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Click here for the full text of this decision FACTS:John Pemberton injured his right shoulder and left knee on the job. His employer’s workers’ compensation insurer, TIG Premiere Ins. Co., paid the uncontested claim. Three months later, Pemberton was hospitalized and diagnosed with blood clots in his right leg. For two years, TIG and the Texas Workers’ Compensation Commission argued over Pemberton’s impairment rating. TWCC finally found that 2 percent of Pemberton’s 10 percent impairment rating was attributable to blood clots. TIG did not dispute the finding until six months later. At that time, TIG said the blood clots were not a byproduct of the on-the-job injury, but of three prior surgeries and a prolonged recovery period. A TWCC hearings officer found that Pemberton did not establish a causal connection between the on-the-job injury and the blood clots, but that the TWCC’s determination was binding, and TIG had waived its right to complain. TIG was required to make such a complaint within 60 days of TWCC’s findings, the officer ruled, referring to Labor Code �409.021(c). Subsection (c) states: “If an insurance carrier does not contest the compensability of an injury on or before the 60th day after the date on which the insurance carrier is notified of the injury, the insurance carrier waives its right to contest compensability. The initiation of payments by an insurance carrier does not affect the right of the insurance carrier to continue to investigate or deny the compensability of an injury during the 60-day period.” A TWCC appeals panel upheld the hearings officer, as did a trial court, granting summary judgment to TWCC. On appeal, TWCC argues that the 60-day rule only applies to challenges to the overall injury upon learning of an employee’s claim; it does not apply to challenges to disputes that arise later on about the extent or specific aspect of the injury. HOLDING:Reversed and remanded. The court reviews the rules of statutory construction, and finding �409.021(c) “somewhat ambiguous,” proceeds to consider other possibly relevant matters. First, by its express wording and its context among other subsections that contain phrases like “initiate compensation” or “initiation of payments,” the statute pertains only to initiation of benefits for the overall injury. Second, other parts of the Labor Code allow for challenges to the individual claims or parts of the overall claim without regard to the 60-day restriction. Third, even though not in existence at the time of the TWCC appeals panel decision, subsequent amendments to the administrative rules regarding investigation of an injury and notice of a denial or dispute, indicate that the challenge to the overall injury and a challenge to its scope are governed by separate limits. OPINION:Vance, J.

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