reglab/statecodes huggingface dataset:
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.002. Survival of Cause of Action

Sec. 408.002.  SURVIVAL OF CAUSE OF ACTION.  A right of action survives in a case based on a compensable injury that results in the employee's death.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1991.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.003. Reimbursable Employer Payments; Salary Continuation; Offset Against Income Benefits; Limits

Sec. 408.003.  REIMBURSABLE EMPLOYER PAYMENTS;  SALARY CONTINUATION;  OFFSET AGAINST INCOME BENEFITS;  LIMITS.  (a)  After an injury, an employer may:
(1)  initiate benefit payments, including medical benefits;  or
(2)  on the written request or agreement of the employee, supplement income benefits paid by the insurance carrier by an amount that does not exceed the amount computed by subtracting the amount of the income benefit payments from the employee's net preinjury wages.
(b)  If an injury is found to be compensable and an insurance carrier initiates compensation, the insurance carrier shall reimburse the employer for the amount of benefits paid by the employer to which the employee was entitled under this subtitle.  Payments that are not reimbursed or reimbursable under this section may be reimbursed under Section 408.127.
(c)  The employer shall notify the division and the insurance carrier on forms prescribed by the commissioner of the initiation of and amount of payments made under this section.
(d)  Employer payments made under this section:
(1)  may not be construed as an admission of compensability;  and
(2)  do not affect the payment of benefits from another source.
(e)  If an employer does not notify the insurance carrier of the injury in compliance with Section 409.005, the employer waives the right to reimbursement under this section.
(f)  Salary continuation payments made by an employer for an employee's disability resulting from a compensable injury shall be considered payment of income benefits for the purpose of determining the accrual date of any subsequent income benefits under this subtitle.
(g)  If an employer is subject to a contractual obligation with an employee or group of employees, such as a collective bargaining agreement or a written agreement or policy, under which the employer is required to make salary continuation payments, the employer is not eligible for reimbursement under this section for those payments.
(h)  Payments made as salary continuation or salary supplementation do not affect the exclusive remedy provisions of Section 408.001.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1999, 76th Leg., ch. 954, Sec. 5, eff. Sept. 1, 1999;  Acts 1999, 76th Leg., ch. 1003, Sec. 1, 2, eff. Sept. 1, 1999.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.078, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.0042. Medical Examination by Treating Doctor to Define Compensable Injury

Sec. 408.0042.  MEDICAL EXAMINATION BY TREATING DOCTOR TO DEFINE COMPENSABLE INJURY.  (a)  The division shall require an injured employee to submit to a single medical examination to define the compensable injury on request by the insurance carrier.
(b)  A medical examination under this section shall be performed by the employee's treating doctor.  The insurance carrier shall pay the costs of the examination.
(c)  After the medical examination is performed, the treating doctor shall submit to the insurance carrier a report that details all injuries and diagnoses related to the compensable injury, on receipt of which the insurance carrier shall:
(1)  accept all injuries and diagnoses as related to the compensable injury; or
(2)  dispute the determination of specific injuries and diagnoses.
(d)  Any treatment for an injury or diagnosis that is not accepted by the insurance carrier under Subsection (c) as compensable at the time of the medical examination under Subsection (a) must be preauthorized before treatment is rendered. If the insurance carrier denies preauthorization because the treatment is for an injury or diagnosis unrelated to the compensable injury, the injured employee or affected health care provider may file an extent of injury dispute.
(e)  Any treatment for an injury or diagnosis that is accepted by the insurance carrier under Subsection (c) as compensable at the time of the medical examination under Subsection (a) may not be reviewed for compensability, but may be reviewed for medical necessity.
(f)  The commissioner may adopt rules relating to requirements for a report under this section, including requirements regarding the contents of a report.
(g)  This section does not limit an injured employee or insurance carrier's ability to request an examination under Section 408.004 or 408.0041, as provided by those sections.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.0805, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.0043. Professional Specialty Certification Required for Certain Review

Sec. 408.0043.  PROFESSIONAL SPECIALTY CERTIFICATION REQUIRED FOR CERTAIN REVIEW.  (a)  This section applies to a person, other than a chiropractor or a dentist, who performs health care services under this title as:
(1)  a doctor performing peer review;
(2)  a doctor performing a utilization review of a health care service provided to an injured employee;
(3)  a doctor performing an independent review of a health care service provided to an injured employee;
(4)  a designated doctor;
(5)  a doctor performing a required medical examination; or
(6)  a doctor serving as a member of the medical quality review panel.
(b)  A person described by Subsection (a) who reviews a specific workers' compensation case must hold a professional certification in a health care specialty appropriate to the type of health care that the injured employee is receiving.
(c)  Notwithstanding Subsection (b), if a health care service is requested, ordered, provided, or to be provided by a physician, a person described by Subsection (a)(1), (2), or (3) who reviews the service with respect to a specific workers' compensation case must be of the same or a similar specialty as that physician.
Added by Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 1, eff. September 1, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 14, eff. September 1, 2009.
Acts 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742), Sec. 3.10, eff. September 1, 2019.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.0044. Review of Dental Services

Sec. 408.0044.  REVIEW OF DENTAL SERVICES.  (a)  This section applies to a dentist who performs dental services under this title as:
(1)  a doctor performing peer review of dental services;
(2)  a doctor performing a utilization review of a dental service provided to an injured employee;
(3)  a doctor performing an independent review of a dental service provided to an injured employee; or
(4)  a doctor performing a required dental examination.
(b)  A person described by Subsection (a) who reviews a dental service provided in conjunction with a specific workers' compensation case must be licensed to practice dentistry.
Added by Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 1, eff. September 1, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 15, eff. September 1, 2009.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.0045. Review of Chiropractic Services

Sec. 408.0045.  REVIEW OF CHIROPRACTIC SERVICES.  (a)  This section applies to a chiropractor who performs chiropractic services under this title as:
(1)  a doctor performing peer review of chiropractic services;
(2)  a doctor performing a utilization review of a chiropractic service provided to an injured employee;
(3)  a doctor performing an independent review of a chiropractic service provided to an injured employee;
(4)  a designated doctor providing chiropractic services;
(5)  a doctor performing a required medical examination; or
(6)  a chiropractor serving as a member of the medical quality review panel.
(b)  A person described by Subsection (a) who reviews a chiropractic service provided in conjunction with a specific workers' compensation case must be licensed to engage in the practice of chiropractic.
Added by Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 1, eff. September 1, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 16, eff. September 1, 2009.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.0046. Rules

Sec. 408.0046.  RULES.  The commissioner may adopt rules as necessary to determine which professional health practitioner specialties are appropriate for treatment of certain compensable injuries.  The rules adopted under this section must require an entity requesting a peer review to obtain and provide to the doctor providing peer review services all relevant and updated medical records.
Added by Acts 2007, 80th Leg., R.S., Ch. 1218 (H.B. 2004), Sec. 1, eff. September 1, 2007.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.005. Settlements and Agreements

Sec. 408.005.  SETTLEMENTS AND AGREEMENTS.  (a)  A settlement may not provide for payment of benefits in a lump sum except as provided by Section 408.128.
(b)  An employee's right to medical benefits as provided by Section 408.021 may not be limited or terminated.
(c)  A settlement or agreement resolving an issue of impairment:
(1)  may not be made before the employee reaches maximum medical improvement;  and
(2)  must adopt an impairment rating using the impairment rating guidelines described by Section 408.124.
(d)  A settlement must be signed by the commissioner and all parties to the dispute.
(e)  The commissioner shall approve a settlement if the commissioner is satisfied that:
(1)  the settlement accurately reflects the agreement between the parties;
(2)  the settlement reflects adherence to all appropriate provisions of law and the policies of the division; and
(3)  under the law and facts, the settlement is in the best interest of the claimant.
(f)  A settlement that is not approved or rejected before the 16th day after the date the settlement is submitted to the commissioner is considered to be approved by the commissioner on that date.
(g)  A settlement takes effect on the date it is approved by the commissioner.
(h)  A party to a settlement may withdraw acceptance of the settlement at any time before its effective date.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.081, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.006. Mental Trauma Injuries

Sec. 408.006.  MENTAL TRAUMA INJURIES.  (a)  It is the express intent of the legislature that nothing in this subtitle shall be construed to limit or expand recovery in cases of mental trauma injuries.
(b)  Notwithstanding Section 504.019, a mental or emotional injury that arises principally from a legitimate personnel action, including a transfer, promotion, demotion, or termination, is not a compensable injury under this subtitle.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 353 (H.B. 1983), Sec. 2, eff. September 1, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.007. Date of Injury for Occupational Disease

Sec. 408.007.  DATE OF INJURY FOR OCCUPATIONAL DISEASE.  For purposes of this subtitle, the date of injury for an occupational disease is the date on which the employee knew or should have known that the disease may be related to the employment.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter A. General Provisions › Section 408.008. Compensability of Heart Attacks

Sec. 408.008.  COMPENSABILITY OF HEART ATTACKS.  A heart attack is a compensable injury under this subtitle only if:
(1)  the attack can be identified as:
(A)  occurring at a definite time and place;  and
(B)  caused by a specific event occurring in the course and scope of the employee's employment;
(2)  the preponderance of the medical evidence regarding the attack indicates that the employee's work rather than the natural progression of a preexisting heart condition or disease was a substantial contributing factor of the attack;  and
(3)  the attack was not triggered solely by emotional or mental stress factors, unless it was precipitated by a sudden stimulus.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter B. Medical Benefits › Section 408.021. Entitlement to Medical Benefits

Sec. 408.021.  ENTITLEMENT TO MEDICAL BENEFITS.  (a)  An employee who sustains a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when needed.  The employee is specifically entitled to health care that:
(1)  cures or relieves the effects naturally resulting from the compensable injury;
(2)  promotes recovery;  or
(3)  enhances the ability of the employee to return to or retain employment.
(b)  Medical benefits are payable from the date of the compensable injury.
(c)  Except in an emergency, all health care must be approved or recommended by the employee's treating doctor.
(d)  An insurance carrier's liability for medical benefits may not be limited or terminated by agreement or settlement.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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 408.0446. Average Weekly Wage; School District Employee

Sec. 408.0446.  AVERAGE WEEKLY WAGE;  SCHOOL DISTRICT EMPLOYEE.  (a)  For determining the amount of temporary income benefits of a school district employee under Chapter 504, the average weekly wage is computed on the basis of wages earned in a week rather than on the basis of wages paid in a week.  The wages earned in any given week are equal to the amount that would be deducted from an employee's salary if the employee were absent from work for one week and the employee did not have personal leave available to compensate the employee for lost wages for that week.
(b)  An insurance carrier may adjust a school district employee's average weekly wage as often as necessary to reflect the wages the employee reasonably could expect to earn during the period for which temporary income benefits are paid.  In adjusting a school district employee's average weekly wage under this subsection, the insurance carrier may consider any evidence of the employee's reasonable expectation of earnings.
(c)  For determining the amount of impairment income benefits, supplemental income benefits, lifetime income benefits, or death benefits of a school district employee under Chapter 504, the average weekly wage of the employee is computed by dividing the total amount of wages earned by the employee during the 12 months immediately preceding the date of the injury by 50.
(d)  If the commissioner determines that computing the average weekly wage of a school district employee as provided by this section is impractical because the employee did not earn wages during the 12 months immediately preceding the date of the injury, the commissioner shall compute the average weekly wage in a manner that is fair and just to both parties.
(e)  The commissioner shall adopt rules as necessary to implement this section.
Added by Acts 2001, 77th Leg., ch. 1456, Sec. 10.04, eff. June 17, 2001.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.098, eff. September 1, 2005.
2023 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 408.045. Nonpecuniary Wages

Sec. 408.045.  NONPECUNIARY WAGES.  The division may not include nonpecuniary wages in computing an employee's average weekly wage during a period in which the employer continues to provide the nonpecuniary wages.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.099, eff. September 1, 2005.
2023 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 408.046. Similar Employees, Services, or Employment

Sec. 408.046.  SIMILAR EMPLOYEES, SERVICES, OR EMPLOYMENT.  For purposes of this subchapter and Subchapter D, the determination as to whether employees, services, or employment are the same or similar must include consideration of:
(1)  the training and experience of the employees;
(2)  the nature of the work;  and
(3)  the number of hours normally worked.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
2023 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 408.047. State Average Weekly Wage

Sec. 408.047.  STATE AVERAGE WEEKLY WAGE.  (a)  On and after October 1, 2006, the state average weekly wage is equal to 88 percent of the average weekly wage in covered employment computed by the Texas Workforce Commission under Section 207.002(c).
(b)  Expired.
(c)  Notwithstanding Subsection (a), the commissioner by rule may increase the state average weekly wage to an amount not to exceed 100 percent of the average weekly wage in covered employment computed by the Texas Workforce Commission under Section 207.002(c).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 2003, 78th Leg., ch. 963, Sec. 6, eff. June 20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.100, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter D. Computation of Benefits › Section 408.061. Maximum Weekly Benefit

Sec. 408.061.  MAXIMUM WEEKLY BENEFIT.  (a)  A weekly temporary income benefit may not exceed 100 percent of the state average weekly wage under Section 408.047 rounded to the nearest whole dollar.
(b)  A weekly impairment income benefit may not exceed 70 percent of the state average weekly wage rounded to the nearest whole dollar.
(c)  A weekly supplemental income benefit may not exceed 70 percent of the state average weekly wage rounded to the nearest whole dollar.
(d)  A weekly death benefit may not exceed 100 percent of the state average weekly wage rounded to the nearest whole dollar.
(e)  A weekly lifetime income benefit may not exceed 100 percent of the state average weekly wage rounded to the nearest whole dollar.
(f)  The division shall compute the maximum weekly income benefits for each state fiscal year not later than October 1 of each year.
(g)  The maximum weekly income benefit in effect on the date of injury is applicable for the entire time that the benefit is payable.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.101, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter D. Computation of Benefits › Section 408.062. Minimum Weekly Income Benefit

Sec. 408.062.  MINIMUM WEEKLY INCOME BENEFIT.  (a)  The minimum weekly income benefit is 15 percent of the state average weekly wage as determined under Section 408.047, rounded to the nearest whole dollar.
(b)  The division shall compute the minimum weekly income benefit for each state fiscal year not later than October 1 of each year.
(c)  The minimum weekly income benefit in effect on the date of injury is applicable for the entire time that income benefits are payable.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.102, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter D. Computation of Benefits › Section 408.063. Wage Presumptions; Administrative Violation

Sec. 408.063.  WAGE PRESUMPTIONS;  ADMINISTRATIVE VIOLATION.  (a)  To expedite the payment of income benefits, the commissioner may by rule establish reasonable presumptions relating to the wages earned by an employee, including the presumption that an employee's last paycheck accurately reflects the employee's usual wage.
(b)  Not later than the 30th day after the date the employer receives notice of an injury to the employee, the employer shall file a wage statement showing the amount of all wages paid to the employee.
(c)  An employer who fails to file a wage statement in accordance with Subsection (b) commits an administrative violation.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.103, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter D. Computation of Benefits › Section 408.064. Interest on Accrued Benefits

Sec. 408.064.  INTEREST ON ACCRUED BENEFITS.  (a)  An order to pay income or death benefits accrued but unpaid must include interest on the amount of compensation due at the rate provided by Section 401.023.
(b)  Accrued but unpaid compensation and interest shall be paid in a lump sum.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 408 - Workers' Compensation Benefits › Subchapter E. Income Benefits in General › Section 408.081. Income Benefits

Sec. 408.081.  INCOME BENEFITS.  (a)  An employee is entitled to timely and accurate income benefits as provided in this chapter.
(b)  Except as otherwise provided by this section or this subtitle, income benefits shall be paid weekly as and when they accrue without order from the commissioner.  Interest on accrued but unpaid benefits shall be paid, without order of the commissioner, at the time the accrued benefits are paid.
(c)  The commissioner by rule shall establish requirements for agreements under which income benefits may be paid monthly.  Income benefits may be paid monthly only:
(1)  on the request of the employee and the agreement of the employee and the insurance carrier; and
(2)  in compliance with the requirements adopted by the commissioner.
(d)  An employee's entitlement to income benefits under this chapter terminates on the death of the employee.  An interest in future income benefits does not survive after the employee's death.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1999, 76th Leg., ch. 1426, Sec. 11, eff. Sept. 1, 1999.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.104, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1153 (H.B. 2089), Sec. 1, eff. September 1, 2011.