reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 53 - CARRIER'S REPORT OF INITIATION AND SUSPENSION OF COMPENSATION PAYMENTS › Section 53.48 - Payment of Partial Benefits for General Injuries

Current through Reg. 49, No. 28; July 12, 2024
(a) When a carrier believes that a claimant
				is no longer entitled to temporary total benefits because the claimant has
				returned to work, or has been released to return to without restrictions, the
				carrier shall:
(1) initiate payment of
				partial benefits based on a determination of the claimant's lost wage earning
				capacity, either periodically or in a lump sum; and
(2) file the appropriate notice with the
				board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 53 - CARRIER'S REPORT OF INITIATION AND SUSPENSION OF COMPENSATION PAYMENTS › Section 53.50 - Resumption of Compensation

Current through Reg. 49, No. 28; July 12, 2024
In the event the carrier shall, after reporting suspension of
				  payment on Form A-2, subsequently resume the payment of compensation, it shall
				  report such resumption on Form A-4 within 10 days from date of first payment
				  after resumption, and a copy of such Form A-4 shall be furnished to the
				  claimant or his attorney.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 53 - CARRIER'S REPORT OF INITIATION AND SUSPENSION OF COMPENSATION PAYMENTS › Section 53.55 - Payment for Amputation

Current through Reg. 49, No. 28; July 12, 2024
When an industrial injury occurring prior to September 1,
				  1973, results in the amputation or partial amputation of a finger, thumb, or
				  toe, the insurance carrier shall file with the board, with copy to the claimant
				  or his attorney, a signed medical report and a chart showing the exact point of
				  amputation at the time a Form A-2, compromise or lump sum payment, is
				  submitted.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 53 - CARRIER'S REPORT OF INITIATION AND SUSPENSION OF COMPENSATION PAYMENTS › Section 53.60 - Application for Suspension of Compensation

Current through Reg. 49, No. 28; July 12, 2024
Where application is made by the carrier for suspension of
				  compensation pursuant to either Texas Civil Statutes, Article 8306, §12a,
				  or Texas Civil Statutes, Article 8307, §4, the question of suspension will
				  be set by the board for hearing within two weeks of said application. No
				  suspension of compensation benefits will be approved by the board, under Texas
				  Civil Statutes, Article 8307, §4a, unless statutory grounds exist for such
				  suspension. No suspension of compensation benefits will be approved by the
				  board, under Texas Civil Statutes, Article 8306, §12a, unless:
(1) the injured employee has returned to
				work; or
(2) the injured employee
				refuses light duty work procured for him in the locality where he was injured
				or at a place agreeable to him; or
(3) the treating physician has released the
				employee to return to work without physical restrictions relating to the
				compensable injuries involved.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 53 - CARRIER'S REPORT OF INITIATION AND SUSPENSION OF COMPENSATION PAYMENTS › Section 53.63 - Suspension of Weekly Compensation

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				carrier may not suspend payment of weekly or other periodic benefits pending
				final adjudication until there exists evidence justifying suspension. However,
				in no event, unless directed otherwise by the board, shall a carrier suspend
				benefits until:
(1) the injured employee
				returns to work;
(2) the injured
				employee is released by a physician to return to work without
				restrictions;
(3) the employee
				refused employment offered him or her consistent with any
				restrictions;
(4) the statutory
				maximum benefit has been paid;
(5)
				the claim is resolved by settlement, A-2 lump sum payment, or matured
				award;
(6) evidence exists showing
				that the carrier has no liability for the employee's injury; or
(7) there is a third-party settlement which
				relieves the carrier of its liability.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 53 - CARRIER'S REPORT OF INITIATION AND SUSPENSION OF COMPENSATION PAYMENTS › Section 53.64 - Nonpayment of Compensation Based on Another Carrier's Liability

Current through Reg. 49, No. 28; July 12, 2024
(a) When the carrier fails or refuses to
				initiate, or suspends, payment of income or medical benefits based on evidence
				that another carrier is liable for the claimant's disability, the carrier or
				the claimant's attorney, if any, shall immediately request a formal hearing
				before the board.
(b) The claim
				will be set for a hearing on the board's next available formal hearing
				docket.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 53 - CARRIER'S REPORT OF INITIATION AND SUSPENSION OF COMPENSATION PAYMENTS › Section 53.65 - Certification Procedure

Current through Reg. 49, No. 28; July 12, 2024
In cases where it appears that the carrier willfully fails,
				  or refuses without justification to pay compensation, the following procedure
				  will apply.
(1) If, on suspension or
				stoppage of workers' compensation payments, it appears to the board that the
				carrier has not fully discharged its obligation to the claimant, the board will
				notify the carrier through its Austin Industrial Accident Board representative
				of the deficiency, and copies of such notice shall be sent to the claimant or
				his attorney.
(2) The board will
				specify a reasonable period of time in which a carrier may either pay the
				deficiency and submit a correct report or submit information to the board
				justifying the amount of its payment.
(3) If the carrier fails to pay the
				deficiency or fails to submit information justifying the amount of its payment,
				the board shall set the case for formal hearing to be held by a majority of the
				board within 100 miles of the claimant's residence. The provision of §
									49.105 of
				this title (relating to Special Formal Hearing and Other Investigative
				Hearings), et seq., shall apply.
(4) At such hearing, if it determined that
				compensation benefits are due, the board shall so order. If the carrier fails
				to obey such order within 10 days the board may certify such fact to the
				commissioner of insurance for proceedings, according to Texas Civil Statutes,
				Article 8306, §18.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.3 - Request for Advance Payment of Compensation

Current through Reg. 49, No. 28; July 12, 2024
(a) A claimant who suffers financial hardship
				because of loss of wages due to an uncontested injury may request of the
				carrier an advance payment of compensation ("advance") to be credited against
				future compensation benefits.
(b) A
				request for an advance shall be:
(1) prepared
				on a board-approved form;
(2)
				signed by the claimant unless waived for good cause; and
(3) submitted in the original to the carrier,
				with a copy filed with the board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.5 - Lump Sum Payments

Current through Reg. 49, No. 28; July 12, 2024
No lump sum payment of fatal benefits may be made without
				  prior board approval. No lump sum payment of fatal benefits may be made to
				  beneficiaries, unless there exists a bona fide dispute as to the liability of
				  the insurance carrier, and no lump sum payment of benefits for injuries
				  enumerated in Texas Civil Statutes, Article 8306, §11a, shall be made
				  unless there is also a bona fide dispute as to the liability of the insurance
				  carrier (Texas Civil Statutes, Article 8306, §8(d) and
				  §10(d)).
(1) When authorized by
				statute, a lump sum payment for a minor's compensation in fatal cases will be
				considered by the board upon receipt of a certified copy of letters of
				guardianship. If the carrier requests an order of a probate court directing a
				lump sum payment, the cost thereof shall be borne by the carrier.
(2) All lump sum payment agreements submitted
				to the board must be submitted in four parts--the original must be white, the
				second copy pink, third copy yellow, and fourth copy white. The forms must
				either be on NCR paper or be submitted with carbon left intact. The board will
				mail a copy of the lump sum payment agreement to the claimant, claimant's
				attorney if one has been employed, and the carrier's Austin representative in
				lieu of a separate approval notice.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.10 - Settlements Final When Approved

Current through Reg. 49, No. 28; July 12, 2024
Compromise settlement agreements between insurance carriers
				  and persons claiming benefits under the Texas Workers' Compensation Law are not
				  final until approval by the board (1953).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.15 - Compromise Settlement Agreements

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				compromise settlement agreement must contain the following information:
(1) that the agreement is executed on a form
				approved by the division;
(2) that
				the agreement is accompanied by physician's signed report of the findings of a
				recent examination of the employee;
(3) that the employee has achieved maximum
				recovery, or that good reason exists for settlement prior to maximum
				recovery;
(4) that in the event of
				serious injury to the claimant's eye, healing has occurred and the division was
				given a medical report on whether the other eye is or may be affected;
				and
(5) that in all instances of
				severe and disfiguring burns or lacerations, a descriptive medical report of
				the scars will be submitted by either the association or claimant. In all such
				cases involving injury to the face, arms, or hands, either the claimant or
				insurance carrier must submit to the division a color photograph taken after
				maximum healing.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.20 - Execution of Compromise Settlement Agreement

Current through Reg. 49, No. 28; July 12, 2024
A compromise settlement agreement must be signed by the
				  claimant personally, unless sufficient good cause is found by the board to
				  excuse strict compliance to this section. Only in extraordinary circumstances
				  will the board approve a compromise settlement agreement in which the attorney
				  signs the claimant's name under a power of attorney.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.25 - Loss of an Eye

Current through Reg. 49, No. 28; July 12, 2024
The board considers "loss of an eye" when loss of vision
				  reached 90%. Permanent partial loss of vision in an eye will be calculated on
				  the actual loss of vision as a result of an injury, and not on loss of vision
				  after restoration of vision by proper fitting glasses. The following table for
				  the estimate of compensation to be paid workers who have suffered partial or
				  complete loss of vision in one eye, through accident or occupation, is adopted
				  by the board (1961) (Rev.1973).
Attached
				  Graphic
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.30 - Hearing Impairment

Current through Reg. 49, No. 28; July 12, 2024
(a) Hearing tests
				for use in compensation ratings shall be derived from the pure-tone audiogram
				calculated to ANSI-S3.6-1969 standards. Examination should be performed by a
				medical specialist who does hearing evaluations or by an audiologist having the
				certificate of clinical competence from the American Speech-Language-Hearing
				Association upon referral. Hearing handicap will be based on the functional
				state of both ears.
(b) The average
				of the hearing threshold levels at 500 Hz, 1,000 Hz, 2,000 Hz, and 3,000 Hz
				should be calculated for each ear. The percent of impairment for each ear
				should be calculated by multiplying by 1.5 the amount by which the above
				average hearing threshold level exceeds 25 dB up to a maximum of 100% which is
				reached at 92dB. The hearing handicap, a bilateral assessment, should then be
				calculated by multiplying the smaller percentage (better ear), by five, adding
				this figure to the larger percentage (poorer ear), and dividing the total by
				six.
(c) Since there is no exact
				scientific test by which non-industrial hearing losses can be distinguished
				from induced impairment, the opinion as to the amount of loss due to such other
				causes shall be made by the examining medical specialist.
(d) No consideration shall be given to
				possible improvements through use of prosthesis. Where artificial appliances
				would materially and beneficially improve the future usefulness and
				occupational opportunities of the employee, the insurer shall provide same, and
				shall continue to furnish the needed artificial appliance or appliances until a
				satisfactory fit is obtained in the judgment of the attending physician or
				physicians. The association shall be liable for replacing or repairing any
				artificial appliances so furnished.
(e) Such prosthesis shall be prescribed upon
				proper evaluation by a medical specialist who does hearing aid evaluations or
				by an audiologist having the certificate of clinical competence from the
				American Speech-Language-Hearing Association upon referral. Such hearing and
				speech centers shall have no commercial properties.
(f) The above formula should be used in
				calculating the percentage of loss of hearing, but the doctor giving the report
				shall state specifically the exact loss of hearing in percentage, and not
				decibels.
(g) See examples and
				chart.
Attached
				  Graphic
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.35 - Stipulation of Medical Payments

Current through Reg. 49, No. 28; July 12, 2024
Where an insurance company agrees to pay accrued medical and
				  hospital expenses in a compromise settlement agreement, any exceptions or
				  special stipulations agreed upon by the parties must be clearly stated on the
				  face of the compromise settlement or an attached affidavit
				  (1970).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.40 - Attorney's Signature

Current through Reg. 49, No. 28; July 12, 2024
Settlement agreements entered into by claimants who are
				  represented by an attorney must be signed by the attorney. The attorney's name
				  and address shall be on the face of the agreement (1953)
				  (Rev.1973).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.45 - Percent of Medical Impairment

Current through Reg. 49, No. 28; July 12, 2024
Where the amount of compensation due is covered by Texas
				  Civil Statutes, Article 8306, §12, the board may consider percentage of
				  medical impairment as only one element in arriving at percentage of legal
				  disability as distinguished from medical disability (1973).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.50 - Attorneys Fees and Expenses

Current through Reg. 49, No. 28; July 12, 2024
Sections 51.5, 51.7,
				  51.10,
				  51.35, 51.45, 51.50, 51.55, and 51.60 of this title (relating to Power of
				  Attorney; Representation in Fatal Cases; Joint Payment of Award; Unauthorized
				  Attorney's Fees; Attorney Fees and Expenses on Fatal Cases; Payments of
				  Attorney's Fees; Attorney's Expenses; and Deductible Expenses) shall be applied
				  by the board to claims disposed of by settlement agreement.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.55 - Compromise Settlement Agreement To Set Aside Award

Current through Reg. 49, No. 28; July 12, 2024
A compromise settlement agreement, properly executed between
				  or among all parties to the claim, when filed in any board office in the period
				  after an award has been entered but before it becomes final, or suit is filed,
				  will serve to set aside the award as of the date the compromise settlement
				  agreement is filed. If the board subsequently fails to approve the compromise
				  settlement agreement, then the original award will be immediately
				  re-entered.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.60 - Consent Withdrawn

Current through Reg. 49, No. 28; July 12, 2024
The board's approval of a compromise settlement agreement
				  shall be final at the time the approval is signed by the board unless the board
				  has received a request in writing prior to entry of the approval order that one
				  or more parties to the agreement wishes to withdraw their consent to the
				  agreement, and the board permits the withdrawal of such consent. Any such
				  written request to the board for permission to withdraw consent to an agreement
				  must fully set out the reason or reasons for such request
				  (1981).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.65 - Withdrawal of Consent by Death

Current through Reg. 49, No. 28; July 12, 2024
If the claimant has died after signing the compromise
				  settlement agreement, but before the board approved the same, the claimant's
				  death will be considered as effectively terminating claimant's continuing
				  consent to the compromise settlement agreement (1981)
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.75 - Tender Payment Time Period

Current through Reg. 49, No. 28; July 12, 2024
An insurance carrier shall have 20 days from and after the
				  date of approval of a compromise settlement agreement in which to pay or tender
				  payment to the injured employee of the amount approved by the board, and shall
				  have 20 days from the receipt of bills in which to tender all accrued medical
				  expenses resulting from the injury. Failure to tender payment within such time
				  shall cause the board to immediately set such cause for formal hearing for the
				  purpose of invoking proper sanctions (Rev.1971).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 55 - LUMP SUM PAYMENTS › Section 55.80 - Waiving of Approval Appearance

Current through Reg. 49, No. 28; July 12, 2024
Personal appearance of the claimant shall be required prior
				  to recommendation by the board representative for approval of compromise
				  settlement agreements, unless upon the showing of good cause said personal
				  appearance is waived by the board representative (1970)
				  (Rev.1977).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.5 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
(1) Annuity company--The
				company from which the carrier is purchasing an annuity for the claimant. The
				annuity company may be the carrier if the carrier meets the tests provided
				following for annuity companies (effective 1987).
(2) Structured settlement--Structured
				compromise settlement agreement.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.10 - Form

Current through Reg. 49, No. 28; July 12, 2024
A structured settlement must:
(1) be submitted on a form approved by the
				board;
(2) be accompanied by a
				physician's signed report of the findings of a recent examination of the
				employee;
(3) be accompanied, in
				the event of serious injury to claimant's eye, by a medical report indicating
				that healing has occurred and whether the other eye is or may be
				affected;
(4) be accompanied, in
				the event of severe and disfiguring burns or lacerations, by a descriptive
				medical report of the scars. In all cases involving injury to the face, arms,
				or hands, a color photograph taken after maximum healing must be submitted to
				the board;
(5) be submitted in five
				parts. The original must be white, the second part pink, the third yellow, the
				fourth white, and the fifth white. The forms must be submitted with carbon left
				intact. The board will furnish the following parties with approved copies of
				the forms.
(A) The claimant will receive the
				pink copy.
(B) The attorney, if
				any, will receive the yellow copy.
(C) The Austin board representative will
				receive the final two copies (effective 1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.15 - Execution

Current through Reg. 49, No. 28; July 12, 2024
A structured settlement must be signed by the claimant
				  personally, unless the board finds good cause to excuse strict compliance to
				  this section. Only in extraordinary circumstances will the board approve a
				  structured settlement in which the attorney signs the claimant's name under a
				  power of attorney (effective 1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.20 - Personal Appearance by Claimant

Current through Reg. 49, No. 28; July 12, 2024
A personal appearance of the claimant may be required by the
				  board prior to approval. The personal meeting is to be set up by the board, not
				  by the carrier. A carrier representative is required to be present (effective
				  1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.25 - Medical Benefits

Current through Reg. 49, No. 28; July 12, 2024
Where a carrier agrees to pay accrued medical and hospital
				  expenses in a structured settlement, any exceptions or special stipulations
				  must be clearly stated on the face of the structured settlement or on an
				  attached affidavit (effective 1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.30 - Consent of Parties - Withdrawal

Current through Reg. 49, No. 28; July 12, 2024
The board's approval of a structured settlement shall be
				  final at the time the approval is signed by the board unless the board has
				  received a request in writing prior to entry of the approval order that one or
				  more parties to the agreement wishes to withdraw their consent to the
				  settlement, and the board permits the withdrawal of such consent. Any such
				  written request to the board for permission to withdraw consent to a settlement
				  must fully set out the reason or reasons for such request (effective
				  1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.35 - Attorney's Signature

Current through Reg. 49, No. 28; July 12, 2024
A structured settlement entered into by a claimant who is
				  represented by an attorney must be signed by the attorney. The attorney's name
				  and address must be on the face of the settlement (effective
				  1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.40 - Attorney's Fees and Expenses

Current through Reg. 49, No. 28; July 12, 2024
Sections 51.5, 51.7,
				  51.10,
				  51.35, 51.40, 51.45, 51.50, 51.55, and 51.60 of this title (relating to Power
				  of Attorney; Representation in Fatal Cases; Joint Payment of Award;
				  Unauthorized Attorney's Fees; Attorneys Not Licensed in Texas; Attorney's Fees
				  and Expenses in Fatal Cases; Payments of Attorney's Fees; Attorney's Expenses;
				  and Deductible Expenses) shall be applied by the board to claims disposed of by
				  structured settlement (effective 1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.45 - Tender Payment Time Period

Current through Reg. 49, No. 28; July 12, 2024
The carrier shall have 20 days after the date of approval of
				  a structured settlement to pay or tender any approved lump sum payment to the
				  injured employee or approved fees and expenses to any attorney(s), and shall
				  have 20 days from the receipt of bills in which to tender all reasonable
				  accrued medical expenses necessarily resulting from the injury. Failure to
				  tender payment within such time shall cause the board to immediately set such
				  case for formal hearing for the purpose of invoking proper sanctions (effective
				  1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.50 - Final When Approved

Current through Reg. 49, No. 28; July 12, 2024
A structured settlement is not final until the settlement is
				  approved by the board. Board approval is deemed to have occurred at 5 p.m. of
				  the day the approval is signed (effective 1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.55 - Annuity Company

Current through Reg. 49, No. 28; July 12, 2024
An annuity company providing an annuity under the terms of a
				  structured settlement must be licensed to do business in Texas and must have a
				  Best's rating of A+, with a financial size category of VII or above, according
				  to the most recent information available (effective 1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.60 - Payments Guaranteed

Current through Reg. 49, No. 28; July 12, 2024
The workers' compensation carrier shall guarantee the
				  payments provided by the annuity company in the event of default (effective
				  1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.65 - Cost of the Annuity

Current through Reg. 49, No. 28; July 12, 2024
(a) The carrier
				shall submit to the board with the structured settlement, in camera, the cost
				of the annuity.
(b) The cost of the
				annuity to a carrier that does not purchase an annuity from a third party is
				the discounted value of the periodic payments to be provided (effective
				1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS › Section 56.70 - Structured Settlement Agreement To Set Aside Award

Current through Reg. 49, No. 28; July 12, 2024
A structured settlement, properly executed between or among
				  all parties to the claim, when filed in the board's office in the period after
				  an award has been entered but before it becomes final, or suit is filed, will
				  serve to set aside the award as of the date the structured settlement is filed.
				  If the board subsequently fails to approve the settlement, then the original
				  award will be re-entered immediately (effective 1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 59 - NOTICES OF INTENTION TO APPEAL › Section 59.5 - Filing of Notice

Current through Reg. 49, No. 28; July 12, 2024
Notices of intention to appeal from a final order or award of
				  the board shall be filed with the board in Austin and must be in writing,
				  clearly and accurately identify the compensation claim to which it pertains,
				  including the board file number, and delivered to the board's office in Austin,
				  either:
(1) in person; or
(2) by mail; or
(3) by wire or telegram; or
(4) by comparable means.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 59 - NOTICES OF INTENTION TO APPEAL › Section 59.10 - Receipt of Notice

Current through Reg. 49, No. 28; July 12, 2024
Receipt of the Notice of Intention to Appeal shall be
				  acknowledged by a board member, the executive director of the board or by
				  persons duly designated by the board for such purpose, who shall immediately
				  stamp and sign each such notice. Acknowledgment will subsequently be made by
				  mail to all interested parties. (1970).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.5 - Request for Prehearing Conference

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Except as otherwise provided, a request for a prehearing conference must be
				submitted on a board-approved form.
(b) Failure to provide the information
				requested may constitute grounds for rejecting the request.
(c) An unrepresented claimant may request a
				prehearing conference by contacting the board in any manner.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.7 - Request of Prehearing Conference

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Except as otherwise provided, the board will give at least 30 days written
				notice of the prehearing conference date to all interested parties.
(b) If income or medical benefits are not
				being paid, the board may set a prehearing conference with less than 30 days
				notice.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.15 - Setting under Texas Civil Statutes, Article 8306, Section 18a

Current through Reg. 49, No. 28; July 12, 2024
(a) If the carrier, having received written
				notice of a compensable lost time injury as provided in Texas Civil Statutes,
				Article 8306, §18a, is not timely paying compensation, or ceases the
				payment of such benefits, the board shall set the claim for a prehearing
				conference on the first available docket.
(b) If a Texas Civil Statutes, Article 8306,
				§18a penalty (18a penalty) appears due, initiation or reinstatement of
				compensation shall not be grounds for cancellation of a prehearing conference
				set under this section. However, the board may waive the claimant's appearance
				at the prehearing conference upon request.
(c) In the event a dispute arises over the
				suspension of medical benefits as defined in these board rules, a health care
				provider may file with the board a written request to attend a prehearing
				conference, as a party and participant therein, and in such event the health
				care provider shall attend the prehearing conference, either in person or by a
				representative. In the request, the health care provider shall certify the
				charges have been itemized and that timely reports have been made in accordance
				with Texas Civil Statutes, Article 8306, §7, and these board
				rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.20 - Setting on Hardship

Current through Reg. 49, No. 28; July 12, 2024
(a) If the board
				determines that financial hardship may exist and the carrier has failed to
				tender an adequate advance or acceleration of benefits within 10 days from the
				filing of a hardship affidavit with the board, the board shall schedule such
				case for prehearing conference on the next docket following 30 days from the
				date of the filing of the hardship affidavit.
(b) Hardship affidavits must contain
				sufficient factual information to support the allegations of hardship, and
				shall be signed and sworn by the claimant personally, unless otherwise waived
				by the board for good cause shown.
(c) A copy of the hardship affidavit shall be
				forwarded to the insurance carrier by the claimant, at the same time the
				original is filed with the board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.25 - Setting at Carrier's Request

Current through Reg. 49, No. 28; July 12, 2024
Upon a showing of good cause, prehearing will be set by the
				  board on the insurance carrier's request. It shall be presumed the payment of
				  compensation benefits for a period of consecutive 52 weeks or longer
				  constitutes a case of "extended disability," and in such cases the carrier,
				  upon written request therefore, approved by the board, shall be entitled to a
				  prehearing conference in order to review the claimant's physical and medical
				  condition and the treatment thereof.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.30 - Filing of Medical Information

Current through Reg. 49, No. 28; July 12, 2024
All available medical information that has a bearing on the
				  claim at hand must be filed with the board at or before the prehearing in
				  accordance with Texas Civil Statutes, Article 8309a(b)
				  (1970).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.35 - Exchange of Medical Information

Current through Reg. 49, No. 28; July 12, 2024
Claimant and carrier shall exchange all available medical
				  information promptly after expiration of six weeks disability or earlier upon
				  written request of either party. Thereafter, all medical information will be
				  exchanged promptly upon receipt. If received less than seven days prior to a
				  prehearing conference, it shall be brought to the prehearing conference for
				  exchange. Both parties shall bring to the prehearing conference all available
				  medical information (1981).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.40 - Additional Medical

Current through Reg. 49, No. 28; July 12, 2024
Where the hearing officer determines that additional medical
				  examination will probably assist in settlement, he may order such additional
				  medical examination at the expense of the board, provided no undue delay shall
				  occur thereby, and the prehearing officer shall reset the prehearing conference
				  (1970) (Rev.1973).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.45 - Charges for Reports

Current through Reg. 49, No. 28; July 12, 2024
Reasonable charges shall be allowed by the board for
				  narrative reports required under Texas Civil Statutes, Article 8306, §7,
				  and such charges shall be considered necessary expenses to be paid by the
				  carrier (1970) (Rev.1977).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.50 - Representatives Must Be Qualified

Current through Reg. 49, No. 28; July 12, 2024
The success of the prehearing conference system depends upon
				  a high level of expertise in workers' compensation matters by representatives
				  of carriers and claimants. Carriers should be represented either by an attorney
				  licensed to practice in this state, or by individuals who can demonstrate a
				  continuing proficiency in compensation law and procedure. Negotiation of a
				  settlement in a workers' compensation case constitutes the practice of law, and
				  no attorney's fees or expenses will be authorized by the board to any
				  representative of the claimant other than an attorney licensed to practice in
				  this state.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.55 - Supply of Forms

Current through Reg. 49, No. 28; July 12, 2024
The carrier's representative shall have a sufficient supply
				  of proper forms to enable him to complete settlements at the prehearing
				  conference.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.60 - Attendance at Conference

Current through Reg. 49, No. 28; July 12, 2024
(a) The claimant
				and the claimant's attorney or authorized agent, if any, and the carrier's
				representative must attend all prehearing conferences pertaining to the claim
				under consideration.
(b) A request
				for a prehearing conference shall constitute an agreement by the requesting
				party to appear personally or arrange for substitute representation in the
				event of a scheduling conflict.
(c)
				Claimant's attendance may be waived for good cause.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.65 - Request for Cancellation of Prehearing Conference

Current through Reg. 49, No. 28; July 12, 2024
(a) The board may cancel a prehearing
				conference:
(1) at the request of the party
				who initially requested the prehearing conference;
(2) at the request of any party required to
				attend the prehearing conference, with the agreement of the party who initially
				requested the prehearing conference; or
(3) on the board's own motion.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.70 - Maintain Setting

Current through Reg. 49, No. 28; July 12, 2024
Where the request for continuance or postponement is based
				  upon the payment of compensation and furnishing of medical aid, the resident
				  reviewer or the prehearing officer may still maintain the setting where there
				  is a showing of hardship on the part of the claimant.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.75 - Failure To Appear

Current through Reg. 49, No. 28; July 12, 2024
(a) Where the
				claimant fails to make a personal appearance at the prehearing conference
				without good cause, such failure to appear shall result in postponement until
				the board is assured in writing of appearance.
(b) Where the attorney or carrier
				representative fails to comply with the cancellation requirements of §
									61.65
				of this title (relating to Request for Cancellation of Prehearing Conference)
				or fails to attend a scheduled prehearing conference, the prehearing officer
				shall prepare a rule violation complaint report as provided by §
									65.10
				of this title (relating to Actions by Carrier, Claimant's Attorney, and/or
				Agent). Violation of this rule may be grounds for sanctions, including
				reduction of fees, written reprimand, or suspension from practice before the
				board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.80 - Participation at Conference

Current through Reg. 49, No. 28; July 12, 2024
Although no testimony will be taken at a prehearing
				  conference, nevertheless, the claimant, carrier's representative, and any other
				  witnesses in attendance must, if called upon by the prehearing examiner or the
				  adverse party, fully participate by responding to requests for information
				  reasonably necessary in the evaluation or defense of the claim presented. A
				  violation of this rule by claimant may result in a continuance of the
				  prehearing conference until a subsequent date, and a violation of the rule by
				  any other party or witness may result in appropriate sanctions by the
				  board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.85 - Carrier Self-Audit of Prehearing Conference

Current through Reg. 49, No. 28; July 12, 2024
A viable prehearing conference system is important to the
				  efficient functioning of the workers' compensation program in this state. This
				  necessarily includes a good faith effort on the part of both claimant or
				  his/her attorney and of the carrier to negotiate in good faith. In order that
				  the board might monitor the designed function of the prehearing conference in
				  all claims which are the subject of a prehearing conference, except fatals,
				  statutory total and permanent claims, and second injury fund claims, and where
				  no A-2 payment is made or compromise settlement agreement is entered into at
				  the prehearing conference:
(1) The
				carrier shall make and keep a written record of each compensation file which
				has been the subject of a prehearing conference, and an award recommendation
				has been made by the prehearing examiner, the following information: the name
				of the claimant; the name and permanent state bar number of the claimant's
				attorney, if known to the carrier; the board file number, the carrier file
				number; the date of the prehearing conference held on the claim; the amount of
				the final demand of the claimant or his/her attorney at the prehearing
				conference; the amount of the final offer made by the carrier; and the net
				award by the board.
(2) Such record
				shall also include the date of final disposition, the net amount thereof, and
				whether by way of compromise settlement agreement, judgment, or dismissal
				without judgment entry.
(3) The
				record described in this rule shall be retained by the carrier for not less
				than five years following its completion, and shall be made available to the
				board, upon its request therefore.
(4) Neither the carrier nor claimant's
				attorney shall ever be required to file such information as directed herein by
				the board, and such information shall never become a part of the records of the
				board. A carrier or an attorney shall, at the request of the board, make these
				records available to the carrier for the purpose of the board and carrier or
				attorney evaluating the negotiation record of the board or the attorney at
				prehearing conferences. No board member or officer or employee of the board
				shall ever disclose such information, or any part thereof, to any other person,
				corporation, or agency.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.90 - Conduct at Prehearing Conference

Current through Reg. 49, No. 28; July 12, 2024
Abusive, threatening, and vulgar language or gestures will
				  not be tolerated at a prehearing conference. Violation of this board rule by
				  any party or witness may result in a continuation of the hearing until a later
				  date, sanctions, or, in appropriate instances, charges of unethical conduct
				  under §
									65.5
				  of this title (relating to Practicing before the Board).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 61 - PREHEARING CONFERENCES › Section 61.95 - Consular Officers

Current through Reg. 49, No. 28; July 12, 2024
Consular officers and their attorneys shall comply with all
				  board rules and shall attend any prehearing conference or board hearing set on
				  any compensation claim where such consular officers or their attorneys shall
				  purport to represent the interests of any resident or nonresident alien
				  beneficiary in a workers' compensation claim under the workers' compensation
				  laws of Texas. No attorney's fees or other expenses shall be deducted or
				  withheld from any compensation paid without prior authorization of the board
				  pursuant to the provisions of Texas Civil Statutes, Article 8306, §7c. The
				  board shall be provided with proper documentation, as it may request, from time
				  to time, of the remission of compensation benefits paid through any consular
				  office pursuant to the provision of Texas Civil Statutes, Article 8306,
				  §17.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 63 - PROMPTNESS OF FIRST PAYMENT › Section 63.5 - Quarterly Report

Current through Reg. 49, No. 28; July 12, 2024
The executive director of the Industrial Accident Board shall
				  make a report, based on each quarter year's performance of all the insurance
				  carriers writing workers' compensation insurance in Texas, which report will
				  reflect the promptness of first payment of each such carrier of benefits due
				  and payable under the Texas Workers' Compensation Act covering all cases
				  occurring after May 18, 1969 (1970).