PJC General Negligence 2024

PJC 20.1

W ORKERS ’ C OMPENSATION —T IMELINESS OF R ESPONDING

COMMENT When to use. PJC 20.1 should be used when the pleadings and evidence present a question whether the insurance carrier waived its right to contest the compensability of the claim. Burden of proof. The burden of proof should be placed appropriately in accor dance with the decision of the appeals panel. See PJC 15.1. Source of question and definitions. PJC 20.1 is based on Tex. Lab. Code § 409.021(c), which provides: If an insurance carrier does not contest the compensability of an injury on or before the 60th day after the date on which the insurance carrier is noti fied of the injury, the insurance carrier waives its right to contest compensa bility. The initiation of payments by an insurance carrier does not affect the right of the insurance carrier to continue to investigate or deny the compen sability of an injury during the 60-day period. The insurance carrier’s notice must be in writing. Tex. Lab. Code § 409.021(a). The Division of Workers’ Compensation of the Texas Department of Insurance (DWC) has defined written notice of injury by rule. 28 Tex. Admin. Code § 124.1(a). The carrier’s refusal to pay benefits is conveyed on a plain-language notice. See Tex. Lab. Code § 409.013; 28 Tex. Admin. Code §§ 124.2, 124.3. The forms referred to, PLN01 and DWC-001, may be located by a search of the DWC’s website at www.tdi.texas.gov/ forms/formlisting.html . Extent-of-injury disputes. The sixty-day deadline contained in Tex. Lab. Code §409.021(c) applies only to compensability; it does not apply to disputes of extent of injury. State Office of Risk Management v. Lawton , 295 S.W.3d 646 (Tex. 2009).

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