reglab/housing_qa huggingface dataset:
TX Lab Code § 413.05122 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter E. Implementation of Commission Powers and Duties|Section 413.05122. Medical Quality Review Panel: Rules; Training

Sec. 413.05122.  MEDICAL QUALITY REVIEW PANEL: RULES; TRAINING.  (a)  The commissioner, after consultation with the medical advisor, shall adopt rules concerning the operation of the medical quality review panel, including rules that establish:(1)  the qualifications necessary for a health care provider to serve on the medical quality review panel;(2)  the composition of the medical quality review panel, including the number of members to be included on the panel and the health care specialty fields required to be represented by the members of the panel;(3)  the maximum length of time a health care provider may serve on the medical quality review panel;(4)  a policy defining situations that constitute a conflict of interest for a member of the medical quality review panel;(5)  procedures and grounds for removing a member of the medical quality review panel from the panel, including as a ground for removal that a member is repeatedly delinquent in conducting case reviews; and(6)  a procedure through which members of the medical quality review panel are notified concerning the status and enforcement outcomes of cases resulting from the medical quality review process.(b)  In addition to the rules required under Subsection (a), the commissioner shall adopt rules concerning the training requirements for members of the medical quality review panel.  The rules adopted under this subsection must ensure that panel members are fully aware of any requirements imposed by this subtitle concerning the medical quality review process and the division's goals concerning the process.  The rules adopted under this subsection may require members to receive training on any topic determined by the division or the commissioner to be relevant to the operations of the panel and must require members of the panel to receive training concerning:(1)  administrative violations that affect the delivery of appropriate medical care;(2)  the confidentiality requirements described by Section 413.0513 and the immunity from liability provided to members of the panel under Section 413.054; and(3)  the medical quality review criteria adopted under Section 413.05115.|Added by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 24, eff. September 1, 2011.|
TX Lab Code § 413.0513 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter E. Implementation of Commission Powers and Duties|Section 413.0513. Confidentiality Requirements

Sec. 413.0513.  CONFIDENTIALITY REQUIREMENTS.  (a)  Information collected, assembled, or maintained by or on behalf of the division under Section 413.0511 or 413.0512 constitutes an investigation file for purposes of Section 402.092 and may not be disclosed under Section 413.0511 or 413.0512 except as provided by that section.(b)  Confidential information, and other information to which access is restricted by law, developed by or on behalf of the division under Section 413.0511 or 413.0512 is not subject to discovery or court subpoena in any action other than:(1)  an action to enforce this subtitle brought by the division, an appropriate licensing or regulatory agency, or an appropriate enforcement authority; or(2)  a criminal proceeding.|Added by Acts 2001, 77th Leg., ch. 1456, Sec. 1.02, eff. June 17, 2001.  Amended by Acts 2003, 78th Leg., ch. 963, Sec. 3, eff. June 20, 2003.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.253, eff. September 1, 2005.|
TX Lab Code § 413.0515 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter E. Implementation of Commission Powers and Duties|Section 413.0515. Reports of Chiropractor Violations

Sec. 413.0515.  REPORTS OF CHIROPRACTOR VIOLATIONS.  (a)  Repealed by Acts 2021, 87th Leg., R.S., Ch. 856 (S.B. 800), Sec. 25(14), eff. September 1, 2021.(b)  If the division or the Texas Board of Chiropractic Examiners discovers an act or omission by a chiropractor that may constitute a felony, a misdemeanor involving moral turpitude, a violation of state or federal narcotics or controlled substance law, an offense involving fraud or abuse under the Medicare or Medicaid program, or a violation of this subtitle, the discovering agency shall report in a widely used electronic format that act or omission to the other agency.|Added by Acts 2003, 78th Leg., ch. 963, Sec. 4, eff. June 20, 2003.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.255, eff. September 1, 2005.Acts 2019, 86th Leg., R.S., Ch. 573 (S.B. 241), Sec. 1.41, eff. September 1, 2019.Acts 2021, 87th Leg., R.S., Ch. 856 (S.B. 800), Sec. 22, eff. September 1, 2021.Acts 2021, 87th Leg., R.S., Ch. 856 (S.B. 800), Sec. 25(14), eff. September 1, 2021.|
TX Lab Code § 413.052 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter E. Implementation of Commission Powers and Duties|Section 413.052. Production of Documents

Sec. 413.052.  PRODUCTION OF DOCUMENTS.  The commissioner by rule shall establish procedures to enable the division to compel the production of documents.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.256, eff. September 1, 2005.|
TX Lab Code § 413.053 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter E. Implementation of Commission Powers and Duties|Section 413.053. Standards of Reporting and Billing

Sec. 413.053.  STANDARDS OF REPORTING AND BILLING.  The commissioner by rule shall establish standards of reporting and billing governing both form and content.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.257, eff. September 1, 2005.|
TX Lab Code § 413.054 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter E. Implementation of Commission Powers and Duties|Section 413.054. Immunity From Liability

Sec. 413.054.  IMMUNITY FROM LIABILITY.  (a)  A person who performs services for the division as a designated doctor, an independent medical examiner, a doctor performing a medical case review, or a member of a peer review panel has the same immunity from liability as the commissioner under Section 402.00123.(b)  Immunity from liability under this section does not apply to a person providing medical treatment to an injured employee.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.258, eff. September 1, 2005.Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 25, eff. September 1, 2011.|
TX Lab Code § 413.055 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 413 - Medical Review|Subchapter E. Implementation of Commission Powers and Duties|Section 413.055. Interlocutory Orders; Reimbursement

Sec. 413.055.  INTERLOCUTORY ORDERS;  REIMBURSEMENT.  (a)  The commissioner may enter an interlocutory order for the payment of all or part of medical benefits.  The order may address accrued benefits, future benefits, or both accrued benefits and future benefits.(b)  The subsequent injury fund shall reimburse an insurance carrier for any overpayments of benefits made under an order entered under Subsection (a) if the order is reversed or modified by final arbitration, order, or decision of the commissioner or a court.  The commissioner shall adopt rules to provide for a periodic reimbursement schedule, providing for reimbursement at least annually.(c)  A party that disputes an order entered under Subsection (a) is entitled to a hearing.  The hearing shall be conducted by the State Office of Administrative Hearings in the manner provided for a contested case under Chapter 2001, Government Code.  The order is binding during the pendency of the appeal.|Added by Acts 1999, 76th Leg., ch. 955, Sec. 6, eff. Sept. 1, 1999.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.259, eff. September 1, 2005.|
TX Lab Code § 415.001 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.001. Administrative Violation by Representative of Employee or Legal Beneficiary

Sec. 415.001.  ADMINISTRATIVE VIOLATION BY REPRESENTATIVE OF EMPLOYEE OR LEGAL BENEFICIARY.  A representative of an employee or legal beneficiary commits an administrative violation if the person:(1)  fails without good cause to attend a dispute resolution proceeding within the division;(2)  attends a dispute resolution proceeding within the division without complete authority or fails to exercise authority to effectuate an agreement or settlement;(3)  commits an act of barratry under Section 38.12, Penal Code;(4)  withholds from the employee's or legal beneficiary's weekly benefits or from advances amounts not authorized to be withheld by the division;(5)  enters into a settlement or agreement without the knowledge, consent, and signature of the employee or legal beneficiary;(6)  takes a fee or withholds expenses in excess of the amounts authorized by the division;(7)  refuses or fails to make prompt delivery to the employee or legal beneficiary of funds belonging to the employee or legal beneficiary as a result of a settlement, agreement, order, or award;(8)  violates the Texas Disciplinary Rules of Professional Conduct of the State Bar of Texas;(9)  misrepresents the provisions of this subtitle to an employee, an employer, a health care provider, or a legal beneficiary;(10)   violates a commissioner rule; or(11)  fails to comply with this subtitle.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.265, eff. September 1, 2005.|
TX Lab Code § 415.003 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.003. Administrative Violation by Health Care Provider

Sec. 415.003.  ADMINISTRATIVE VIOLATION BY HEALTH CARE PROVIDER.  A health care provider commits an administrative violation if the person:(1)  submits a charge for health care that was not furnished;(2)  administers improper, unreasonable, or medically unnecessary treatment or services;(3)  makes an unnecessary referral;(4)  violates the division's fee and treatment guidelines;(5)  violates a commissioner rule; or(6)  fails to comply with a provision of this subtitle.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.45, eff. Sept. 1, 1995.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.267, eff. September 1, 2005.|
TX Lab Code § 415.0035 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.0035. Additional Violations by Insurance Carrier or Health Care Provider

Sec. 415.0035.  ADDITIONAL VIOLATIONS BY INSURANCE CARRIER OR HEALTH CARE PROVIDER.  (a)  An insurance carrier or its representative commits an administrative violation if that person:(1)  fails to submit to the division a settlement or agreement of the parties;(2)  fails to timely notify the division of the termination or reduction of benefits and the reason for that action; or(3)  denies preauthorization in a manner that is not in accordance with rules adopted by the commissioner under Section 413.014.(b)  A health care provider commits an administrative violation if that person:(1)  fails or refuses to timely file required reports or records; or(2)  fails to file with the division the annual disclosure statement required by Section 413.041.(c)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff. September 1, 2011.(d)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff. September 1, 2011.(e)  A person regulated by the division under this title commits an administrative violation if the person violates this subtitle or a rule, order, or decision of the commissioner.(f)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff. September 1, 2011.|Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.45, eff. Sept. 1, 1995.  Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.06, eff. June 17, 2001.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.268, eff. September 1, 2005.Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 27, eff. September 1, 2011.Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 37(2), eff. September 1, 2011.|
TX Lab Code § 415.0036 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.0036. Administrative Violation by Person Performing Certain Claim Services

Sec. 415.0036.  ADMINISTRATIVE VIOLATION BY PERSON PERFORMING CERTAIN CLAIM SERVICES.  (a)  This section applies to an insurance adjuster, case manager, or other person who has authority under this title to request the performance of a service affecting the delivery of benefits to an injured employee or who actually performs such a service, including peer reviews, performance of required medical examinations, or case management.(b)  A person described by Subsection (a) commits an administrative violation if the person offers to pay, pays, solicits, or receives an improper inducement relating to the delivery of benefits to an injured employee or improperly attempts to influence the delivery of benefits to an injured employee, including through the making of improper threats. This section applies to each person described by Subsection (a) who is a participant in the workers' compensation system of this state and to an agent of such a person.(c)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(3), eff. September 1, 2011.|Added by Acts 2007, 80th Leg., R.S., Ch. 198 (H.B. 34), Sec. 1, eff. September 1, 2007.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 37(3), eff. September 1, 2011.|
TX Lab Code § 415.005 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.005. Overcharging by Health Care Providers Prohibited; Administrative Violation

Sec. 415.005.  OVERCHARGING BY HEALTH CARE PROVIDERS PROHIBITED;  ADMINISTRATIVE VIOLATION.  (a)  A health care provider commits a violation if the person charges an insurance carrier an amount greater than that normally charged for similar treatment to a payor outside the workers' compensation system, except for mandated or negotiated charges.(b)  A violation under this section is an administrative violation.  A health care provider may be liable for an administrative penalty regardless of whether a criminal action is initiated under Section 413.043.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.269, eff. September 1, 2005.|
TX Lab Code § 415.006 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.006. Employer Chargebacks Prohibited; Administrative Violation

Sec. 415.006.  EMPLOYER CHARGEBACKS PROHIBITED;  ADMINISTRATIVE VIOLATION.  (a)  An employer may not collect from an employee, directly or indirectly, a premium or other fee paid by the employer to obtain workers' compensation insurance coverage, except as provided by Sections 406.123 and 406.144.(b)  An employee or legal beneficiary of an employee has a right of action to recover damages against an employer who violates Subsection (a).(c)  A person commits an administrative violation if the person violates Subsection (a). |Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.270, eff. September 1, 2005.|
TX Lab Code § 415.007 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.007. Loans by Attorneys Prohibited

Sec. 415.007.  LOANS BY ATTORNEYS PROHIBITED.  (a)  An attorney who represents a claimant before the division may not lend money to the claimant during the pendency of the workers' compensation claim.(b)  The attorney may assist the claimant in obtaining financial assistance from another source if the attorney is not personally liable for the credit extended to the claimant.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.271, eff. September 1, 2005.|
TX Lab Code § 415.008 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.008. Fraudulently Obtaining or Denying Benefits; Administrative Violation

Sec. 415.008.  FRAUDULENTLY OBTAINING OR DENYING BENEFITS;  ADMINISTRATIVE VIOLATION.  (a)  A person commits an administrative violation if the person, to obtain or deny a payment of a workers' compensation benefit or the provision of a benefit for the person or another, knowingly or intentionally:(1)  makes a false or misleading statement;(2)  misrepresents or conceals a material fact;(3)  fabricates, alters, conceals, or destroys a document; or(4)  conspires to commit an act described by Subdivision (1), (2), or (3).(b)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(5), eff. September 1, 2011.(c)  A person who has obtained an excess payment in violation of this section is liable for full repayment plus interest computed at the rate prescribed by Section 401.023.  If the person is an employee or person claiming death benefits, the repayment may be redeemed from future income or death benefits to which the person is otherwise entitled.(d)  An employer who has committed an act described by Subsection (a) that results in denial of payments is liable for the past benefit payments that would otherwise have been payable by the insurance carrier during the period of denial, plus interest computed at the rate prescribed by Section 401.023.  The insurance carrier is not liable for benefit payments during the period of denial.(e)  If an administrative violation proceeding is pending under this section against an employee or person claiming death benefits, the division may not take final action on the person's benefits.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.272, eff. September 1, 2005.Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 28, eff. September 1, 2011.Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 37(5), eff. September 1, 2011.|
TX Lab Code § 415.009 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.009. Frivolous Actions; Administrative Violation

Sec. 415.009.  FRIVOLOUS ACTIONS; ADMINISTRATIVE VIOLATION.   A person commits an administrative violation if the person brings, prosecutes, or defends an action for benefits under this subtitle or requests initiation of an administrative violation proceeding that does not have a basis in fact or is not warranted by existing law or a good faith argument for the extension, modification, or reversal of existing law.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.273, eff. September 1, 2005.Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 29, eff. September 1, 2011.|
TX Lab Code § 415.010 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.010. Breach of Agreement; Administrative Violation

Sec. 415.010.  BREACH OF AGREEMENT; ADMINISTRATIVE VIOLATION.   A party to an agreement approved by the division commits an administrative violation if the person breaches a provision of the agreement.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.274, eff. September 1, 2005.Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 29, eff. September 1, 2011.|
TX Lab Code § 415.011 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 415 - Administrative Violations|Subchapter A. Prohibited Acts|Section 415.011. Notice of Professional Employer Organization Workers' Compensation Claim and Payment Information; Administrative Violation

Sec. 415.011.  NOTICE OF PROFESSIONAL EMPLOYER ORGANIZATION WORKERS' COMPENSATION CLAIM AND PAYMENT INFORMATION; ADMINISTRATIVE VIOLATION.  (a)  In this section, "license holder" has the meaning assigned by Section 91.001.(a-1)  Except as provided by Subsection (c), a license holder commits a violation if the license holder fails to provide the information required by Sections 91.042(g) and (h).(b)  A violation under Subsection (a) is an administrative violation.(c)  A license holder does not commit an administrative violation under this section if the license holder requested the information required by Sections 91.042(g) and (h) from the license holder's workers' compensation insurance provider and the provider does not provide the information to the license holder within the required time.  A license holder shall notify the Texas Department of Insurance of a provider's failure to comply with the requirements of Section 2051.151, Insurance Code.|Added by Acts 2011, 82nd Leg., R.S., Ch. 477 (H.B. 625), Sec. 3, eff. September 1, 2011.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 117 (S.B. 1286), Sec. 20, eff. September 1, 2013.Acts 2013, 83rd Leg., R.S., Ch. 117 (S.B. 1286), Sec. 21, eff. September 1, 2013.|