Medical Contested Case Hearings Manual Published Online

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Published 02/17/2010 - 6:45 a.m. CDT

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The Texas Department of Insurance, Division of Workers Compensation (TDI-DWC) has published an online precedent manual for medical contested case hearings. The purpose of the manual is to educate workers compensation system participants regarding evidentiary standards and burden of proof when preparing for contested case hearings (CCH).

The Medical CCH Precedent Manual, which was modeled after the agencys Appeals Panel Decision Manual, contains basic principals of law that TDI-DWC hearing officers apply in deciding medical necessity and medical fee disputes. The manual is available on the TDI website at http://www.tdi.state.tx.us/wc/idr/mddm.html .

A Contested Case Hearing is a formal proceeding conducted by a TDI-DWC hearing officer, who makes decisions about the disputed issues. The CCH is recorded, an official record is made, evidence is presented and sworn testimony is taken. Generally, the injured employee, the employees representative (if any), a sub-claimant (if any), witnesses, and the insurance carriers representative attend and participate in the CCH. Employers are also entitled to attend the CCH.

For more information on the Medical CCH Precedent Manual, contact Daniel Barry, Manager of the Appeals Panel, at 512-804-4439, or via e-mail at Daniel.Barry@tdi.state.tx.us.

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