reglab/housing_qa huggingface dataset:
TX Lab Code § 408.022 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.022. Selection of Doctor

Sec. 408.022.  SELECTION OF DOCTOR.  (a)  Except in an emergency, the division shall require an employee to receive medical treatment from a doctor chosen from a list of doctors approved by the commissioner.  A doctor may perform only those procedures that are within the scope of the practice for which the doctor is licensed.  The employee is entitled to the employee's initial choice of a doctor from the division's list.(b)  If an employee is dissatisfied with the initial choice of a doctor from the division's list, the employee may notify the division and request authority to select an alternate doctor.  The notification must be in writing stating the reasons for the change, except notification may be by telephone when a medical necessity exists for immediate change.(c)  The commissioner shall prescribe criteria to be used by the division in granting the employee authority to select an alternate doctor.  The criteria may include:(1)  whether treatment by the current doctor is medically inappropriate;(2)  the professional reputation of the doctor;(3)  whether the employee is receiving appropriate medical care to reach maximum medical improvement; and(4)  whether a conflict exists between the employee and the doctor to the extent that the doctor-patient relationship is jeopardized or impaired.(d)  A change of doctor may not be made to secure a new impairment rating or medical report.(e)  For purposes of this section, the following is not a selection of an alternate doctor:(1)  a referral made by the doctor chosen by the employee if the referral is medically reasonable and necessary;(2)  the receipt of services ancillary to surgery;(3)  the obtaining of a second or subsequent opinion only on the appropriateness of the diagnosis or treatment;(4)  the selection of a doctor because the original doctor:(A)  dies;(B)  retires;  or(C)  becomes unavailable or unable to provide medical care to the employee;  or(5)  a change of doctors required because of a change of residence by the employee.(f)  This section does not apply to requirements regarding the selection of a doctor under a workers' compensation health care network established under Chapter 1305, Insurance Code, except as provided by that chapter.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.082, eff. September 1, 2005.|
TX Lab Code § 408.0221 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.0221. Request for Description of Employment

Sec. 408.0221.  REQUEST FOR DESCRIPTION OF EMPLOYMENT.  (a)  This section applies only to an employee of an employer who has 10 or more employees.(b)  To facilitate an injured employee's return to employment as soon as it is considered safe and appropriate by the injured employee's treating doctor, the treating doctor may request that the injured employee's employer provide the treating doctor with the information described by Subsection (d) on the form adopted under that subsection.(c)  Information provided to a treating doctor under Subsection (b) does not constitute:(1)  a request by the employer that the injured employee return to the employment;(2)  an offer of employment by the employer for the injured employee to return to employment; or(3)  an admission of the compensability of the injury of the employee.(d)  The commissioner shall prescribe a form to provide information from an employer to a treating doctor concerning the functions and physical responsibilities of an injured employee's job.  To the extent possible, the form prescribed under this subsection shall be one page, use a check box format as appropriate, and be compatible with electronic mail.  The form must include:(1)  the name and address of the employer and the contact information and availability of the individual representing the employer who has knowledge of the injured employee's job;(2)  the scope of the injured employee's employment, including any specific tasks, job duties, or work activities that the injured employee was required to perform at the time the employee sustained the injury; and(3)  an area for additional comments or information  by the employer or individual representing the employer concerning:(A)  the injured employee's job; or(B)  the availability, if any, of other jobs that the employer may have that the employer would like the treating doctor to consider in determining whether an injured employee is able to return to work.(e)  The commissioner may adopt rules as necessary to implement this section and to facilitate communication between the employer and the treating doctor regarding return-to-work opportunities.|Added by Acts 2009, 81st Leg., R.S., Ch. 456 (H.B. 2547), Sec. 1, eff. September 1, 2009.|
TX Lab Code § 408.024 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.024. Noncompliance With Selection Requirements

Sec. 408.024.  NONCOMPLIANCE WITH SELECTION REQUIREMENTS.  Except as otherwise provided, and after notice and an opportunity for hearing, the commissioner may relieve an insurance carrier of liability for health care that is furnished by a health care provider or another person selected in a manner inconsistent with the requirements of this subchapter.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.085, eff. September 1, 2005.|
TX Lab Code § 408.025 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.025. Reports and Records Required From Health Care Providers

Sec. 408.025.  REPORTS AND RECORDS REQUIRED FROM HEALTH CARE PROVIDERS.  (a)  The commissioner by rule shall adopt requirements for reports and records that are required to be filed with the division or provided to the injured employee, the employee's attorney, or the insurance carrier by a health care provider.(a-1)  A treating doctor may delegate to a physician assistant who is licensed to practice in this state under Chapter 204, Occupations Code, or an advanced practice registered nurse who is licensed to practice in this state under Chapter 301, Occupations Code, the authority to complete and sign a work status report regarding an injured employee's ability to return to work.  The delegating treating doctor is responsible for the acts of the physician assistant or advanced practice registered nurse under this subsection.(b)  The commissioner by rule shall adopt requirements for reports and records that are to be made available by a health care provider to another health care provider to prevent unnecessary duplication of tests and examinations.(c)  The treating doctor is responsible for maintaining efficient utilization of health care.(d)  On the request of an injured employee, the employee's attorney, or the insurance carrier, a health care provider shall furnish records relating to treatment or hospitalization for which compensation is being sought.  The division may regulate the charge for furnishing a report or record, but the charge may not be less than the fair and reasonable charge for furnishing the report or record.  A health care provider may disclose to the insurance carrier of an affected employer records relating to the diagnosis or treatment of the injured employee without the authorization of the injured employee to determine the amount of payment or the entitlement to payment.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1999, 76th Leg., ch. 1426, Sec. 9, eff. Sept. 1, 1999.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.086, eff. September 1, 2005.Acts 2017, 85th Leg., R.S., Ch. 483 (H.B. 2546), Sec. 1, eff. June 9, 2017.Acts 2019, 86th Leg., R.S., Ch. 723 (H.B. 387), Sec. 1, eff. September 1, 2019.|
TX Lab Code § 408.0251 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.0251. Electronic Billing Requirements

Sec. 408.0251.  ELECTRONIC BILLING REQUIREMENTS.  (a)  The commissioner, by rule and in cooperation with the commissioner of insurance, shall adopt rules regarding the electronic submission and processing of medical bills by health care providers to insurance carriers.(b)  Insurance carriers shall accept medical bills submitted electronically by health care providers in accordance with commissioner rule.(c)  The commissioner shall by rule establish criteria for granting exceptions to insurance carriers and health care providers who are unable to submit or accept medical bills electronically.(d)  On or after January 1, 2008, the commissioner may adopt rules regarding the electronic payment of medical bills by insurance carriers to health care providers.|Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.087, eff. September 1, 2005.|
TX Lab Code § 408.0252 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.0252. Underserved Areas

Sec. 408.0252.  UNDERSERVED AREAS.  The commissioner by rule may identify areas of this state in which access to health care providers is less available and may adopt appropriate standards, guidelines, and rules regarding the delivery of health care in those areas.|Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.087, eff. September 1, 2005.|
TX Lab Code § 408.026 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.026. Spinal Surgery

Sec. 408.026.  SPINAL SURGERY.  Except in a medical emergency, an insurance carrier is liable for medical costs related to spinal surgery only as provided by Section 413.014 and commissioner rules.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 4.01, eff. June 17, 2001.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.088, eff. September 1, 2005.|
TX Lab Code § 408.0271 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.0271. Reimbursement by Health Care Provider

Sec. 408.0271.  REIMBURSEMENT BY HEALTH CARE PROVIDER.  (a)  If the health care services provided to an injured employee are determined by the insurance carrier to be inappropriate, the insurance carrier shall:(1)  notify the health care provider in writing of the carrier's decision; and(2)  demand a refund by the health care provider of the portion of payment on the claim that was received by the health care provider for the inappropriate services.(b)  The health care provider may appeal the insurance carrier's determination under Subsection (a).  The health care provider must file an appeal under this subsection with the insurance carrier not later than the 45th day after the date of the insurance carrier's request for the refund.  The insurance carrier must act on the appeal not later than the 45th day after the date on which the provider files the appeal.(c)  A health care provider shall reimburse the insurance carrier for payments received by the provider for inappropriate charges not later than the 45th day after the date of the carrier's notice.  The failure by the health care provider to timely remit payment to the carrier constitutes an administrative violation.|Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.0895, eff. September 1, 2005.|
TX Lab Code § 408.0272 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.0272. Certain Exceptions for Untimely Submission of Claim

Sec. 408.0272.  CERTAIN EXCEPTIONS FOR UNTIMELY SUBMISSION OF CLAIM.  (a)  In this section:(1)  "Group accident and health insurance" has the meaning assigned by Chapter 1251, Insurance Code.(2)  "Health maintenance organization" has the meaning assigned by Chapter 843, Insurance Code.(b)  Notwithstanding Section 408.027, a health care provider who fails to timely submit a claim for payment to the insurance carrier under Section 408.027(a) does not forfeit the provider's right to reimbursement for that claim for payment solely for failure to submit a timely claim if:(1)  the provider submits proof satisfactory to the commissioner that the provider, within the period prescribed by Section 408.027(a), erroneously filed for reimbursement with:(A)  an insurer that issues a policy of group accident and health insurance under which the injured employee is a covered insured;(B)  a health maintenance organization that issues an evidence of coverage under which the injured employee is a covered enrollee; or(C)  a workers' compensation insurance carrier other than the insurance carrier liable for the payment of benefits under this title; or(2)  the commissioner determines that the failure resulted from a catastrophic event that substantially interfered with the normal business operations of the provider.(c)  Notwithstanding Subsection (b), a health care provider who erroneously submits a claim for payment to an entity described by Subdivision (1) of that subsection forfeits the provider's right to reimbursement for that claim if the provider fails to submit the claim to the correct workers' compensation insurance carrier within 95 days after the date the provider is notified of the provider's erroneous submission of the claim.(d)  Notwithstanding any other provision of this section or Section 408.027, the period for submitting a claim for payment may be extended by agreement of the parties.|Added by Acts 2007, 80th Leg., R.S., Ch. 459 (H.B. 1005), Sec. 1, eff. September 1, 2007.|
TX Lab Code § 408.0282 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.0282. Requirements for Certain Informal or Voluntary Networks

Sec. 408.0282.  REQUIREMENTS FOR CERTAIN INFORMAL OR VOLUNTARY NETWORKS.  (a)  Each informal or voluntary network described by Section 408.0281 or 408.0284 shall, not later than the 30th day after the date the network is established, report the following information to the division:(1)  the name of the informal or voluntary network and federal employer identification number;(2)  an executive contact for official correspondence for the informal or voluntary network;(3)  a toll-free telephone number by which a health care provider may contact the informal or voluntary network;(4)  a list of each insurance carrier with whom the informal or voluntary network contracts, including the carrier's federal employer identification number; and(5)  a list of, and contact information for, each entity with which the informal or voluntary network has a contract or other business relationship that benefits or is entered into on behalf of an insurance carrier, including an insurance carrier's authorized agent or a subsidiary or other affiliate of the network.(b)  Each informal or voluntary network shall report any changes to the information provided under Subsection (a) to the division not later than the 30th day after the effective date of the change.(c)  An informal or voluntary network shall submit a report required under this section, including a report of changes required under Subsection (b), to the division through the division's online reporting system available through the division's Internet website.(d)  An informal or voluntary network commits an administrative violation if the informal or voluntary network violates any provision of this section.|Added by Acts 2011, 82nd Leg., R.S., Ch. 705 (H.B. 528), Sec. 3, eff. June 17, 2011.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 1202 (S.B. 1322), Sec. 2, eff. September 1, 2013.|
TX Lab Code § 408.029 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.029. Nurse First Assistant Services

Sec. 408.029.  NURSE FIRST ASSISTANT SERVICES.  An insurance carrier may not refuse to reimburse a health care practitioner solely because that practitioner is a nurse first assistant, as defined by Section 301.1525, Occupations Code, for a covered service that a physician providing health care services under this subtitle has requested the nurse first assistant to perform.|Added by Acts 2001, 77th Leg., ch. 812, Sec. 9, eff. Sept. 1, 2001.|
TX Lab Code § 408.031 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter B. Medical Benefits|Section 408.031. Workers' Compensation Health Care Networks

Sec. 408.031.  WORKERS' COMPENSATION HEALTH CARE NETWORKS.  (a)  Notwithstanding any other provision of this chapter, an injured employee may receive benefits under a workers' compensation health care network established under Chapter 1305, Insurance Code, in the manner provided by that chapter.(b)  In the event of a conflict between this title and Chapter 1305, Insurance Code, as to the provision of medical benefits for injured employees, the establishment and regulation of fees for medical treatments and services, the time frames for payment of medical bills, the operation and regulation of workers' compensation health care networks, the regulation of the health care providers who contract with those networks, or the resolution of disputes regarding medical benefits provided through those networks, Chapter 1305, Insurance Code, prevails.|Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.092, eff. September 1, 2005.|
TX Lab Code § 408.041 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter C. Computation of Average Weekly Wage|Section 408.041. Average Weekly Wage

Sec. 408.041.  AVERAGE WEEKLY WAGE.  (a)  Except as otherwise provided by this subtitle, the average weekly wage of an employee who has worked for the employer for at least the 13 consecutive weeks immediately preceding an injury is computed by dividing the sum of the wages paid in the 13 consecutive weeks immediately preceding the date of the injury by 13.(b)  The average weekly wage of an employee whose wage at the time of injury has not been fixed or cannot be determined or who has worked for the employer for less than the 13 weeks immediately preceding the injury equals:(1)  the usual wage that the employer pays a similar employee for similar services;  or(2)  if a similar employee does not exist, the usual wage paid in that vicinity for the same or similar services provided for remuneration.(c)  If Subsection (a) or (b) cannot reasonably be applied because the employee's employment has been irregular or because the employee has lost time from work during the 13-week period immediately preceding the injury because of illness, weather, or another cause beyond the control of the employee, the commissioner may determine the employee's average weekly wage by any method that the commissioner considers fair, just, and reasonable to all parties and consistent with the methods established under this section.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.094, eff. September 1, 2005.|
TX Lab Code § 408.043 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter C. Computation of Average Weekly Wage|Section 408.043. Average Weekly Wage for Seasonal Employee

Sec. 408.043.  AVERAGE WEEKLY WAGE FOR SEASONAL EMPLOYEE.  (a)  For determining the amount of temporary income benefits of a seasonal employee, the average weekly wage of the employee is computed as provided by Section 408.041 and is adjusted as often as necessary to reflect the wages the employee could reasonably have expected to earn during the period that temporary income benefits are paid.(b)  For determining the amount of impairment income benefits, supplemental income benefits, lifetime income benefits, or death benefits of a seasonal employee, the average weekly wage of the employee is computed by dividing the amount of total wages earned by the employee during the 12 months immediately preceding the date of the injury by 50.(c)  If, for good reason, the commissioner determines that computing the average weekly wage for a seasonal employee as provided by this section is impractical, the commissioner shall compute the average weekly wage as of the time of the injury in a manner that is fair and just to both parties.(d)  In this section, "seasonal employee" means an employee who, as a regular course of the employee's conduct, engages in seasonal or cyclical employment that does not continue throughout the entire year.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.096, eff. September 1, 2005.|
TX Lab Code § 408.044 (2021)
2021 Texas Statutes|Labor Code|Title 5 - Workers' Compensation|Subtitle A - Texas Workers' Compensation Act|Chapter 408 - Workers' Compensation Benefits|Subchapter C. Computation of Average Weekly Wage|Section 408.044. Average Weekly Wage for Minor, Apprentice, Trainee, or Student

Sec. 408.044.  AVERAGE WEEKLY WAGE FOR MINOR, APPRENTICE, TRAINEE, OR STUDENT.  (a)  For computing impairment income benefits, supplemental income benefits, lifetime income benefits, or death benefits, the average weekly wage of an employee shall be adjusted to reflect the level of expected wages during the period that the benefits are payable if:(1)  the employee is a minor, apprentice, trainee, or student at the time of the injury;(2)  the employee's employment or earnings at the time of the injury are limited primarily because of apprenticeship, continuing formal training, or education intended to enhance the employee's future wages;  and(3)  the employee's wages would reasonably be expected to change because of a change of employment during that period.(b)  An adjustment under Subsection (a) may not consider expected wage levels for a period occurring after the third anniversary of the date of the injury.|Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.|