28 Tex. Admin. Code § 142.5 - Sequence of Proceedings to Resolve Benefit Disputes
(a) Usual sequence. Except as provided in
this section, parties to a benefit dispute are required to attempt to resolve
the dispute by mediation at a benefit review conference before proceeding to a
contested case hearing or to arbitration by mutual election.
(b) Guidelines for proceeding directly to a
benefit contested case hearing. Parties may proceed directly to a contested
case hearing without attending a benefit review conference if the division
determines that:
(1) mediation would not
prove effective to resolve the dispute;
(2) necessary evidence cannot be obtained
without subpoena; or
(3) the
situation of the parties or the nature of the facts or law of the case is such
that the overall policy of the Act would be advanced by proceeding directly to
a contested case hearing.
(c) Requesting a hearing. A party may request
that the division set a benefit contested case hearing. The request shall be
made in the following manner:
(1) If the
requester is a carrier, carrier representative, claimant represented by an
attorney, or claimant assisted by OIEC, the request shall:
(A) be made in writing and signed by the
requestor;
(B) identify and
describe the disputed issue or issues;
(C) state the reason for requesting the
hearing;
(D) be sent to the
division; and
(E) be delivered to
all the other parties, as provided by §
142.4 of this chapter (relating to
Delivery of Copies to All Parties).
(2) A claimant who is neither represented by
an attorney nor assisted by OIEC may request a hearing by contacting the
division in any manner.
(d) Division action on a request for hearing.
The division will rule on the request and notify the parties. A ruling granting
the request will include a notice of hearing, as provided in §
142.6 of this chapter (relating to
Setting a Benefit Contested Case Hearing). A ruling denying the request may
include a notice of benefit review conference.
(e) Response. If a hearing is set upon
request, the other party or parties may submit a response. The response shall:
(1) be made in writing and signed;
(2) describe and explain the party's position
on the dispute or disputes;
(3) be
sent to the division no later than five days before the hearing; and
(4) be delivered to all other parties, as
provided by §
142.4 of this title (relating to
Delivery of Copies to All Parties).
(f) A claimant who is neither represented by
an attorney nor assisted by OIEC may respond by contacting the division in any
manner.
Notes
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