Our article offers a variety of professionally written templates that you can use to draft your own successful appeal. Law Cites: (Timeliness of Protest to the IC) Section 208.004 of the Act provides that a person who receives notice of the filing of an initial claim for benefits shall notify the Commission promptly of any facts known to the person that may adversely affect the claimant's right to benefits, or affect a charge to the person's account. Did the claimant read and understand the instructions? Particularly in cases of one-party chargeback hearings, the hearing must be reset to afford the claimant an opportunity to rebut the employer's testimony. Under Custom Search Results, locate the Determination you want to appeal, and then click the person's SSN link. Is there documented evidence of the claimant's consent? ________ may interrupt you in order to interpret what you have said, and after he or she has finished the interpretation, you may continue to answer the question." Since the claimant's search for work is a determining factor in most cases in ruling on the claimant's availability for work, the Hearing Officer should inquire as to the names of employers the claimant has contacted, the dates contacted, the type of work for which the claimant applied, the names of individuals the claimant contacted, and the results of these contacts. Timeliness Of Appeal and Petition to Reopen. Did the party mail the appeal/petition? Does the claimant have wage credits from any educational institutions? Circle the item (s) and/or services you disagree with on the MSN. Law Cite: Section 207.021(a)(4) of the Act provides that an unemployed individual is eligible to receive benefits for a benefit period if the individual is available for work. If yes, is that still the correct mailing address? These determinations did not rule on the claimant's availability. The main form of persuasion on appeal is the written appellate brief, filed by counsel for each party. (If either or both parties have more than one person present on their behalf) "Since there is more than one person appearing on behalf of the [claimant, employer, or both parties] you need to designate a primary representative. After logging in, select your claim and navigate to the "Decision" status tab. When a witness is testifying, no one else should be permitted to break in. What did he do there? The Hearing Officer should tell the parties not to base their arguments on facts not in evidence. Does the person testifying know when the mail was picked up on the particular day the appeal/petition was mailed? Has the claimant had these hours, pay, and type of work in the past? Where did the party mail it? was she advised of the standards or expectations when hired Questions should be phrased in an interrogatory manner requiring the witness to provide information from their own personal knowledge or observation. how difficult was the task How often was he supposed to pay? Was there any specific event that provoked the quit? This will insure that all party discussions are on record. When did he receive them? Was the claimant confronted with the test results? was there a union contract providing for the vacation while shut down What type of work was he looking for (for each claim week)? The claimant's answers to the questions caused the claimant to be instructed to contact the Tele-Center. why did claimant refuse. A separate request should be made for each claimant to prevent the disclosure of confidential information. for an individual precluded because of a medically verifiable injury or illness from working during a major part of a calendar quarter of the period that would otherwise be the individual's base period under Paragraph A, the first four calendar quarters of the five consecutive calendar quarters preceding the calendar quarter in which the illness began or the injury occurred if the individual files an initial claim for benefits not later than 24 months after the date on which the individual's injury or illness began or occurred. If witnesses for one party are placed "under the rule", witnesses for both parties must be placed "under the rule". Parties not familiar with legal terminology can become unduly tense which could affect the quality of the hearing. What you will see on the mainframe Benefits and Appeals Benefits screens is "Availability - Failed to Register for Work." IMPORTANT NOTE: You must enter the determination/decision appealed and the party's appeal/petition to reopen into evidence during the hearing. If yes, what type of degree? You should direct UISS to contact the claimant and take a backdated initial claim. You must get a statement regarding the reason so you can determine if the claimant's reason for giving the wrong last work is fraudulent. Notwithstanding any other provision of this Act, work is not suitable and benefits may not be denied under this Act to an otherwise eligible individual for refusing to accept new work if: (1) the position offered is vacant directly because of a strike, lockout, or other labor dispute; (2) the wages, hours, or other conditions of the work offered are substantially less favorable to the individual than those prevailing for similar work in the locality; or (3) as a condition of being employed, the individual is required to join a company union or to resign from or refrain from joining a bona fide labor organization. was claimant aware that failure to contest tickets could jeopardize his job Did the party normally receive mail at the address to which the determination/decision was mailed? Was he given a deadline date to call? This method involves the Hearing Officer asking the witness to recount relevant testimony in their own words. The parties' titles or positions (e.g., attorney, witness, supervisor, plant superintendent) should be listed on the folder for use on the coversheet of the decision. If questions are suggested by a witness himself, the Hearing Officer should make appropriate notes for the further interrogation of that or other witnesses. Was claimant aware of the policy? why did employer accept notice early If the claimant did not report his earnings, why didn't he? Party conversations should be properly documented in the case folder. prior occurrences If the claimant was unable to report as instructed, did he call the number on the letter to try to reschedule? Before beginning the appeals process, please call Cigna Customer Service at 1 (800) 88Cigna (882-4462) to try to resolve the issue. What is the claimant's education? How often was he told he would have to file his CCs? At the time of the hearing, any party (employer or claimant) who appears should be confronted with all evidence in the file, documentary or otherwise, whether secured by independent investigation or not, which is adverse to their interest and which may be considered in arriving at a decision in the case. what action did the employer take toward the other participant When a witness uses proper names in giving testimony, the Hearing Officer should get the identity of the individual or place with the subject matter of the appeal. or Fact Pattern: Claimant failed to return to work after 3 day disciplinary suspension. did he report for reassignment Although it is rare, there have been cases in which, The Hearing Officer must administer the oath to the, An appeal evolving from an investigation of the Benefit Accuracy Measurement (. Did the claimant perform services for an educational institution in the previous term or year? Written statements which provide facts that the substitute teacher had been asked to continue in a similar capacity are required rather than merely placing the substitute teacher on a list for the following year. If yes, did the doctor ever say the claimant couldn't work? What kinds of problems? Did he complete a job application? If the telephone circuits are busy, the Hearing Officer will hear a "fast busy signal." The hearing should not be adjourned until each side has had a distinct opportunity to add any additional relevant testimony. A memorandum should always be in the file showing the reason for any postponement or rescheduling which is requested. had claimant filled out vouchers before Law Cite: Section 207.047 of the Act provides that an individual is disqualified for benefits if during the individual's current benefit year the individual failed, without good cause, to apply for available, suitable work when directed to do so by the Commission, or to accept suitable work offered to the individual, or to return to the individual's customary self-employment, if any, when directed to do so by the Commission. Section 207.053(b) of the Act provides that an individual is not disqualified under this section unless the person for whom the individual last worked made available to the individual the facilities, equipment, training, and supplies necessary to permit the individual to take reasonable precautions to preclude the infection of the individual with the communicable disease. was it a preexisting condition In cases involving the claimant's separation from work, detailed information should be obtained concerning the claimant's last work such as the dates of employment, job title and duties, hours of work, rate of pay, and complete facts on the reason for separation from work. The Hearing Officer shall ask all persons giving testimony to identity themselves by name and date of birth and afford the parties the opportunity to challenge the identity of a witness. The form of the oath should require the witnesses to swear or affirm that they will tell the truth, the whole truth and nothing but the truth under penalty of perjury. For a case in which Texas is the liable state but claimant now resides in another state, you should e-mail UI Central to inquire whether the claimant has registered for work in that state. "Improper benefit" means the benefit obtained by a person because of the nondisclosure or misrepresentation by the person or by another of a material fact, without regard to whether the nondisclosure or misrepresentation was known or fraudulent; and while any condition for the person's qualifying was not fulfilled in the person's case; or the person was disqualified from receiving benefits. Fact Pattern: At time of employer's annual two week shutdown, claimant and other similar workers are placed on vacation status, performing no work and with a recall date two weeks thereafter, and were issued vacation pay equivalent to two weeks pay for the period. It is also dangerous to refer to an individual who is about to testify as a "hostile witness". Working Conditions Quit/Medically Verified Quit. HELD: The Commission affirmed the deletion of the wage credits erroneously credited to the claimant's base period. when did employer learn of incorrect voucher However, at no time should the Hearing Officer permit note-taking to interfere with the conduct of an effective hearing. The second issue we will be addressing is [if chargeback is at issue, state "whether any benefits will be charged back to the employer's account as a result of this claim"]. When offering the right of cross-examination to a party, the Hearing Officer should exercise care in the use of legal terminology. Was the initial positive conformed with a GC/MS test? how often are audits made After a decision is rendered, the Hearing Officer should be careful about discussing the merits of the case or the reasons for the decision with the parties. Occasionally, inquiries may be received from attorneys or other agents who represent individuals at hearings. Did the claimant admit drug use to the employer? how was claimant made aware of the policy If a witness is not available by phone after repeated efforts, the Hearing Officer normally should proceed without the witness. If such person does not mail or otherwise deliver the notification to the Commission within 14 days (prior to September 1, 1997, 12 days) after the date notice of claim was mailed by the Commission, such person waives all rights in connection with the claim, including rights under Subchapter B, Chapter 204, other than rights relating to a clerical or machine error as to the amount of the person's chargeback or maximum potential chargeback in connection with the claim for benefits. Cell Phone. was the denial of insurability due to an on the job violation Changes made in the Texas Workers' Compensation Act (Act) effective January 1, 1991 redefined benefits payable under that Act and replaced the former Industrial Accident Board with the Texas Workers' Compensation (TWCC). (Send to the parties copies of the earnings the claimant reported for the CCs in question. You can still appeal if you are late. had those duties recently been increased or changed has claimant been released by doctor? The print-out of either of those screens may be another document you may need to send to the parties for the hearing and admit into evidence during the hearing.). The Filing determinations rule the claim certifications are incomplete because the claimant did not provide the necessary information so they could be completed and accepted. when did claimant report for reassignment? State to what address the notice (of initial claim or Maximum Potential Chargeback) was mailed to the employer. Did the claimant see a doctor? Issues: Whether the claimant received benefits to which the claimant was not entitled. The term "single-issue" hearing will include cases in which there may be two issues, the timeliness of the petition to reopen and whether there was good cause to reopen. Law Cite: Section 207.021(a)(3) of the Act provides that an unemployed individual is eligible to receive benefits for a benefit period if the individual is able to work. Section 1860D-4 of the Act sets forth the appeals process for Part D coverage determinations. What is the length of the claimant's unemployment? If the Hearing Officer is unable to keep a party on the line due to failure of a cordless phone, the situation should be handled in the same manner as a cellular phone. Do not interrupt, except to maintain control. However, of these, only the Impairment Income Benefits are NOT disqualifying. The date mailed is located on the top of the Determination Notice form, and the last day you can file an appeal is at the bottom of the form. If it appears the employer should be covered under the Act, and liability has not been established, an e-mail should be sent to the tax department to investigate. The Hearing Officer should make every effort to resolve the wage credit issue even if neither party appears. Did the employer understand the notice? 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