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APPEAL NO. 040445 FILED APRIL 21, 2004, This appeal arises pursuant to the Texas Workers\' Compensation Act, TEX. LAB. CODE ANN. 401.001 et seq. (1989 Act). A contested case hearing was held on February
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Fill out the personal details section accurately, providing your name, contact information, and any other requested information.
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Identify the reason for the appeal and clearly state it in the appropriate section of the form.
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This appeal arises pursuant to anyone who has been affected or involved in a particular situation or decision.
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It can be individuals, organizations, or groups who believe they have grounds for challenging an outcome, decision, or judgment.
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This appeal arises pursuant to a specific statute or regulation.
The party involved in the decision that is being appealed is required to file this appeal.
The appeal can usually be filled out by submitting a written document explaining the reasons for the appeal.
The purpose of this appeal is to review and potentially overturn a decision made by a lower authority.
The appeal must include all relevant details of the decision being appealed and any supporting evidence.
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