reglab/statecodes huggingface dataset:
2023 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(c)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff.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(d)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff.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(f)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff.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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter B. Sanctions › Section 415.0211. Emergency Cease and Desist Order

Sec. 415.0211.  EMERGENCY CEASE AND DESIST ORDER.  (a)  The commissioner ex parte may issue an emergency cease and desist order if:
(1)  the commissioner believes a person regulated by the division under this title is engaging in conduct violating a law, rule, or order; and
(2)  the commissioner believes that the alleged conduct under Subdivision (1) will result in harm to the health, safety, or welfare of another person.
(b)  On issuance of an order under Subsection (a), the commissioner shall serve on the affected person an order that contains a statement of the charges and requires the person immediately to cease and desist from the acts, methods, or practices stated in the order.  The commissioner shall serve the order by registered or certified mail, return receipt requested, to the affected person's last known address.  The order is final on the 31st day after the date the affected person receives the order, unless the affected person requests a hearing under Subsection (c).
(c)  A person affected by an order is entitled to request a hearing to contest the order.  The affected person must request the hearing not later than the 30th day after the date the person receives the order required by Subsection (b).  A request to contest an order must:
(1)  be in writing;
(2)  be directed to the commissioner; and
(3)  state the grounds for the request to set aside or modify the order.
(d)  On receiving a request for a hearing, the commissioner shall serve notice of the time and place of the hearing.  The hearing is subject to the procedures for a contested case under Chapter 2001, Government Code.  The hearing shall be held not later than the 10th day after the date the commissioner receives the request for a hearing unless the parties mutually agree to a later hearing date.  At the hearing, the person requesting the hearing is entitled to show cause why the order should not be affirmed.  Following receipt of the proposal for decision from the State Office of Administrative Hearings regarding the hearing, the commissioner shall wholly or partly affirm, modify, or set aside the order.
(e)  Pending a hearing under this section, an order continues in effect unless the order is stayed by the commissioner.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 32, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter B. Sanctions › Section 415.0215. Sanctions

Sec. 415.0215.  SANCTIONS.  (a)  The division may impose sanctions against any person regulated by the division under this subtitle.
(b)  Only the commissioner may impose:
(1)  a sanction that deprives a person of the right to practice before the division or of the right to receive remuneration under this subtitle for a period exceeding 30 days; or
(2)  another sanction suspending for more than 30 days or revoking a license, certification, or permit required for practice in the field of workers' compensation.
(c)  A sanction imposed by the division is binding pending appeal.
Transferred and redesignated from Labor Code, Section 402.072 by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 33, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter B. Sanctions › Section 415.023. Commission of Wrongful Act as Matter of Practice; Administrative Violation

Sec. 415.023.  COMMISSION OF WRONGFUL ACT AS MATTER OF PRACTICE;  ADMINISTRATIVE VIOLATION.  (a)  A person who commits an administrative violation under Section 415.001, 415.002, 415.003, or 415.0035 as a matter of practice is subject to an applicable rule adopted under Subsection (b) in addition to the penalty assessed for the violation.
(b)  The commissioner may adopt rules providing for:
(1)  a reduction or denial of fees;
(2)  public or private reprimand by the commissioner;
(3)  suspension from practice before the division;
(4)  restriction, suspension, or revocation of the right to receive reimbursement under this subtitle; or
(5)  referral and petition to the appropriate licensing authority for appropriate disciplinary action, including the restriction, suspension, or revocation of the person's license.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.08, eff. June 17, 2001.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.276, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter B. Sanctions › Section 415.024. Breach of Settlement Agreement; Administrative Violation

Sec. 415.024.  BREACH OF SETTLEMENT AGREEMENT; ADMINISTRATIVE VIOLATION.  A material and substantial breach of a settlement agreement that establishes a compliance plan is an administrative violation.  In determining the amount of the penalty, the commissioner shall consider the total volume of claims handled by the insurance carrier.
Added by Acts 1997, 75th Leg., ch. 1443, Sec. 9, eff. Sept. 1, 1997.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.277, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter B. Sanctions › Section 415.025. References to a Class of Violation or Penalty

Sec. 415.025.  REFERENCES TO A CLASS OF VIOLATION OR PENALTY.  A reference in this code or other law, or in rules of the former Texas Workers' Compensation Commission or the commissioner, to a particular class of violation, administrative violation, or penalty shall be construed as a reference to an administrative penalty.  An administrative penalty may not exceed $25,000 per day per occurrence.  Each day of noncompliance constitutes a separate violation.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.278, eff. September 1, 2005.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 34, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter C. Procedures › Section 415.031. Initiation of Administrative Violation Proceedings

Sec. 415.031.  INITIATION OF ADMINISTRATIVE VIOLATION PROCEEDINGS.  Any person may request the initiation of administrative violation proceedings by filing a written allegation with the division.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.279, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter C. Procedures › Section 415.032. Notice of Possible Administrative Violation; Response

Sec. 415.032.  NOTICE OF POSSIBLE ADMINISTRATIVE VIOLATION; RESPONSE.  (a)  If investigation by the division indicates that an administrative violation has occurred, the division shall notify the person alleged to have committed the violation in writing of:
(1)  the charge;
(2)  the proposed sanction;
(3)  the right to consent to the charge and the sanction; and
(4)  the right to request a hearing.
(b)  Not later than the 20th day after the date on which notice is received, the charged party shall:
(1)  remit the amount of the sanction to the division or otherwise consent to the imposed sanction; or
(2)  submit to the division a written request for a hearing.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.280, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 34, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter C. Procedures › Section 415.033. Failure to Respond

Sec. 415.033.  FAILURE TO RESPOND.  If, without good cause, a charged party fails to respond as required under Section 415.032, the division shall initiate enforcement proceedings.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.281, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 34, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter C. Procedures › Section 415.034. Hearing Procedures

Sec. 415.034.  HEARING PROCEDURES.   On the request of the charged party or the commissioner, the State Office of Administrative Hearings shall set a hearing.  The hearing shall be conducted in the manner provided for a contested case under Chapter 2001, Government Code (the administrative procedure law).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff. Sept. 1, 1995;  Acts 1995, 74th Leg., ch. 980, Sec. 1.46, eff. Sept. 1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.282, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 34, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter C. Procedures › Section 415.035. Judicial Review

Sec. 415.035.  JUDICIAL REVIEW.  A decision under Section 415.034 is subject to judicial review in the manner provided for judicial review under Chapter 2001, Government Code.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff. Sept. 1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.283, eff. September 1, 2005.
Acts 2017, 85th Leg., R.S., Ch. 140 (H.B. 1456), Sec. 1, eff. May 26, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 415 - Administrative Violations › Subchapter C. Procedures › Section 415.036. Standard of Judicial Review of Commissioner's Order

Sec. 415.036.  STANDARD OF JUDICIAL REVIEW OF COMMISSIONER'S ORDER.  An order of the commissioner is subject to judicial review under the substantial evidence rule.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 35, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 416 - Actions Against Insurance Carrier for Breach of Duty › Section 416.001. Certain Causes of Action Precluded

Sec. 416.001.  CERTAIN CAUSES OF ACTION PRECLUDED.  An action taken by an insurance carrier under an order of the commissioner or recommendations of a benefit review officer under Section 410.031, 410.032, or 410.033 may not be the basis of a cause of action against the insurance carrier for a breach of the duty of good faith and fair dealing.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.284, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 416 - Actions Against Insurance Carrier for Breach of Duty › Section 416.002. Exemplary Damages

Sec. 416.002.  EXEMPLARY DAMAGES.  (a)  In an action against an insurance carrier for a breach of the duty of good faith and fair dealing, recovery of exemplary damages is limited to the greater of:
(1)  four times the amount of actual damages;  or
(2)  $250,000.
(b)  An action against a governmental entity or unit or an employee of a governmental entity or unit for a breach of the duty of good faith and fair dealing is governed by Chapters 101 and 104, Civil Practice and Remedies Code.
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 417 - Third-Party Liability › Section 417.001. Third-Party Liability

Sec. 417.001.  THIRD-PARTY LIABILITY.  (a)  An employee or legal beneficiary may seek damages from a third party who is or becomes liable to pay damages for an injury or death that is compensable under this subtitle and may also pursue a claim for workers' compensation benefits under this subtitle.
(b)  If a benefit is claimed by an injured employee or a legal beneficiary of the employee, the insurance carrier is subrogated to the rights of the injured employee and may enforce the liability of the third party in the name of the injured employee or the legal beneficiary.  The insurance carrier's subrogation interest is limited to the amount of the total benefits paid or assumed by the carrier to the employee or the legal beneficiary, less the amount by which the court reduces the judgment based on the percentage of responsibility determined by the trier of fact under Section 33.003, Civil Practice and Remedies Code, attributable to the employer.  If the recovery is for an amount greater than the amount of the insurance carrier's subrogation interest, the insurance carrier shall:
(1)  reimburse itself and pay the costs from the amount recovered;  and
(2)  pay the remainder of the amount recovered to the injured employee or the legal beneficiary.
(c)  If a claimant receives benefits from the subsequent injury fund, the division is:
(1)  considered to be the insurance carrier under this section for purposes of those benefits;
(2)  subrogated to the rights of the claimant; and
(3)  entitled to reimbursement in the same manner as the insurance carrier.
(d)  The division shall remit money recovered under this section to the comptroller for deposit to the credit of the subsequent injury fund.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 1423, Sec. 12.13, eff. Sept. 1, 1997;  Acts 2003, 78th Leg., ch. 204, Sec. 4.09, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.285, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 417 - Third-Party Liability › Section 417.002. Recovery in Third-Party Action

Sec. 417.002.  RECOVERY IN THIRD-PARTY ACTION.  (a)  The net amount recovered by a claimant in a third-party action shall be used to reimburse the insurance carrier for benefits, including medical benefits, that have been paid for the compensable injury.
(b)  Any amount recovered that exceeds the amount of the reimbursement required under Subsection (a) shall be treated as an advance against future benefits, including medical benefits, that the claimant is entitled to receive under this subtitle.
(c)  If the advance under Subsection (b) is adequate to cover all future benefits, the insurance carrier is not required to resume the payment of benefits.  If the advance is insufficient, the insurance carrier shall resume the payment of benefits when the advance is exhausted.
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 417 - Third-Party Liability › Section 417.003. Attorney's Fee for Representation of Insurance Carrier's Interest

Sec. 417.003.  ATTORNEY'S FEE FOR REPRESENTATION OF INSURANCE CARRIER'S INTEREST.  (a)  An insurance carrier whose interest is not actively represented by an attorney in a third-party action shall pay a fee to an attorney representing the claimant in the amount agreed on between the attorney and the insurance carrier.  In the absence of an agreement, the court shall award to the attorney payable out of the insurance carrier's recovery:
(1)  a reasonable fee for recovery of the insurance carrier's interest that may not exceed one-third of the insurance carrier's recovery;  and
(2)  a proportionate share of expenses.
(b)  An attorney who represents the claimant and is also to represent the subrogated insurance carrier shall make a full written disclosure to the claimant before employment as an attorney by the insurance carrier.  The claimant must acknowledge the disclosure and consent to the representation.  A signed copy of the disclosure shall be furnished to all concerned parties and made a part of the division file.  A copy of the disclosure with the claimant's consent shall be filed with the claimant's pleading before a judgment is entered and approved by the court.  The claimant's attorney may not receive a fee under this section to which the attorney is otherwise entitled under an agreement with the insurance carrier unless the attorney complies with the requirements of this subsection.
(c)  If an attorney actively representing the insurance carrier's interest actively participates in obtaining a recovery, the court shall award and apportion between the claimant's and the insurance carrier's attorneys a fee payable out of the insurance carrier's subrogation recovery.  In apportioning the award, the court shall consider the benefit accruing to the insurance carrier as a result of each attorney's service.  The total attorney's fees may not exceed one-third of the insurance carrier's recovery.
(d)  For purposes of determining the amount of an attorney's fee under this section, only the amount recovered for benefits, including medical benefits, that have been paid by the insurance carrier may be considered.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.286, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 417 - Third-Party Liability › Section 417.004. Employer Liability to Third Party

Sec. 417.004.  EMPLOYER LIABILITY TO THIRD PARTY.  In an action for damages brought by an injured employee, a legal beneficiary, or an insurance carrier against a third party liable to pay damages for the injury or death under this chapter that results in a judgment against the third party or a settlement by the third party, the employer is not liable to the third party for reimbursement or damages based on the judgment or settlement unless the employer executed, before the injury or death occurred, a written agreement with the third party to assume the liability.
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 418 - Criminal Investigations and Penalties › Section 418.001. Penalty for Fraudulently Obtaining or Denying Benefits

Sec. 418.001.  PENALTY FOR FRAUDULENTLY OBTAINING OR DENYING BENEFITS.  (a)  A person commits an offense if the person, with the intent to obtain or deny payment of benefits, including medical benefits, under this subtitle or Subtitle C, for himself or another, knowingly or intentionally:
(1)  makes a false or misleading statement;
(2)  misrepresents or conceals a material fact;  or
(3)  fabricates, alters, conceals, or destroys a document other than a governmental record.
(b)  An offense under Subsection (a) is:
(1)  a Class A misdemeanor if the value of the benefits is less than $2,500; and
(2)  a state jail felony if the value of the benefits is $2,500 or more.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.47, eff. Sept. 1, 1995.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 463 (H.B. 2053), Sec. 4, eff. June 9, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 418 - Criminal Investigations and Penalties › Section 418.002. Penalty for Fraudulently Obtaining Workers' Compensation Insurance Coverage

Sec. 418.002.  PENALTY FOR FRAUDULENTLY OBTAINING WORKERS' COMPENSATION INSURANCE COVERAGE.  (a)  A person commits an offense if the person, with the intent to obtain workers' compensation insurance coverage under the workers' compensation insurance laws of this state or to avoid payment of premiums due for that coverage, for himself or another, knowingly or intentionally:
(1)  makes a false statement;
(2)  misrepresents or conceals a material fact;  or
(3)  makes a false entry in, fabricates, alters, conceals, or destroys a document other than a governmental record.
(b)  An offense under Subsection (a) is:
(1)  a Class A misdemeanor if the amount of premium avoided is less than $2,500; and
(2)  a state jail felony if the amount of the premium avoided is $2,500 or more.
(c)  The court may order a person to pay restitution to an insurance company, including the Texas Mutual Insurance Company, if the person commits an offense under this section.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.47, eff. Sept. 1, 1995.  Amended by Acts 2001, 77th Leg., ch. 1195, Sec. 2.12, eff. Sept. 1, 2001.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 463 (H.B. 2053), Sec. 5, eff. June 9, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 418 - Criminal Investigations and Penalties › Section 418.003. Election of Prosecution

Sec. 418.003.  ELECTION OF PROSECUTION.  A person who commits an offense under this chapter may be prosecuted under this chapter or any other law of this state under which the person may be prosecuted.
Added by Acts 2007, 80th Leg., R.S., Ch. 429 (S.B. 1627), Sec. 1, eff. June 15, 2007.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 418 - Criminal Investigations and Penalties › Section 418.004. Subpoena Authority

Sec. 418.004.  SUBPOENA AUTHORITY.  (a)  The commissioner may issue a subpoena to compel the attendance and testimony of a witness or the production of materials relevant to an investigation of an offense under this chapter.
(b)  The commissioner may issue a subpoena under Subsection (a) regarding a witness or materials located in this state or in another state.
Added by Acts 2017, 85th Leg., R.S., Ch. 463 (H.B. 2053), Sec. 6, eff. June 9, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 419 - Misuse of Division Name › Section 419.001. Definitions

Sec. 419.001.  DEFINITIONS.  (a)  In this chapter:
(1)  "Representation of the division's logo" includes a nonexact representation that is deceptively similar to the logo used by the division.
(2)  "Representation of the state seal" has the meaning assigned by Section 17.08(a)(2), Business & Commerce Code.
(b)  A term or representation is "deceptively similar" for purposes of this chapter if:
(1)  a reasonable person would believe that the term or representation is in any manner approved, endorsed, sponsored, authorized by, the same as, or associated with the division, the department, this state, or an agency of this state; or
(2)  the circumstances under which the term is used could mislead a reasonable person as to its identity.
(c)  For purposes of this chapter, a person acts in a "deceptive manner" if the person knows or should know that the person's actions would convey, or could reasonably be interpreted or construed as conveying, the false impression that:
(1)  an item is approved, endorsed, sponsored, authorized by, the same as, or associated with the division, the department, this state, or an agency of this state; or
(2)  the person represents, speaks for, or has an authorization from the division, the department, this state, or an agency of this state.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.287, eff. September 1, 2005.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 743 (S.B. 381), Sec. 1, eff. September 1, 2013.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 419 - Misuse of Division Name › Section 419.002. Misuse of Division's Name or Symbols Prohibited

Sec. 419.002.  MISUSE OF DIVISION'S NAME OR SYMBOLS PROHIBITED.  (a)  Except as authorized by law, a person, in connection with any impersonation, advertisement, solicitation, business name, business activity, business document, product, or service made or offered by the person regarding workers' compensation coverage or benefits, may not knowingly use or cause to be used in a deceptive manner:
(1)  the words "Texas Department of Insurance," "Department of Insurance," "Texas Workers' Compensation," or "division of workers' compensation";
(2)  any term using both "Texas" and "Workers' Compensation" or any term using both "Texas" and "Workers' Comp";
(3)  the initials "T.D.I."; or
(4)  any combination or variation of the words or initials, or any term deceptively similar to the words or initials, described by Subdivisions (1)-(3).
(b)  A person subject to Subsection (a) may not knowingly use or cause to be used in a deceptive manner a word, term, or initials described by Subsection (a) alone or in conjunction with:
(1)  the state seal or a representation of the state seal;
(2)  a picture or map of this state; or
(3)  the official logo of the department or the division or a representation of the department's or division's logo.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.287, eff. September 1, 2005.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 743 (S.B. 381), Sec. 2, eff. September 1, 2013.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 419 - Misuse of Division Name › Section 419.003. Rules

Sec. 419.003.  RULES.  The commissioner may adopt rules relating to the regulation of the use of the division's name and other rules as necessary to implement this chapter.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.287, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 419 - Misuse of Division Name › Section 419.004. Civil Penalty

Sec. 419.004.  CIVIL PENALTY.  (a)  A person who violates Section 419.002 or a rule adopted under this chapter is liable for a civil penalty not to exceed $5,000 for each violation.
(b)  The attorney general, at the request of the commissioner, shall bring an action to collect a civil penalty under this section in a district court in Travis County.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.287, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 419 - Misuse of Division Name › Section 419.005. Administrative Penalty

Sec. 419.005.  ADMINISTRATIVE PENALTY.  (a)  The division may assess an administrative penalty against a person who violates Section 419.002 or a rule adopted under this chapter.
(b)  An administrative penalty imposed under this section is subject to the procedural requirements adopted for administrative penalties imposed under Section 415.021.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.287, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 419 - Misuse of Division Name › Section 419.006. Injunctive Relief

Sec. 419.006.  INJUNCTIVE RELIEF.  (a)  At the request of the commissioner, the attorney general or a district attorney may bring an action in district court in Travis County to enjoin or restrain a violation or threatened violation of this chapter on a showing that a violation has occurred or is likely to occur.
(b)  The division may recover the costs of investigating an alleged violation of this chapter if an injunction is issued.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.287, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 419 - Misuse of Division Name › Section 419.007. Remedies Not Exclusive

Sec. 419.007.  REMEDIES NOT EXCLUSIVE.  The remedies provided by this chapter are not exclusive and may be sought in any combination determined by the commissioner as necessary to enforce this chapter.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.287, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle B - Discrimination Issues › Chapter 451 - Discrimination Prohibited › Section 451.001. Discrimination Against Employees Prohibited

Sec. 451.001.  DISCRIMINATION AGAINST EMPLOYEES PROHIBITED.  A person may not discharge or in any other manner discriminate against an employee because the employee has:
(1)  filed a workers' compensation claim in good faith;
(2)  hired a lawyer to represent the employee in a claim;
(3)  instituted or caused to be instituted in good faith a proceeding under Subtitle A;   or
(4)  testified or is about to testify in a proceeding under Subtitle A.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle B - Discrimination Issues › Chapter 451 - Discrimination Prohibited › Section 451.002. Remedies; Burden of Proof

Sec. 451.002.  REMEDIES;  BURDEN OF PROOF.  (a)  A person who violates Section 451.001 is liable for reasonable damages incurred by the employee as a result of the violation.
(b)  An employee discharged in violation of Section 451.001 is entitled to reinstatement in the former position of employment.
(c)  The burden of proof in a proceeding under this section is on the employee.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle B - Discrimination Issues › Chapter 451 - Discrimination Prohibited › Section 451.0025. Waiver of Immunity; Permission for First Responder to Sue

Sec. 451.0025.  WAIVER OF IMMUNITY; PERMISSION FOR FIRST RESPONDER TO SUE.  (a)  In this section, "first responder" has the meaning assigned by Section 421.095, Government Code.
(b)  A first responder who alleges a violation of Section 451.001 by a state or local governmental entity that employs the first responder may sue the governmental entity for the relief provided by this chapter.  Sovereign or governmental immunity from suit is waived and abolished to the extent of liability created by this chapter.
(c)  To the extent a person has official or individual immunity from a claim for damages, this section does not affect that immunity.
Added by Acts 2017, 85th Leg., R.S., Ch. 810 (H.B. 451), Sec. 1, eff. September 1, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle B - Discrimination Issues › Chapter 451 - Discrimination Prohibited › Section 451.003. Injunction

Sec. 451.003.  INJUNCTION.  A district court may restrain, for cause shown, a violation of Section 451.001.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle C - Workers' Compensation Insurance Coverage for Certain Government Employees › Chapter 501 - Workers' Compensation Insurance Coverage for State Employees, Including Employees Under the Direction or Control of the Board of Regents of Texas Tech University › Subchapter A. General Provisions › Section 501.002. Application of General Workers' Compensation Laws; Limit on Actions and Damages

Sec. 501.002.  APPLICATION OF GENERAL WORKERS' COMPENSATION LAWS;  LIMIT ON ACTIONS AND DAMAGES.  (a)  The following provisions of Subtitles A and B apply to and are included in this chapter except to the extent that they are inconsistent with this chapter:
(1)  Chapter 401, other than Section 401.012 defining "employee";
(2)  Chapter 402;
(3)  Chapter 403, other than Sections 403.001-403.005;
(4)  Chapters 404 and 405;
(5)  Subchapters B and D through H, Chapter 406, other than Sections 406.071(a), 406.073, and 406.075;
(6)  Chapter 408, other than Sections 408.001(b) and (c);
(7)  Chapters 409 and 410;
(8)  Subchapters A and G, Chapter 411, other than Sections 411.003 and 411.004;
(9)  Chapters 412-417; and
(10)  Chapter 451.
(b)  For the purposes of this chapter and Chapter 451, the individual state agency shall be considered the employer.
(c)  For the purpose of applying the provisions listed by Subsection (a) to this chapter, "insurer" or "employer" means "state," "office," "director," or "state agency," as applicable.
(d)  Neither this chapter nor Subtitle A authorizes a cause of action or damages against the state, a state agency, or an employee of the state beyond the actions and damages authorized by Chapter 101, Civil Practice and Remedies Code.
(e)  For the purposes of this chapter and Chapter 451, the adjutant general is considered the employer of a member of the state military forces while engaged in authorized training or duty.
(f)  For purposes of this chapter and Subchapter D, Chapter 88, Education Code, the Texas Engineering Extension Service of The Texas A&M University System shall perform all duties of an employer in relation to a Texas Task Force 1 member who is injured and receives benefits under this chapter.
(g)  For purposes of this chapter and Section 88.126, Education Code, the Texas A&M Forest Service shall perform all duties of an employer in relation to an intrastate fire mutual aid system team member or a regional incident management team member who is injured and receives benefits under this chapter.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1995, 74th Leg., ch. 980, Sec. 2.01, eff. Sept. 1, 1995;  Acts 1997, 75th Leg., ch. 1098, Sec. 3, eff. Sept. 1, 1997;  Acts 1999, 76th Leg., ch. 1205, Sec. 6, eff. Sept. 1, 1999;  Acts 2003, 78th Leg., ch. 644, Sec. 4, eff. June 20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.289, eff. September 1, 2005.
Acts 2017, 85th Leg., R.S., Ch. 991 (H.B. 919), Sec. 5, eff. September 1, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle C - Workers' Compensation Insurance Coverage for Certain Government Employees › Chapter 501 - Workers' Compensation Insurance Coverage for State Employees, Including Employees Under the Direction or Control of the Board of Regents of Texas Tech University › Subchapter A. General Provisions › Section 501.003. Legal Beneficiary of Deceased Employee

Sec. 501.003.  LEGAL BENEFICIARY OF DECEASED EMPLOYEE.  (a)  The provisions of this chapter and the rules of the board affecting an employee also apply to the legal beneficiary of a deceased employee.
(b)  In this section, "legal beneficiary" has the meaning assigned to that term under Section 401.011.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 1098, Sec. 4, eff. Sept. 1, 1997.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle C - Workers' Compensation Insurance Coverage for Certain Government Employees › Chapter 501 - Workers' Compensation Insurance Coverage for State Employees, Including Employees Under the Direction or Control of the Board of Regents of Texas Tech University › Subchapter B. Coverage › Section 501.021. Workers' Compensation Coverage for Employees

Sec. 501.021.  WORKERS' COMPENSATION COVERAGE FOR EMPLOYEES.  An employee with a compensable injury is entitled to compensation by the director as provided by this chapter.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.