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Advisory 94-06

Improper Benefit Review Conference Agreements

A Commission review of claim files has revealed Benefit Review Conference Agreements that do not comply with the Texas Workers' Compensation Act, rules and Commission policies. Examples of such agreements have allowed the parties to resolve a dispute by allowing:

The insurance carrier to pay monies in exchange for the claimant dropping the claim.

The insurance carrier to pay monies when the agreement also establishes the injury is not compensable.

A party to forfeit their statutory right to pursue a claim in exchange for money.

The parties to agree to a date of maximum medical improve not certified by a doctor or an impairment rating not assessed by a doctor.

A party to dismiss or withdraw an administrative violation complaint pending before the Commission.

The parties to agree to compromise periods of know disability.

The parties to agree to limit the period over which medical benefits will be paid.

The parties to agree to limit medical benefits to treatment with specific providers.

Agreements not in compliance with the Act, rules, and Commission policies will be set aside by the Commission and are not binding upon the parties. Any money paid by this type of agreement which is outside the Act, rules and Commission policies may be considered gratuitous. Additionally, a person that enters into an improper agreement will be subject to sanctions as provided under the Act.

If a party to the agreement disputes the Commission's determination that an agreement is in violation of the Act or Commission rules or policies, the party may request a benefit review conference as provided for by Commission Rules 141.1, Requesting and Setting a Benefit Review Conference.

Signed this 19 th day of July, 1994.

Todd K. Brown Executive Director


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