A 60-day period in which workers’ compensation claim payers can challenge the compensability of an injury does not apply to disputes over the extent of an injury, the Texas Supreme Court has ruled.
The ruling Friday, August 28, in State Office of Risk Management v. Mary Lawton overturned an appellate court ruling in the case in which Lawton injured her left knee in 2005 while working for the Texas Department of Criminal Justice.
A dispute arose over whether the state office should pay for surgery after a “peer-review” doctor reported that a degenerative condition caused the need for surgery and not the workplace injury.
The state office contested the claim, but a workers’ comp hearing officer ruled the agency waived its right to contest it by waiting too long to dispute it.
The officer ruled that the state office could have discovered the extent of Lawton’s injury within a 60-day period established to streamline claims processing. A state appellate court agreed.
But the Texas Supreme Court ruled that the 60-day rule applies to compensability and not to disputes over the extent of an injury.
The case was remanded for proceedings consistent with the court’s opinion.
Filed by Roberto Ceniceros of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.
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