties proceed to a contested case hearing
administered by a hearing officer. See id. §§ 410.151-.169. The hearing officer is the only individual with the
authority to excuse exhaustion of administrative remedies upon a showing of good cause. Jackson, 225
S.W.3d at 736. A party dissatisfied with the hearing officer's decision can appeal to the Division's appeals
panel, which is the third and final tier in the administrative process. See Tex. Lab. Code Ann. § 410.202
(Vernon 2006); see id. at 737 (noting legislature has made clear that it intended for hearing officer to make
initial decision in workers' compensation dispute and that all subsequent proceedings are limited to review of
that decision). The request for appeal and the opposing party's response must clearly and concisely rebut or
support the decision of the hearing officer on each issue on which review is sought. Tex. Lab. Code Ann. §
410.202(c). The Division appeal is not a de novo trial, but rather is limited to a review of the record from the
contested case hearing. See id. § 410.203(a). After considering briefs and the record from the contested
case hearing, the Division's appeals panel may affirm the decision of the hearing officer, reverse and render
a new decision, or remand no more than one time to the hearing officer for further consideration and
development of the record. Id. § 410.203(6)(c); Garcia, 893 S.W.2d at 515. The Texas Workers'
Compensation Act provides that the Division must adopt the impairment rating of one of the doctors, giving
the designated doctor's rating presumptive weight. Tex. Lab. Code Ann. § 408.125(c) (Vernon 2006); Brown,
86 S.W.3d at 359.

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