PJC General Negligence 2024

W ORKERS ’ C OMPENSATION —T IMELINESS OF R ESPONDING

PJC 20.5

COMMENT When to use. PJC 20.5 should be used if no claim was filed with the Division of Workers’ Compensation of the Texas Department of Insurance (DWC) within one year of the date of injury, the pleadings and evidence raise a dispute about whether the worker had good cause for failing to file the claim with the DWC, and the carrier has contested the claim. PJC 20.5A should be used when the claimant is attempting to overcome a Division finding that the employee did not have good cause for failing to timely file a claim for compensation. PJC 20.5B should be used when the carrier is attempting to overcome a Division finding that the employee did have good cause for failing to timely file a claim for compensation. 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 instructions. Failure to file a claim for compensation with the DWC relieves the employer and the employer’s insurance carrier of liability unless good cause exists for the failure to file a claim in a timely manner or the employer or the employer’s insurance carrier does not contest the claim. Tex. Lab. Code § 409.004. Ultimate question is worker’s belief. The ultimate question in a good-cause issue is the worker’s belief. The worker may have believed that his injury was trivial ( see Liberty Mutual Insurance Co. v. Stanley , 534 S.W.2d 191, 192 (Tex. App.—Tex arkana 1976, writ ref’d n.r.e.)), that his claim had been filed by his employer ( see Texas Employers’ Insurance Ass’n v. Thomas , 517 S.W.2d 832, 837 (Tex. App.—San Antonio 1974, writ ref’d n.r.e.)), or that his disability was due to other causes ( see Davis v. Texas Employers’ Insurance Ass’n , 516 S.W.2d 452, 453–54 (Tex. App.—El Paso 1974, no writ). Evidence of more than one injury. If there is evidence of more than one injury, the date of the injury inquired about should be included in the question. Good cause must extend to time of filing. In Travelers Insurance Co. v. Echols , 508 S.W.2d 422, 425 (Tex. App.—Texarkana 1974, no writ), the court stated that the ultimate question in a case involving good cause for delay in filing a claim is the claimant’s belief, which in that case was the belief that the claim had been filed by the adjuster for the defendant. Good cause must arise within one year of the date of injury and must continue until the time of filing. See Continental Casualty Co. v. Cook , 515 S.W.2d 261 (Tex. 1974); Texas Casualty Insurance Co. v. Beaseley, 391 S.W.2d 33 (Tex. 1965). Occupational disease. In an occupational disease case, the phrase after the date that Paul Payne knew or should have known that the injury may be related to the employment must replace the phrase of the date of the injury in the second instruction following the question.

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