Current through Reg. 49, No. 38; September 20, 2024
(a) Statement of
disputes. The statement of disputes is a written description of the benefit
dispute or disputes to be considered by the administrative law judge. A dispute
not expressly included in the statement of disputes will not be considered by
the administrative law judge.
(b)
Statement of disputes after a benefit review conference. The statement of
disputes for a hearing held after a benefit review conference includes:
(1) the benefit review officer's report,
identifying the disputes remaining unresolved at the close of the benefit
review conference;
(2) the parties'
responses, if any;
(3) additional
disputes by unanimous consent, as provided by subsection (c) of this section;
and
(4) additional disputes
presented by a party, as provided by subsections (d) and (e) of this section,
if the administrative law judge determines that the party has good
cause.
(c) Party response
to the benefit review officer's report. A party may submit a response to the
disputes identified as unresolved in the benefit review officer's report. The
response shall:
(1) be in writing;
(2) describe and explain the party's position
on the unresolved dispute or disputes;
(3) be sent to the division no later than 20
days after receiving the benefit review officer's report; and
(4) be delivered to all other parties, as
provided by §
142.4
of this title (relating to Delivery of Copies to All
Parties).
(d) Additional
disputes by unanimous consent. Parties may, by unanimous consent, submit for
inclusion in the statement of disputes one or more disputes not identified as
unresolved in the benefit review officer's report. Additional disputes
submitted by consent shall:
(1) be made in
writing;
(2) identify the dispute
and explain the party's position on it;
(3) be signed by all parties;
(4) be sent to the division no later than 10
days before the hearing; and
(5)
explain why the issue was not raised earlier.
(e) Additional disputes by permission of the
administrative law judge. A party may request the administrative law judge to
include in the statement of disputes one or more disputes not identified as
unresolved in the benefit review officer's report. The administrative law judge
will allow such amendment only on a determination of good cause.
(1) If the requester is a carrier, carrier
representative, claimant represented by an attorney, or claimant assisted by
OIEC, the request shall:
(A) be made in
writing;
(B) identify and describe
the dispute or disputes;
(C) state
the reason for the request;
(D) be
sent to the division no later than 15 days before the hearing; and
(E) be delivered to all other parties, as
provided by §
142.4
of this title (relating to Delivery of Copies to All
Parties).
(2) A claimant
who is neither represented by an attorney nor assisted by OIEC may request
additional disputes to be included in the statement of disputes by contacting
the division in any manner no later than 15 days before the hearing.
(3) The administrative law judge will rule on
the request, and notify the parties of the ruling.
(f) Statement of disputes without prior
benefit review conference. The statement of disputes for a hearing held without
a prior benefit review conference includes:
(1) the request for hearing, as described in
§
142.5(c)
of this title (relating to Sequence of Proceedings To Resolve Benefit
Disputes); and
(2) the other
party's response, as described in §
142.5(e)
of this title (relating to Sequence of Proceedings To Resolve Benefit
Disputes), if any.
