28 Tex. Admin. Code § 53.65 - Certification Procedure
In cases where it appears that the carrier willfully fails, or refuses without justification to pay compensation, the following procedure will apply.
(1) If, on suspension or
stoppage of workers' compensation payments, it appears to the board that the
carrier has not fully discharged its obligation to the claimant, the board will
notify the carrier through its Austin Industrial Accident Board representative
of the deficiency, and copies of such notice shall be sent to the claimant or
his attorney.
(2) The board will
specify a reasonable period of time in which a carrier may either pay the
deficiency and submit a correct report or submit information to the board
justifying the amount of its payment.
(3) If the carrier fails to pay the
deficiency or fails to submit information justifying the amount of its payment,
the board shall set the case for formal hearing to be held by a majority of the
board within 100 miles of the claimant's residence. The provision of §
49.105 of this title (relating to
Special Formal Hearing and Other Investigative Hearings), et seq., shall
apply.
(4) At such hearing, if it
determined that compensation benefits are due, the board shall so order. If the
carrier fails to obey such order within 10 days the board may certify such fact
to the commissioner of insurance for proceedings, according to Texas Civil
Statutes, Article 8306, §18.
Notes
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