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State Office of Risk Management v. Lawton

In workers' comp cases, the 60-day deadline in Texas Labor Code �409.021(c) applies only to compensability and not to disputes regarding extent of injury. Under Texas Administration Code �124.3(e) and �133.240(a), a carrier has up to 45 days from the date it receives a complete medical bill to dispute whether that treatment was necessary. Texas Supreme Court, No. 08-0363, 08-28-2009

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Argued March 11, 2009

In an effort to streamline workers’ compensation claim processing, the Legislature established time limits applicable to compensability disputes. See Act of Dec. 11, 1989, 71st Leg., 2nd C.S., ch. 1, § 5.21(a), 1989 Tex. Gen. Laws 1, 51. These limits furthered “the legislative goal of providing employees with either prompt payment or notice of denial of benefits.” Cont’l Cas. Co. v. Downs, 81 S.W.3d 803, 806 (Tex. 2002), overruled on other grounds by Sw. Bell Tel. Co. v. Mitchell, 276 S.W.3d 443, 448 (Tex. 2008). Today we must decide whether the sixty-day period for challenging compensabilityof an injury also applies to a dispute over the extentof injury, if the basis for that dispute could have been discovered by a reasonable investigation within the waiver period. We hold it does not and therefore reverse the court of appeals’ judgment.

I. Factual and Procedural Background

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