SECTION 53.65. Certification Procedure

In cases where it appears that the carrier willfully fails, or refuses without justification to pay compensation, the following procedure will apply.

(1) If, on suspension or stoppage of workers' compensation payments, it appears to the board that the carrier has not fully discharged its obligation to the claimant, the board will notify the carrier through its Austin Industrial Accident Board representative of the deficiency, and copies of such notice shall be sent to the claimant or his attorney.

(2) The board will specify a reasonable period of time in which a carrier may either pay the deficiency and submit a correct report or submit information to the board justifying the amount of its payment.

(3) If the carrier fails to pay the deficiency or fails to submit information justifying the amount of its payment, the board shall set the case for formal hearing to be held by a majority of the board within 100 miles of the claimant's residence. The provision of §49.105 of this title (relating to Special Formal Hearing and Other Investigative Hearings), et seq., shall apply.

(4) At such hearing, if it determined that compensation benefits are due, the board shall so order. If the carrier fails to obey such order within 10 days the board may certify such fact to the commissioner of insurance for proceedings, according to Texas Civil Statutes, Article 8306, §18.

Source Note: The provisions of this §53.65 adopted to be effective October 1, 1985, 10 TexReg 3507.