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 L. Attorney's Fees in Workers' Compensation Benefit Matters › Section 408.222. Attorney's Fees Paid to Defense Counsel

Sec. 408.222.  ATTORNEY'S FEES PAID TO DEFENSE COUNSEL.  (a)  The amount of an attorney's fee for defending an insurance carrier in a workers' compensation action brought under this subtitle must be approved by the division or court and determined by the division or court to be reasonable and necessary.
(b)  In determining whether a fee is reasonable under this section, the division or court shall consider issues analogous to those listed under Section 408.221(d).  The defense counsel shall present written evidence to the division or court relating to:
(1)  the time spent and expenses incurred in defending the case; and
(2)  other evidence considered necessary by the division or court in making a determination under this section.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 8.03, eff. June 17, 2001.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.133, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.001. Notice of Injury to Employer

Sec. 409.001.  NOTICE OF INJURY TO EMPLOYER.  (a)  An employee or a person acting on the employee's behalf shall notify the employer of the employee of an injury not later than the 30th day after the date on which:
(1)  the injury occurs;  or
(2)  if the injury is an occupational disease, the employee knew or should have known that the injury may be related to the employment.
(b)  The notice required under Subsection (a) may be given to:
(1)  the employer;  or
(2)  an employee of the employer who holds a supervisory or management position.
(c)  If the injury is an occupational disease, for purposes of this section, the employer is the person who employed the employee on the date of last injurious exposure to the hazards of the disease.
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 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.002. Failure to File Notice of Injury

Sec. 409.002.  FAILURE TO FILE NOTICE OF INJURY.  Failure to notify an employer as required by Section 409.001(a) relieves the employer and the employer's insurance carrier of liability under this subtitle unless:
(1)  the employer, a person eligible to receive notice under Section 409.001(b), or the employer's insurance carrier has actual knowledge of the employee's injury;
(2)  the division determines that good cause exists for failure to provide notice in a timely manner; or
(3)  the employer or the employer's insurance carrier does not contest the claim.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.134, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.003. Claim for Compensation

Sec. 409.003.  CLAIM FOR COMPENSATION.  An employee or a person acting on the employee's behalf shall file with the division a claim for compensation for an injury not later than one year after the date on which:
(1)  the injury occurred; or
(2)  if the injury is an occupational disease, the employee knew or should have known that the disease was related to the employee's employment.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.135, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.004. Effect of Failure to File Claim for Compensation

Sec. 409.004.  EFFECT OF FAILURE TO FILE CLAIM FOR COMPENSATION.  Failure to file a claim for compensation with the division as required under Section 409.003 relieves the employer and the employer's insurance carrier of liability under this subtitle unless:
(1)  good cause exists for failure to file a claim in a timely manner; or
(2)  the employer or the employer's insurance carrier does not contest the claim.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.136, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.006. Record of Injuries; Administrative Violation

Sec. 409.006.  RECORD OF INJURIES;  ADMINISTRATIVE VIOLATION.  (a)  An employer shall maintain a record of each employee injury as reported by an employee or otherwise made known to the employer.
(b)  The record shall be available to the division at reasonable times and under conditions prescribed by the commissioner.
(c)  The commissioner may adopt rules relating to the information that must be contained in an employer record under this section.
(d)  Information contained in a record maintained under this section is not an admission by the employer that:
(1)  the injury did in fact occur;  or
(2)  a fact maintained in the record is true.
(e)  A person commits an administrative violation if the person fails to comply with 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. 3.138, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.007. Death Benefit Claims

Sec. 409.007.  DEATH BENEFIT CLAIMS.  (a)  A person must file a claim for death benefits with the division or insurance carrier not later than the first anniversary of the date of the employee's death.
(b)  Failure to file in the time required by Subsection (a) bars the claim unless:
(1)  the person is a minor or incompetent;  or
(2)  good cause exists for the failure to file a claim under this section.
(c)  A separate claim must be filed for each legal beneficiary unless the claim expressly includes or is made on behalf of another person.
(d)  If a person files a claim for death benefits with an insurance carrier, at the time the carrier receives the claim the carrier shall, in the form and manner prescribed by the division:
(1)  create and maintain a record documenting receipt of the claim; and
(2)  provide written notice to the division that the person filed the claim.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.139, eff. September 1, 2005.
Acts 2023, 88th Leg., R.S., Ch. 502 (H.B. 2314), Sec. 2, eff. June 10, 2023.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.008. Failure to File Employer Report of Injury; Limitations Tolled

Sec. 409.008.  FAILURE TO FILE EMPLOYER REPORT OF INJURY;  LIMITATIONS TOLLED.  If an employer or the employer's insurance carrier has been given notice or has knowledge of an injury to or the death of an employee and the employer or insurance carrier fails, neglects, or refuses to file the report under Section 409.005, the period for filing a claim for compensation under Sections 409.003 and 409.007 does not begin to run against the claim of an injured employee or a legal beneficiary until the day on which the report required under Section 409.005 has been furnished.
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 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.009. Subclaims

Sec. 409.009.  SUBCLAIMS.  A person may file a written claim with the division as a subclaimant if the person has:
(1)  provided compensation, including health care provided by a health care insurer, directly or indirectly, to or for an employee or legal beneficiary; and
(2)  sought and been refused reimbursement from the insurance carrier.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.140, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.010. Information Provided to Employee or Legal Beneficiary

Sec. 409.010.  INFORMATION PROVIDED TO EMPLOYEE OR LEGAL BENEFICIARY.  Immediately on receiving notice of an injury or death from any person, the division shall send to the employee or legal beneficiary a clear and concise description of:
(1)  the services provided by:
(A)  the division; and
(B)  the office of injured employee counsel, including the services of the ombudsman program;
(2)  the division's procedures; and
(3)  the person's rights and responsibilities under this subtitle.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.141, eff. September 1, 2005.
Acts 2017, 85th Leg., R.S., Ch. 467 (H.B. 2112), Sec. 7, eff. June 9, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.011. Information Provided to Employer; Employer's Rights

Sec. 409.011.  INFORMATION PROVIDED TO EMPLOYER;  EMPLOYER'S RIGHTS.  (a)  Immediately on receiving notice of an injury or death from any person, the division shall send to the employer a description of:
(1)  the services provided by the division and the office of injured employee counsel;
(2)  the division's procedures; and
(3)  the employer's rights and responsibilities under this subtitle.
(b)  The information must include a clear statement of the following rights of the employer:
(1)  the right to be present at all administrative proceedings relating to an employee's claim;
(2)  the right to present relevant evidence relating to an employee's claim at any proceeding;
(3)  the right to report suspected fraud;
(4)  the right to contest the compensability of an injury if the insurance carrier accepts liability for the payment of benefits;
(5)  the right to receive notice, after making a written request to the insurance carrier, of:
(A)  a proposal to settle a claim;  or
(B)  an administrative or a judicial proceeding relating to the resolution of a claim;  and
(6)  the right to contest the failure of the insurance carrier to provide accident prevention services under Subchapter E, Chapter 411.
(c)  The division is not required to provide the information to an employer more than once during a calendar 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. 3.142, eff. September 1, 2005.
Acts 2017, 85th Leg., R.S., Ch. 467 (H.B. 2112), Sec. 8, eff. June 9, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.012. Vocational Rehabilitation Information

Sec. 409.012.  VOCATIONAL REHABILITATION INFORMATION.  (a)  The division shall analyze each report of injury received from an employer under this chapter to determine whether the injured employee would be assisted by vocational rehabilitation.
(b)  If the division determines that an injured employee would be assisted by vocational rehabilitation, the division shall notify:
(1)  the injured employee in writing of the services and facilities available through the Texas Workforce Commission and private providers of vocational rehabilitation; and
(2)  the Texas Workforce Commission that the injured employee has been identified as one who could be assisted by vocational rehabilitation.
(c)  The division shall cooperate with the office of injured employee counsel, the Texas Workforce Commission, and private providers of vocational rehabilitation in the provision of services and facilities to employees by the Texas Workforce Commission.
(d)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 467 (H.B. 2112), Sec. 11(6), eff. June 9, 2017.
(e)  The commissioner by rule may require that a private provider of vocational rehabilitation services maintain certain credentials and qualifications in order to provide services in connection with a workers' compensation insurance claim.
(f)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1083, Sec. 25(127), eff. June 17, 2011.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1999, 76th Leg., ch. 956, Sec. 2, eff. Sept. 1, 1999.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.143, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1083 (S.B. 1179), Sec. 25(127), eff. June 17, 2011.
Acts 2017, 85th Leg., R.S., Ch. 467 (H.B. 2112), Sec. 9, eff. June 9, 2017.
Acts 2017, 85th Leg., R.S., Ch. 467 (H.B. 2112), Sec. 11(6), eff. June 9, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter A. Injury Reports, Claims, and Records › Section 409.013. Plain Language Information; Notification of Injured Employee

Sec. 409.013.  PLAIN LANGUAGE INFORMATION; NOTIFICATION OF INJURED EMPLOYEE.  (a)  The division shall develop information for public dissemination about the benefit process and the compensation procedures established under this chapter.  The information must be written in plain language and must be available in English and Spanish.
(b)  On receipt of a report under Section 409.005, the division shall:
(1)  contact the affected employee; and
(2)  provide the information required under Subsection (a) to that employee, together with any other information that may be prepared by the office of injured employee counsel or the division for public dissemination that relates to the employee's situation, such as information relating to back injuries or occupational diseases.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.30, eff. Sept. 1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.144, eff. September 1, 2005.
Acts 2017, 85th Leg., R.S., Ch. 467 (H.B. 2112), Sec. 10, eff. June 9, 2017.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter B. Payment of Benefits › Section 409.022. Refusal to Pay Benefits; Notice; Administrative Violation

Sec. 409.022.  REFUSAL TO PAY BENEFITS;  NOTICE;  ADMINISTRATIVE VIOLATION.  (a)  An insurance carrier's notice of refusal to pay benefits under Section 409.021 must specify the grounds for the refusal.
(b)  The grounds for the refusal specified in the notice constitute the only basis for the insurance carrier's defense on the issue of compensability in a subsequent proceeding, unless the defense is based on newly discovered evidence that could not reasonably have been discovered at an earlier date.
(c)  An insurance carrier commits an administrative violation if the insurance carrier does not have reasonable grounds for a refusal to pay benefits, as determined by the commissioner.
(d)  In this subsection, the terms "custodial officer," "detention officer," "emergency medical technician," "firefighter," and "peace officer" have the meanings assigned by Section 607.051, Government Code.  In addition to the other requirements of this section, if an insurance carrier's notice of refusal to pay benefits under Section 409.021 is sent in response to a claim for compensation resulting from a custodial officer's, a detention officer's, an emergency medical technician's, a firefighter's, or a peace officer's disability or death for which a presumption is claimed to be applicable under Subchapter B, Chapter 607, Government Code, the notice must include a statement by the carrier that:
(1)  explains why the carrier determined a presumption under that subchapter does not apply to the claim for compensation; and
(2)  describes the evidence that the carrier reviewed in making the determination described by Subdivision (1).
(d-1)  An insurance carrier has not committed an administrative violation under Section 409.021 if the carrier has sent notice to the employee as required by Subsection (d) of this section or Section 409.021(a-3).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.146, eff. September 1, 2005.
Acts 2015, 84th Leg., R.S., Ch. 224 (H.B. 1388), Sec. 2, eff. May 29, 2015.
Acts 2019, 86th Leg., R.S., Ch. 701 (S.B. 2551), Sec. 4, eff. June 10, 2019.
Acts 2019, 86th Leg., R.S., Ch. 993 (S.B. 1582), Sec. 9, eff. September 1, 2019.
Acts 2021, 87th Leg., R.S., Ch. 505 (S.B. 22), Sec. 9, eff. June 14, 2021.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter B. Payment of Benefits › Section 409.023. Payment of Benefits; Administrative Violation

Sec. 409.023.  PAYMENT OF BENEFITS;  ADMINISTRATIVE VIOLATION.  (a)  An insurance carrier shall continue to pay benefits promptly as and when the benefits accrue without a final decision, order, or other action of the commissioner, except as otherwise provided.
(b)  Benefits shall be paid solely to the order of the employee or the employee's legal beneficiary.
(c)  An insurance carrier commits an administrative violation if the insurance carrier fails to comply with this section.
(d)  An insurance carrier that commits multiple violations of this section commits an additional administrative violation and is subject to:
(1)  the sanctions provided under Section 415.023; and
(2)  revocation of the right to do business under the workers' compensation laws of this state.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.147, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter B. Payment of Benefits › Section 409.0231. Payment by Electronic Funds Transfer

Sec. 409.0231.  PAYMENT BY ELECTRONIC FUNDS TRANSFER.  (a)  An insurance carrier shall offer employees entitled to the payment of benefits for a period of sufficient duration the option of receiving the payments by electronic funds transfer.  The insurance carrier shall provide the necessary forms to an employee who requests that benefits be paid by electronic funds transfer.
(b)  The commissioner shall adopt rules in consultation with the Texas Department of Information Resources as necessary to implement this section, including rules prescribing a period of benefits that is of sufficient duration to allow payment by electronic funds transfer.
Added by Acts 1999, 76th Leg., ch. 690, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.148, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter B. Payment of Benefits › Section 409.0232. Timeliness of Payments

Sec. 409.0232.  TIMELINESS OF PAYMENTS.  An insurance carrier is considered to have paid benefits in a timely manner if a payment:
(1)  is made by electronic funds transfer and is deposited in the employee's account on or before the benefit payment due date;
(2)  is made by mail and is mailed in time for the payment to be postmarked on or before the benefit payment due date;  or
(3)  is to be picked up by the employee and the payment is made available to the employee during regular business hours not later than the opening of business on the benefit payment due date.
Added by Acts 1999, 76th Leg., ch. 690, Sec. 1, eff. June 18, 1999.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 409 - Compensation Procedures › Subchapter B. Payment of Benefits › Section 409.024. Termination or Reduction of Benefits; Notice; Administrative Violation

Sec. 409.024.  TERMINATION OR REDUCTION OF BENEFITS; NOTICE; ADMINISTRATIVE VIOLATION.  (a)  An insurance carrier shall file with the division a notice of termination or reduction of benefits, including the reasons for the termination or reduction, not later than the 10th day after the date on which benefits are terminated or reduced.
(b)  An insurance carrier commits an administrative violation if the insurance carrier does not have reasonable grounds to terminate or reduce benefits, as determined by the commissioner.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.149, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter A. General Provisions › Section 410.002. Law Governing Liability Proceedings

Sec. 410.002.  LAW GOVERNING LIABILITY PROCEEDINGS.  A proceeding before the division to determine the liability of an insurance carrier for compensation for an injury or death under this subtitle is governed by this 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. 3.150, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter A. General Provisions › Section 410.003. Application of Administrative Procedure and Texas Register Act

Sec. 410.003.  APPLICATION OF ADMINISTRATIVE PROCEDURE AND TEXAS REGISTER ACT.  Except as otherwise provided by this chapter, Chapter 2001, Government Code does not apply to a proceeding under this chapter.
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.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter A. General Provisions › Section 410.005. Conducting Administrative Proceedings

Sec. 410.005.  CONDUCTING ADMINISTRATIVE PROCEEDINGS.  (a)  Unless the division determines that good cause exists for the selection of a different location, a contested case hearing may not be conducted at a site more than 75 miles from the claimant's residence at the time of the injury.
(b)  Unless the assigned arbitrator determines that good cause exists for the selection of a different location, arbitration may not be conducted at a site more than 75 miles from the claimant's residence at the time of the injury.
(c)  All appeals panel proceedings shall be conducted in Travis County.
(d)  The division may conduct a benefit review conference:
(1)  telephonically;
(2)  by videoconference; or
(3)  in person, on showing of good cause as determined by the division.
(e)  Unless the division determines that good cause exists for the selection of a different location, a benefit review conference conducted in person under Subsection (d)(3) may not be conducted at a site more than 75 miles from the claimant's residence at the time of the injury.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.151, eff. September 1, 2005.
Acts 2021, 87th Leg., R.S., Ch. 261 (H.B. 1752), Sec. 1, eff. June 4, 2021.
Acts 2021, 87th Leg., R.S., Ch. 261 (H.B. 1752), Sec. 2, eff. June 4, 2021.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter A. General Provisions › Section 410.006. Representation at Administrative Proceedings

Sec. 410.006.  REPRESENTATION AT ADMINISTRATIVE PROCEEDINGS.  (a)  A claimant may be represented at a benefit review conference, a contested case hearing, or arbitration by an attorney or may be assisted by an individual of the claimant's choice who does not work for an attorney or receive a fee.  An employee of an attorney may represent a claimant if that employee:
(1)  is a relative of the claimant;  and
(2)  does not receive a fee.
(b)  An insurance carrier may be represented by an attorney or adjuster.
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 410 - Adjudication of Disputes › Subchapter A. General Provisions › Section 410.007. Information List

Sec. 410.007.  INFORMATION LIST.  (a)  The division shall determine the type of information that is most useful to parties to help resolve disputes regarding income benefits. That information may include:
(1)  reports regarding the compensable injury;
(2)  medical information regarding the injured employee; and
(3)  wage records.
(b)  The division shall publish a list developed from the information described under Subsection (a) in appropriate media, including the division's Internet website, to provide guidance to a party to a dispute regarding the type of information the party should have available at a benefit review conference or a contested case hearing.
(c)  At the time a benefit review conference or contested case hearing is scheduled, the division shall make available a copy of the list developed under Subsection (b) to each party to the dispute.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.152, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.021. Purpose

Sec. 410.021.  PURPOSE.  A benefit review conference is a nonadversarial, informal dispute resolution proceeding designed to:
(1)  explain, orally and in writing, the rights of the respective parties to a workers' compensation claim and the procedures necessary to protect those rights;
(2)  discuss the facts of the claim, review available information in order to evaluate the claim, and delineate the disputed issues; and
(3)  mediate and resolve disputed issues by agreement of the parties in accordance with this subtitle and the policies of 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. 3.153, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.022. Benefit Review Officers; Qualifications

Sec. 410.022.  BENEFIT REVIEW OFFICERS;  QUALIFICATIONS.  (a)  A benefit review officer shall conduct a benefit review conference.
(b)  A benefit review officer must:
(1)  be an employee of the division;
(2)  be trained in the principles and procedures of dispute mediation; and
(3)  have documentation satisfactory to the commissioner that evidences the completion by the officer of at least 40 classroom hours of training in dispute resolution techniques from an alternative dispute resolution organization recognized by the commissioner.
(c)  The division shall institute and maintain an education and training program for benefit review officers and shall consult or contract with the Federal Mediation and Conciliation Service or other appropriate organizations for this purpose.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.154, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.023. Request for Benefit Review Conference

Sec. 410.023.  REQUEST FOR BENEFIT REVIEW CONFERENCE.  (a)  On receipt of a request from a party or on its own motion, the division may direct the parties to a disputed workers' compensation claim to meet in a benefit review conference to attempt to reach agreement on disputed issues involved in the claim.
(b)  The division shall require the party requesting the benefit review conference to provide documentation of efforts made to resolve the disputed issues before the request was submitted.
(c)  The commissioner by rule shall:
(1)  adopt guidelines regarding the type of information necessary to satisfy the requirements of Subsection (b); and
(2)  establish a process through which the division evaluates the sufficiency of the documentation provided under Subsection (b).
(d)  The division may deny a request for a benefit review conference if the party requesting the benefit review conference does not provide the documentation required under Subsection (b).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.155, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 14, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.024. Benefit Review Conference as Prerequisite to Further Proceedings on Certain Claims

Sec. 410.024.  BENEFIT REVIEW CONFERENCE AS PREREQUISITE TO FURTHER PROCEEDINGS ON CERTAIN CLAIMS.  (a)  Except as otherwise provided by law or commissioner rule, the parties to a disputed compensation claim are not entitled to a contested case hearing or arbitration on the claim unless a benefit review conference is conducted as provided by this subchapter.
(b)  The commissioner by rule shall adopt guidelines relating to claims that do not require a benefit review conference and may proceed directly to a contested case hearing or arbitration.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.156, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.025. Scheduling of Benefit Review Conference; Notice

Sec. 410.025.  SCHEDULING OF BENEFIT REVIEW CONFERENCE; NOTICE.  (a)  The commissioner by rule shall prescribe the time within which a benefit review conference must be scheduled.
(b)  The division shall schedule a contested case hearing to be held not later than the 60th day after the date of the benefit review conference if the disputed issues are not resolved at the benefit review conference.
(c)  The division shall send written notice of the benefit review conference to the parties to the claim and the employer.
(d)  The commissioner by rule shall provide for expedited proceedings in cases in which compensability or liability for essential medical treatment is in dispute.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.157, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.026. Powers and Duties of Benefit Review Officer

Sec. 410.026.  POWERS AND DUTIES OF BENEFIT REVIEW OFFICER.  (a)  A benefit review officer shall:
(1)  mediate disputes between the parties and assist in the adjustment of the claim consistent with this subtitle and the policies of the division;
(2)  thoroughly inform all parties of their rights and responsibilities under this subtitle, especially in a case in which the employee is not represented by an attorney or other representative;
(3)  ensure that all documents and information relating to the employee's wages, medical condition, and any other information pertinent to the resolution of disputed issues are contained in the claim file at the conference, especially in a case in which the employee is not represented by an attorney or other representative; and
(4)  prepare a written report that details each issue that is not resolved at the benefit review conference, as required under Section 410.031, including any issue raised for the first time at the conclusion of an additional benefit review conference conducted under Subsection (b).
(b)  A benefit review officer may schedule an additional  benefit review conference if:
(1)  the benefit review officer determines that any available information pertinent to the resolution of disputed issues was not produced at the initial benefit review conference; and
(2)  a second benefit review conference has not already been conducted.
(c)  A benefit review officer may not take testimony but may direct questions to an employee, an employer, or a representative of an insurance carrier to supplement or clarify information in a claim file.
(d)  A benefit review officer may not make a formal record.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.158, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.027. Rules

Sec. 410.027.  RULES.  (a)  The commissioner shall adopt rules for conducting benefit review conferences.
(b)  A benefit review conference is not subject to common law or statutory rules of evidence or procedure.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.159, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.028. Failure to Attend; Administrative Violation

Sec. 410.028.  FAILURE TO ATTEND; ADMINISTRATIVE VIOLATION.  (a)  A scheduled benefit review conference shall be conducted even though a party fails to attend unless the benefit review officer determines that good cause, as defined by commissioner rule, exists to reschedule the conference.
(b)  If a party to a benefit review conference under Section 410.023 requests that the benefit review conference be rescheduled under this section, the party must submit a request in the same manner as an initial request under Section 410.023.  The division shall evaluate a request for a rescheduled benefit review conference received under this section in the same manner as an initial request received under Section 410.023.
(c)  If a party fails to request that a benefit review conference be rescheduled in the time required by commissioner rule or fails to attend a benefit review conference without good cause as defined by commissioner rule, the party forfeits the party's entitlement to attend a benefit review conference on the issue in dispute, unless a benefit review officer is authorized to schedule an additional benefit review conference under Section 410.026(b).
(d)  The commissioner shall adopt rules necessary to implement and enforce this section, including rules that:
(1)  define good cause; and
(2)  establish deadlines for requesting that a benefit review conference be rescheduled under Subsection (b).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.160, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 15, eff. September 1, 2011.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.029. Resolution at Benefit Review Conference; Written Agreement

Sec. 410.029.  RESOLUTION AT BENEFIT REVIEW CONFERENCE;  WRITTEN AGREEMENT.  (a)  A dispute may be resolved either in whole or in part at a benefit review conference.
(b)  If the conference results in the resolution of some disputed issues by agreement or in a settlement, the benefit review officer shall reduce the agreement or the settlement to writing.  The benefit review officer and each party or the designated representative of the party shall sign the agreement or settlement.
(c)  A settlement takes effect on the date it is approved by the director in accordance with Section 408.005.
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 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.030. Binding Effect of Agreement

Sec. 410.030.  BINDING EFFECT OF AGREEMENT.  (a)  An agreement signed in accordance with Section 410.029 is binding on the insurance carrier through the conclusion of all matters relating to the claim, unless the division or a court, on a finding of fraud, newly discovered evidence, or other good and sufficient cause, relieves the insurance carrier of the effect of the agreement.
(b)  The agreement is binding on the claimant, if represented by an attorney, to the same extent as on the insurance carrier.  If the claimant is not represented by an attorney, the agreement is binding on the claimant through the conclusion of all matters relating to the claim while the claim is pending before the division, unless the commissioner for good cause relieves the claimant of the effect 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. 3.161, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.031. Incomplete Resolution; Report

Sec. 410.031.  INCOMPLETE RESOLUTION; REPORT.  (a)  If a dispute is not entirely resolved at a benefit review conference, the benefit review officer shall prepare a written report that details each issue that is not resolved at the conference.
(b)  The report must also include:
(1)  a statement of each resolved issue;
(2)  a statement of each issue raised but not resolved;
(3)  a statement of the position of the parties regarding each unresolved issue;
(4)   a statement of the procedures required to request a contested case hearing or arbitration and a complete explanation of the differences in those proceedings and the rights of the parties to subsequent review of the determinations made in those proceedings; and
(5)  the date of the contested case hearing scheduled in accordance with Section 410.025(b).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.162, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.032. Payment of Benefits Under Interlocutory Order

Text of section as amended by Acts 2007, 80th Leg., R.S., Ch. 1177 (H.B. 473), Sec. 1
For text of section as amended by Acts 2007, 80th Leg., R.S., Ch. 1150 (S.B. 1169), Sec. 4, see other Sec. 410.032.
Sec. 410.032. PAYMENT OF BENEFITS UNDER INTERLOCUTORY ORDER.  (a)  The benefit review officer who presides at the benefit review conference shall consider a request for an interlocutory order and shall give the opposing party the opportunity to respond before issuing an interlocutory order.
(b)  The interlocutory order may address the payment or suspension of accrued benefits, future benefits, or both accrued benefits and future benefits.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1999, 76th Leg., ch. 955, Sec. 2, eff. Sept. 1, 1999.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.162, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch. 1177 (H.B. 473), Sec. 1, eff. September 1, 2007.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.032. Payment of Benefits Under Interlocutory Order

Text of section as amended by Acts 2007, 80th Leg., R.S., Ch. 1150 (S.B. 1169), Sec. 4
For text of section as amended by Acts 2007, 80th Leg., R.S., Ch. 1177 (H.B. 473), Sec. 1, see other Sec. 410.032.
Sec. 410.032.  PAYMENT OF BENEFITS UNDER INTERLOCUTORY ORDER.  (a)  The benefit review officer who presides at the benefit review conference shall:
(1)  consider a written or verbal request for an interlocutory order for the payment of benefits; and
(2)  if the benefit review officer determines that issuance of an interlocutory order is appropriate, issue the interlocutory order not later than the third day after the date of receipt of the request under Subdivision (1).
(b)  The interlocutory order may address accrued benefits, future benefits, or both accrued benefits and future benefits.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1999, 76th Leg., ch. 955, Sec. 2, eff. Sept. 1, 1999.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.162, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch. 1150 (S.B. 1169), Sec. 4, eff. September 1, 2007.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.033. Multiple Carriers

Sec. 410.033.  MULTIPLE CARRIERS.  (a)  If there is a dispute as to which of two or more insurance carriers is liable for compensation for one or more compensable injuries, the commissioner may issue an interlocutory order directing each insurance carrier to pay a proportionate share of benefits due pending a final decision on liability.  The proportionate share is computed by dividing the compensation due by the number of insurance carriers involved.
(b)  On final determination of liability, an insurance carrier determined to be not liable for the payment of benefits is entitled to reimbursement for the share paid by the insurance carrier from any insurance carrier determined to be liable.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.163, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter B. Benefit Review Conference › Section 410.034. Filing of Agreement and Report

Sec. 410.034.  FILING OF AGREEMENT AND REPORT.  (a)  The benefit review officer shall file the signed agreement and the report with the division.
(b)  The commissioner by rule shall prescribe the times within which the agreement and report must be filed.
(c)  The division shall furnish a copy of the file-stamped report to:
(1)  the claimant;
(2)  the employer; and
(3)  the insurance carrier.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.164, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter C. Arbitration › Section 410.101. Purpose

Sec. 410.101.  PURPOSE.  The purpose of arbitration is to:
(1)  enter into formal, binding stipulations on issues on which the parties agree;
(2)  resolve issues on which the parties disagree;  and
(3)  render a final award with respect to all issues in dispute.
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 410 - Adjudication of Disputes › Subchapter C. Arbitration › Section 410.102. Arbitrators; Qualifications

Sec. 410.102.  ARBITRATORS; QUALIFICATIONS.  (a)  An arbitrator must be an employee of the division, except that the division may contract with qualified arbitrators on a determination of special need.
(b)  An arbitrator must:
(1)  be a member of the National Academy of Arbitrators;
(2)  be on an approved list of the American Arbitration Association or Federal Mediation and Conciliation Service; or
(3)  meet qualifications established by the commissioner by rule.
(c)  The division shall require that each arbitrator have appropriate training in the workers' compensation laws of this state.  The commissioner shall establish procedures to carry out this subsection.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.165, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter C. Arbitration › Section 410.103. Duties of Arbitrator

Sec. 410.103.  DUTIES OF ARBITRATOR.  An arbitrator shall:
(1)  protect the interests of all parties;
(2)  ensure that all relevant evidence has been disclosed to the arbitrator and to all parties; and
(3)  render an award consistent with this subtitle and the policies of 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. 3.166, eff. September 1, 2005.
2023 Texas Statutes › Labor Code › Title 5 - Workers' Compensation › Subtitle A - Texas Workers' Compensation Act › Chapter 410 - Adjudication of Disputes › Subchapter C. Arbitration › Section 410.104. Election of Arbitration; Effect

Sec. 410.104.  ELECTION OF ARBITRATION;  EFFECT.  (a)  If issues remain unresolved after a benefit review conference, the parties, by agreement, may elect to engage in arbitration in the manner provided by this subchapter.  Arbitration may be used only to resolve disputed benefit issues and is an alternative to a contested case hearing.  A contested case hearing scheduled under Section 410.025(b) is canceled by an election under this subchapter.
(b)  To elect arbitration, the parties must file the election with the division not later than the 20th day after the last day of the benefit review conference.  The commissioner shall prescribe a form for that purpose.
(c)  An election to engage in arbitration under this subchapter is irrevocable and binding on all parties for the resolution of all disputes arising out of the claims that are under the jurisdiction of the division.
(d)  An agreement to elect arbitration binds the parties to the provisions of Chapter 408 relating to benefits, and any award, agreement, or settlement after arbitration is elected must comply with 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. 3.167, eff. September 1, 2005.