Appeals Panel Decision Manual - Table of Contents

Introduction

This manual is prepared under the supervision of the Appeals Panel. It serves as a guide for use by the Appeals Panel in deciding appeals of hearing officer's contested case hearing decisions. The primary purpose of the guide is to help the Appeals Panel achieve consistency in its decisions and inform its customers of the legal principles it expects to follow in deciding appeals. Use of this manual is not intended to be a substitute for obtaining legal counsel or advise. Due to the changing nature of the law, the manual will be updated frequently. The manual is an abbreviated summary of selected aspects of Texas workers' compensation law. An accurate understanding of the law covered in the manual may require reading the Act, rules, and cases referenced. The content of the manual does not constitute official DWC policy.

Organization for the Manual

The organization for the manual is based on the Disputed Issue Codes & Related Issue Guide, as revised in January 2004. This guide is the basis for the issue statements in benefit review conference reports that are referred for resolution at contested case hearings. An issue will be listed and directly to the right of the issue in parentheses will be the disputed issue code. For example, Existence of Coverage (C01).

For some of the Disputed Issue codes the law is changing or not well developed. Those codes have been intentionally left blank and the notation "Intentionally left blank" has been added after those codes.

Added at the end of the manual is a list of abbreviations and cross-references for use of this manual. There are also cross-references within the text.

How to Use the Manual On the Internet

There are links from the table of contents to the section or subsection you wish to read. In addition, there are links to each reference to a statute, rule, and APD. Any reference to a Section in the 400s and 500s refer to the 1989 Act. Any reference to a Section in the 100s refers to the DWC Rules. Because many issues overlap cross-references are added where appropriate.

Table of Contents

• Attorney Fee Issues (Intentionally left blank)
• Liability/Compensability Issues
• Death Benefits Issues
• Employer Reimbursement Issues
• Income Benefit Issues
• Medical Benefits Issues
• Procedural Issues
• Wage Issues
• Abbreviation List

Attorney Fee Issues (A01-A04, A00) (Intentionally left blank)

Liability/Compensability Issues Part 1

• Existence of Coverage. (C01) (Rev. 9/8/2020)
• Existence of Employment Relationship. (C02) (Rev. 1/15/2021)
• Timely Contest by Carrier. (C03)
• Contest by Employer. (C04) (Rev. 12/23/2019)
• Date of Injury. (C05) (Rev. 12/23/2019)
• Compensability/Injury (Existence). (C06) (Revised 2/18/2022)
• Extent of Injury. (C07)
• Alcohol Intoxication. (C08) (Rev. 3/14/2024)
• Drug Intoxication. (C09) (Rev. 8/5/2022)
• Not in Course and Scope Because of Other Grounds. (C10) (Rev. 4/3/2023)
• Willful Attempt to Injure. (C11) (Rev. 8/9/2021)
• Act of a Third Party/Personal Reasons. (C12) (Rev. 11/05/2021)
• Voluntary Social/Recreational Activity. (C13) (Rev. 12/30/2021)
• Compensability/Occupational Disease. (C14) (Rev. 10/23/2019)
• Compensability/Mental Trauma. (C15) (Rev. 4/21/2022)
• Compensability/Heart Attack. (C16) (Rev. 1/5/2023)

Liability/Compensability Issues Part 2

• Reporting Injury to Employer. (C17) (Rev. 6/6/2024)
• Filing Claim with Division. (C18) (Rev. 3/6/2020)
• Extraterritorial Injury. (C19) (Rev. 1/27/2020)
• Election of Remedies. (C20) (Rev. 4/30/2020)
• Liability of SIF/Carrier Reimbursement. (C21) (Rev. 4/30/2020)

Liability/Compensability Issues Part 3

• Other Compensability Issues. (C00)
  • Course and Scope of Employment

Death Benefits Issues

• Identity of Legal Beneficiaries. (D01) (Rev. 1/11/2024)
• Death Benefit Rate Calculation. (D03)
• Distribution of Death Benefits. (D04) (Rev. 9/23/2019)
• Payment to SIF. (D05) (Rev. 11/22/2019)
• Entitlement To and Amount of Burial Benefits. (D06) (Rev. 2/26/2020)
• Other Death Benefits Issues. (D00) (Rev. 5/21/2019)

Employer Reimbursement Issues

• Amount of Reimbursement (E01)
• Entitlement to Reimbursement (E02)
• Other Employer Reimbursement Issues (E00) (Intentionally left blank)

Income Benefit Issues

• Income Benefit Rate Calculation. (I01) (Rev. 10/27/2020)
• Existence/Duration Disability Raised by Allegation of BFOE. (I02) (Rev. 7/29/2019)
• Existence/Duration Disability Raised by Other Evidence. (I03) (Rev. 11/22/2023)
  • Dates of Disability
• Income Benefits Accrual Date. (I04) (Rev. 2/26/2021)
• Date of MMI. (I06)
• Impairment Rating. (I07)
• RME Request/Failure to Attend. (I08) (Rev. 10/7/2021)
• Dispute of Designated Doctor MMI Date. (I10) (Rev. 6/2/2020)
• Dispute of Designated Doctor IR. (I11) (Rev. 6/18/2020)
• IR Finality/90 Day Dispute. (I12)
• Renewed Entitlement to SIBs Based on Allegation of Discharge with Intent to Deprive. (I13) (Intentionally left blank)
• Entitlement to Acceleration or Advance. (I14) (Intentionally left blank)
• Reduction or Suspension (IIBs or SIBs) for Contribution from a Prior Compensable Injury. (I15) (Rev. 11/28/2022)
• Reduction/Suspension to Recoup Overpayment. (I16) (Rev. 6/14/2022)
• Entitlement to Commutation of IIBs. (I17) (Rev. 1/27/2020)
• Abandonment of Medical. (I18) (Rev. 1/27/2020)
• Reduction/Suspension for Statutory Liens. (I20) (Intentionally left blank)
• Entitlement to LIBs. (I22)
• Failure to Attend Designated Doctor Appointment. (I24) (Rev. 6/16/2021)
• Entitlement to Multi-Employer Benefits. (I25) (Rev. 10/27/2020)
• SIBs (I31 - I42)
  • SIBs/Initial (First) Quarter. (I31)
  • SIBs/Subsequent Quarters. (I32-I39)
  • SIBs/Loss of Entitlement. (I40)
  • SIBs/Timely Filing of SIBs App. (I41)
  • SIBs/Carrier Timely Dispute. (I42)
• RME/RTW Dispute. (I50) (Intentionally left blank)
• RME/MMI Dispute. (I51) (Intentionally left blank)
• Designated Doctor-Medical Condition. (I52) (Intentionally left blank)
• Improper Denial/Approval of a Designated Doctor Appointment. (I53) (Rev. 2/4/2019)
• Other Income Benefits. (I00)  (Rev. 2/4/2019)

Medical Benefits Issues

• Compliance with Choice of Doctor Requirements. (M01) (Rev. 5/19/2021)
• Reimbursement for Medical Travel Expenses. (M02) (Rev. 2/26/2021)
• Timely Dispute of Treating Doctor. (M03) (Rev. 3/29/2021)
• Other Medical Benefits Issues. (M00) (Intentionally left blank)

Procedural Issues

• Admissibility of Evidence. (P01) (Rev. 10/7/2022)
• Issue Not Previously Raised. (P02) (Rev. 4/3/2019)
• Jurisdiction. (P03) (Rev. 7/24/2020)
• Relief of Agreement. (P04) (Rev. 6/19/2019)
• Other Procedural Issues. (P00) (Rev. 8/30/2023)

Wage Issues

• Amount of Average Weekly Wage. (W01) (Rev. 10/27/2020 - partial revision)
• Amount of Current Weekly Wage for Adjustment of TIBs. (W02) (Rev. 7/15/2024)
• Amount of Offered Weekly Wage for Adjustment of TIBs. (W03)
• Amount of Current Weekly Wage for Calculation of SIBs. (W04)
• Seasonal AWW Dispute. (W05)
• Multi-Employment AWW dispute. (W06) (Rev. 10/27/2020)
• Other Wage Issues. (W00) (Intentionally left blank)

Abbreviation List