A Texas Notice of Disputed Issue(s) and Refusal to Pay Benefits is a form used by an insurance company to inform an injured worker that it is disputing certain issues related to their claim and is refusing to pay benefits. This form is typically sent to an injured worker after the insurance company has completed its investigation into the claim. There are two types of Texas Notice of Disputed Issue(s) and Refusal to Pay Benefits: Statutory and Non-Statutory. The Statutory Notice of Disputed Issue(s) and Refusal to Pay Benefits is sent when the insurance company is disputing the compensability of the claim (i.e. the injury or illness is not work-related). The Non-Statutory Notice of Disputed Issue(s) and Refusal to Pay Benefits is sent when the insurance company is disputing any other issue related to the claim, such as the amount of benefits being paid, the type of benefits being paid, or the duration of benefits being paid. The Texas Notice of Disputed Issue(s) and Refusal to Pay Benefits must include information such as the reason for the dispute, a description of the disputed issue(s), and a statement of the amount of benefits being withheld. The form must also include an explanation of the injured worker's right to request a hearing before the Texas Department of Insurance, Division of Workers' Compensation.