reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 42 - MEDICAL BENEFITS › Subchapter D - DISPUTE RESOLUTION › Section 42.305 - Requesting Dispute Review and Resolution

Current through Reg. 49, No. 28; July 12, 2024
(a) Either the carrier or the provider may
				  request board review and resolution of a dispute arising over a medical bill
				  under the following conditions:
(1) the
				  charge has been incurred; and
(2)
				  the carrier has admitted liability for compensation.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 42 - MEDICAL BENEFITS › Subchapter D - DISPUTE RESOLUTION › Section 42.307 - Procedure for Requesting Dispute Review

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  request for dispute review shall be made in writing, and filed with the
				  administrator of the Medical Cost Evaluation Division.
(b) The request shall be made no later than
				  365 days after the date the disputed bill was submitted to the
				  carrier.
(c) The request shall
				  include the following:
(1) all identifying
				  information required by §
											42.30(d)
				  of this title (relating to Written Communications);
(2) the bill as originally submitted to the
				  carrier;
(3) copies of all written
				  communications relating to the dispute; and
(4) written documentation that all reasonable
				  efforts to resolve the dispute have been exhausted.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 42 - MEDICAL BENEFITS › Subchapter D - DISPUTE RESOLUTION › Section 42.308 - Procedure for Responding to a Request for Dispute Review

Current through Reg. 49, No. 28; July 12, 2024
(a) The respondent may file a response with
				  the administrator of the Medical Cost Evaluation Division no later than 30 days
				  after receiving the request. A copy of the response shall be sent
				  simultaneously to the requestor.
(b) The response shall include, but shall not
				  be limited to, the items set out in subsection (c) of §
										42.307
				  of this title (relating to Procedure for Requesting Dispute Review).
(c) The board may request additional
				  information, and may compel production of documents, if necessary.
(d) If the respondent is a health care
				  provider who is responsible for the review fee, as provided in §
										42.309 of
				  this title (relating to Payment for the Review), he or she shall tender the fee
				  to the board when filing the response. If such provider fails or refuses to
				  tender the fee, the board will notify the carrier to tender the fee or withdraw
				  the request.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 42 - MEDICAL BENEFITS › Subchapter D - DISPUTE RESOLUTION › Section 42.309 - Payment for the Review

Current through Reg. 49, No. 28; July 12, 2024
(a) The board shall
				  set reasonable fees for reviewing fee and utilization disputes. The board may
				  adjust these fees periodically, as necessary.
(b) The review fee shall be paid by check or
				  money order, payable to Industrial Accident Board.
(c) The carrier, whether requester or
				  respondent, shall be responsible to pay for the review, unless the board has
				  found that the provider has overutilized the board's review system.
(d) A provider shall be found to have
				  overutilized the board's review system after three separate disputes involving
				  the provider have been presented to the board for review, and have been
				  resolved by the board against the provider within a 12-month period. The board
				  will notify a provider when such finding is made, and shall maintain a record
				  of such findings. In all subsequent reviews of that provider's bills, the
				  provider, whether requester or respondent, shall be responsible to pay for the
				  review.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 42 - MEDICAL BENEFITS › Subchapter D - DISPUTE RESOLUTION › Section 42.310 - Board Review and Resolution

Current through Reg. 49, No. 28; July 12, 2024
(a) After all
				  required information has been filed, the board will commence to review the
				  dispute.
(b) No later than 31 days
				  after commencing the review, the executive director or designee shall issue
				  findings and conclusions in writing to the disputing parties.
(c) If the merits of the injured worker's
				  claim have not been previously resolved by final award, judgment, or
				  settlement, the findings and conclusions of the executive director or designee
				  will be issued as a recommendation, to be filed pending final resolution of the
				  merits of the injured worker's claim.
(d) If the merits of the injured worker's
				  claim have been previously resolved by final award, judgment, or settlement, or
				  if the injured worker is entitled to lifetime benefits under Texas Civil
				  Statutes, Article 8306, §10(b), the board may, upon request of a disputing
				  party, issue an award of medical benefits, based on the findings and
				  conclusions of the executive director or designee.
(e) If the award is entered against the
				  carrier on the issue of fees and charges only, it shall include an assessment
				  of the statutory interest due.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 42 - MEDICAL BENEFITS › Subchapter D - DISPUTE RESOLUTION › Section 42.315 - Appeal

Current through Reg. 49, No. 28; July 12, 2024
An award entered under this chapter may be appealed
					 pursuant to the provisions of Texas Civil Statutes, Article 8307,
					 §5.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 43 - INSURANCE COVERAGE › Section 43.5 - Notice That Employer Has Become Subscriber

Current through Reg. 49, No. 28; July 12, 2024
The notice that employer has become subscriber shall be filed
				  with the board's Austin office by certified mail or in person within 30 days of
				  the effective date of the policy and the notice must be completed in detail and
				  shall include:
(1) name, address, and
				occupation of insured;
(2)
				effective date of the policy;
(3)
				signature of the insurance company representative;
(4) complete name of the insurance
				company;
(5) policy number, and if
				notice is a rewrite of an existing policy, this information must be included on
				the notice;
(6) area or location of
				the business;
(7) Form 154, which
				shall be filed for divided risk coverage; and
(8) the employer's federal tax identification
				number (effective 1987).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 43 - INSURANCE COVERAGE › Section 43.10 - Termination of Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions.
				The following words and terms, when used in this section, shall have the
				following meanings, unless the context clearly indicates otherwise.
(1) Termination of coverage--Occurs when
				either party withdraws from a policy of workers' compensation insurance, either
				by canceling the policy in the middle of its term, or by declining to renew the
				policy on its anniversary date.
(2)
				Rejection of the workers' compensation system--Occurs when a subscriber
				terminates coverage and fails or refuses to purchase a policy of workers'
				compensation insurance.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 45 - EMPLOYER'S REPORT OF INJURY OR DISEASE › Section 45.5 - Forms

Current through Reg. 49, No. 28; July 12, 2024
The employer's first report of injury and supplemental report
				  of injury shall be completed on standardized forms approved by the board for
				  that purpose. Every insurance carrier writing workers' compensation coverage
				  effective in Texas shall provide an adequate number of the current forms in use
				  to each insured employer.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 45 - EMPLOYER'S REPORT OF INJURY OR DISEASE › Section 45.10 - Employer's Report of Injury and Disease

Current through Reg. 49, No. 28; July 12, 2024
(a) Since the efficient operation of workers'
				compensation depends so greatly upon the insurance carrier and Industrial
				Accident Board receiving prompt notice of possible claims, the employer shall
				report injuries and occupational diseases by completing board Form E-1,
				Employer's First Report of Injury, and sending the original to the Industrial
				Accident Board and a copy to the employer's insurance carrier no later than
				eight days after:
(1) the employer has notice
				or knowledge of an injury to an employee resulting in absence from work for
				more than one day; or
(2) the
				employer receives notice from an employee of the manifestation of an
				occupational disease.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 45 - EMPLOYER'S REPORT OF INJURY OR DISEASE › Section 45.13 - Wage Statement

Current through Reg. 49, No. 28; July 12, 2024
(a) When requested
				by the board or carrier, the employer shall immediately complete Board Form
				IAB-150, Employer's Wage Statement, and file the original with the board and a
				copy with the carrier.
(b)
				Noncompliance with this requirement may result in imposition of a civil penalty
				not to exceed $500.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 45 - EMPLOYER'S REPORT OF INJURY OR DISEASE › Section 45.20 - Board Request for Additional Information

Current through Reg. 49, No. 28; July 12, 2024
When requested in writing by the board, the employer shall
				  promptly furnish to the board the information requested if such information is
				  either known to the employer or reasonably available to said employer and which
				  is pertinent to the compensation claim in question.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 45 - EMPLOYER'S REPORT OF INJURY OR DISEASE › Section 45.25 - Employer's Supplemental Report of Injury

Current through Reg. 49, No. 28; July 12, 2024
When the employee returns to work or is no longer
				  incapacitated as a result of the injury or occupational disease, the employer
				  shall file an employer's supplemental report of injury promptly with the board
				  and shall simultaneously deliver a copy thereof to the insurance
				  carrier.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 45 - EMPLOYER'S REPORT OF INJURY OR DISEASE › Section 45.30 - Sanctions

Current through Reg. 49, No. 28; July 12, 2024
If the employer fails to timely submit any information to the
				  board which the board is entitled to request under the authority of the
				  Workers' Compensation Act, the board shall notify the employer by certified
				  mail with a copy sent to the employer's insurance carrier to either file the
				  requested information or request a hearing by the board within 10 days of
				  notice. If the employer timely requests a hearing, the matter will be heard by
				  the board in Austin within 10 days of the request. If the employer does not
				  timely request a hearing and does not timely provide the requested information,
				  the board may impose a penalty authorized by Texas Civil Statutes, Article
				  8307, §7. The employer will be promptly notified of any imposition of
				  penalty by the board. The board may consider a request for extension of time to
				  provide the requested information if the employer makes the request in writing
				  and shows good cause therefore within 10 days of the receipt of notice from the
				  board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 47 - EMPLOYEE NOTICE OF INJURY OR DEATH AND CLAIM FOR BENEFITS › Section 47.5 - Information Constituting Claim

Current through Reg. 49, No. 28; July 12, 2024
The prescribed claim form, or any written communications from
				  an injured employee, claiming either medical care or compensation payments,
				  giving his name, the date and the general nature of injury, and the name of his
				  employer shall constitute a claim (1970).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 47 - EMPLOYEE NOTICE OF INJURY OR DEATH AND CLAIM FOR BENEFITS › Section 47.10 - Signature of Claimant

Current through Reg. 49, No. 28; July 12, 2024
All claim forms must be personally signed by the injured
				  employee and give his home address. If the employee is unable to write, he must
				  make an "X" for his signature, and his mark must be witnessed by at least one
				  credible witness (1978) (Rev.1973).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 47 - EMPLOYEE NOTICE OF INJURY OR DEATH AND CLAIM FOR BENEFITS › Section 47.15 - Employer Advances Compensation

Current through Reg. 49, No. 28; July 12, 2024
Where an employer advances compensation in accordance with
				  Texas Civil Statutes, Article 8309, §4b, it is necessary that IAB Form
				  EAC-70 be completed and forwarded by the employer within 10 days to the board
				  in Austin, and such form shall also be furnished within 10 days to the employee
				  and the insurance carrier advising the date first payment was made
				  (Rev.1979).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 47 - EMPLOYEE NOTICE OF INJURY OR DEATH AND CLAIM FOR BENEFITS › Section 47.20 - Beneficiaries Filing Claim

Current through Reg. 49, No. 28; July 12, 2024
In cases of injury resulting in death, the claim form or any
				  written communication claiming compensation payments giving the employee's
				  name, the employer's name, the date of the employee's death, and the name of
				  the claimant shall constitute a claim. One of several beneficiaries may file
				  claim for all beneficiaries. The names of all beneficiaries should be listed on
				  the claim (1953).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.5 - Schedule of Hearings

Current through Reg. 49, No. 28; July 12, 2024
Formal hearing before the board will be scheduled the first
					 Friday following the expiration of 14 days from the date of prehearing
					 conference. If the Friday upon which a hearing would otherwise be scheduled is
					 a legal holiday or follows a legal holiday, the hearing will be scheduled for
					 the following Monday. A claimant or his attorney must give the board and all
					 parties seven days written notice if they intend to be present for such formal
					 hearing. Hearings will begin at 9:30 a.m. in the board's Austin office and
					 cases normally will be heard by the board in the order registered with the
					 receptionist (1970) (Rev.1977).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.10 - Timely Acceptance of Evidence

Current through Reg. 49, No. 28; July 12, 2024
All interested parties required to file evidence with the
					 board for consideration in a claim scheduled for a hearing must file this
					 evidence not later than 5 p.m. on date of hearing. The board will consider
					 requests for delayed evidence filing from any interested party. The request
					 must be filed with the board in writing no later than 5 p.m. on the date of
					 hearing and it must include a statement of the facts showing good cause and
					 necessity for the delay. If delayed evidence is filed by any party after
					 permission has been granted by the board, copies of such evidence must be
					 simultaneously furnished to the opposing party (1970)
					 (Rev.1975).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.15 - Formal Statement of Position

Current through Reg. 49, No. 28; July 12, 2024
The insurance carrier and attorney representing the
					 claimant shall file their formal statement of position in the board's Austin
					 office on or before the date of formal hearing.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.20 - Request for Cancellation

Current through Reg. 49, No. 28; July 12, 2024
Upon written request by claimant or all claimant
					 beneficiaries, the board, at its discretion, may at any time prior to the entry
					 of an award, cancel a scheduled hearing when good cause is shown. Request for
					 cancellation of a scheduled hearing shall be by written notice and filed with
					 the board's Austin office (Rev.1979).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.25 - Delay or Postponement of Hearing

Current through Reg. 49, No. 28; July 12, 2024
On the date of hearing, the board will review the case in
					 accordance with the provisions of Article 8309a of the Act, the Industrial
					 Accident Board may delay or postpone the hearing of the claim provided that
					 within its discretion the board deems it to be the best interest of the injured
					 employee that the case not be heard at that time; and such hearing may be
					 delayed or postponed until the carrier discontinues payment of compensation or
					 the furnishing of hospitalization, chiropractic service or medical treatment or
					 until the board deems it to the best interest of such employee for an award to
					 be rendered (1968) (Rev.1977).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.30 - Filing of Medical Bills

Current through Reg. 49, No. 28; July 12, 2024
All bills unpaid by the insurance carrier or copies of
					 receipts for medical services for claim for reimbursement must be filed with
					 the board at the prehearing conference or attached to the formal statement of
					 position. There must be clear itemization of all prescriptions or incidentals,
					 date of purchase, treatment rendered and physician prescribing same on items
					 furnished (Rev.1979).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.35 - Filing of Medical Reports and Records

Current through Reg. 49, No. 28; July 12, 2024
If not previously filed pursuant to other board rules, all
					 medical reports and records shall be filed at the time of formal
					 hearing.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.40 - Carrier Attendance

Current through Reg. 49, No. 28; July 12, 2024
The carrier's designated Austin representative must be
					 available to the board on the day a claim is scheduled for formal hearing. In
					 the event the Industrial Accident Board needs a copy of the carrier's file, or
					 a portion thereof, the carrier's designated Austin representative shall obtain
					 the file, or portion thereof, as requested by the board, from the carrier by
					 suitable overnight mail or delivery service.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.45 - Contents of Formal Statement of Position

Current through Reg. 49, No. 28; July 12, 2024
The formal statement of position shall be responsive to the
					 prehearing officer's recommendations and shall be sufficiently detailed to
					 apprise the board of all controverted issues. Legal contentions should be
					 supported by citations to applicable authorities.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter A - FORMAL HEARINGS › Section 49.50 - Sanctions

Current through Reg. 49, No. 28; July 12, 2024
Failure to file a formal statement of position or filing a
					 formal statement of position that does not comply with the requirements of
					 §
										49.45
					 of this title (relating to Contents of Formal Statement of Position) may be
					 punishable by appropriate sanctions of the board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.105 - Procedures

Current through Reg. 49, No. 28; July 12, 2024
These hearings will only generally follow the Texas Rules
					 of Civil Procedure. Evidence will be received in accordance with the Texas
					 Rules of Evidence as generally applied in Texas judicial proceedings, although
					 not with the same degree of strictness. The procedures used in these hearings
					 shall generally follow that used in judicial proceedings in the courts of this
					 state.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.110 - Commencement of Hearings

Current through Reg. 49, No. 28; July 12, 2024
Upon its own motion, or upon the written request or
					 complaint of either a party or employer, the board may schedule a special
					 formal hearing, fraud hearing, or investigative hearing to be conducted by the
					 board or any member therefore under the authority of applicable provisions of
					 the Workers' Compensation Law of Texas.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.115 - Notice

Current through Reg. 49, No. 28; July 12, 2024
All hearings shall be commenced by written notice, in
					 accordance with the provisions of Chapter 41 of this title (relating to
					 Communications and General Medical Provisions) to the individuals and
					 businesses or agencies directly concerned with the subject of the hearing.
					 Sufficiency of the notice shall be presumed unless the issue is raised by an
					 interested party on or before the hearing date.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.120 - Special Statutory Notice

Current through Reg. 49, No. 28; July 12, 2024
In the event of hearings conducted by the board pursuant to
					 the provisions of Texas Civil Statutes, Article 8306, §18, or Texas Civil
					 Statutes, Article 8307, §7 and §9a, or Texas Civil Statutes, Article
					 8308, §18a, the notice requirements of those statutes will prevail whether
					 same or inconsistent with any other provisions of these board rules pertaining
					 to notice.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.125 - Notice of Special Formal Hearing

Current through Reg. 49, No. 28; July 12, 2024
In all other hearings except for those described in §
										49.120
					 of this title (relating to Special Statutory Notice), and unless waived by the
					 board upon its own motion, or for good cause shown, no less than 14 days
					 written notice of the date, time, and place of such hearing will be given to
					 the parties concerned.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.130 - Personal Appearance Hearings in Austin

Current through Reg. 49, No. 28; July 12, 2024
A party desiring to make a personal appearance hearing
					 before the board on a claim which is scheduled for formal hearing by the board
					 in Austin shall give the board and all other interested parties not less than
					 seven days written notice thereof. The claimant's attendance at such hearing is
					 required unless waived by the board for good cause shown. Hearings will begin
					 at 9:30 a.m. in the board's Austin office, and cases normally will be heard by
					 the board in the order they are registered with the receptionist. Strict
					 compliance with the notice provisions of this rule may be waived for good
					 cause.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.131 - Withdrawal of Attorney

Current through Reg. 49, No. 28; July 12, 2024
After a compensation claim has been scheduled for a special
					 formal hearing, or other hearing as provided in §
										53.65 of
					 this title (relating to Certification Procedures), et seq., an attorney may not
					 voluntarily withdraw as counsel for a claimant, except upon written request
					 therefore as approved by the Industrial Accident Board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.135 - Use of Court Reporters

Current through Reg. 49, No. 28; July 12, 2024
Testimony will be recorded under the direction and control
					 of the board member conducting the hearing. It will be permissible for any
					 party to have a court reporter record the proceedings, conditioned upon:
(1) notification thereof shall be made to the
				  presiding board member not less than three days before the scheduled hearing;
				  and
(2) the original of the
				  transcript shall be promptly furnished by the court reporter to the board,
				  without cost to the board; and
(3)
				  a true copy of the transcript shall be made available to the opposing party or
				  parties at the usual and customary charge therefore.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.140 - Continuance

Current through Reg. 49, No. 28; July 12, 2024
After a hearing is scheduled and notice is given to the
					 party or parties as herein provided, a postponement or cancellation may be had
					 by any party only for good cause. A request for postponement or cancellation
					 shall be first and promptly made by telephone or in person to the presiding
					 board member. If the request is granted, the party shall confirm the request
					 and the grounds therefore by letter to the board member, with a copy thereof
					 being delivered to the opposing party/parties or counsel.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.145 - Recess

Current through Reg. 49, No. 28; July 12, 2024
After a hearing has commenced, circumstances may develop
					 which, in the best interest of equity and justice, require the presiding board
					 member to recess the hearing until a later time or date. If this occurs, the
					 parties and all subpoenaed witnesses shall be entitled to notice of the date,
					 time, and place of the resumption of hearing, in accordance with the same
					 provisions as herein before provided for in these rules for the initial notice,
					 except not less than 10 days written notice thereof shall be given to the party
					 or parties.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.150 - Complaint Specifications

Current through Reg. 49, No. 28; July 12, 2024
For all hearings for which complaint and allegation of
					 violation of any provision of the Workers' Compensation Law or of Industrial
					 Accident Board rules, the written notice herein provided for shall describe in
					 detail the areas of investigation or complaint so as to fairly inform the party
					 under investigation.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.155 - Documentary Evidence

Current through Reg. 49, No. 28; July 12, 2024
If documentary evidence is to be tendered at the hearing,
					 true copies thereof shall be prepared in advance by the parties offering such
					 evidence, sufficient in number for all interested parties to the
					 hearing.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD › Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS › Section 49.160 - Filing of Formal Statement of Position

Current through Reg. 49, No. 28; July 12, 2024
Although no formal statement of position is required to be
					 filed in these types of hearings, any party may file a written brief concerning
					 the facts, law, or argument which a party may desire to present in written form
					 to the board.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 51 - AWARD OF THE BOARD › Section 51.10 - Joint Payment of Award

Current through Reg. 49, No. 28; July 12, 2024
Any payment by an insurance carrier of an award of the board
				  to a claimant represented by counsel shall be made payable jointly to the
				  claimant and to his attorney (1970).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 51 - AWARD OF THE BOARD › Section 51.15 - Periodic Installments

Current through Reg. 49, No. 28; July 12, 2024
When an award is made for payment of compensation in periodic
				  installments, the carrier will notify the board of payment of the award by
				  filing Form A-1 (report of initial payment of compensation), or A-4 (report of
				  resumption of compensation), whichever is appropriate. An A-2 (report of
				  suspension of compensation) will be filed with the board when the carrier
				  discharges its obligation (1974).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 51 - AWARD OF THE BOARD › Section 51.20 - Lump Sum Payment

Current through Reg. 49, No. 28; July 12, 2024
When an award is made for payment of compensation in a lump
				  sum the carrier will notify the board of payment of the award by filing Form
				  A-2 (report of suspension of compensation) (1974).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 51 - AWARD OF THE BOARD › Section 51.25 - Request for Review

Current through Reg. 49, No. 28; July 12, 2024
Requests for review shall be filed in writing with the board
				  stating the reason for which the award is sought to be modified or set aside.
				  The board in its discretion may set a date on which the request may be
				  considered and will give notice of the hearing to all parties. As soon as
				  possible after the hearing is held, the board will affirm, set aside, or modify
				  the award on the basis of the information available to it at the time from any
				  source. The board may on its own motion correct typographical errors at any
				  time (1974).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 51 - AWARD OF THE BOARD › Section 51.30 - Review of Award

Current through Reg. 49, No. 28; July 12, 2024
Review may be granted if any erroneous award was made because
				  of fraud or mistake, or if a change has occurred in the physical condition of
				  the injured employee requiring modification of the award as to amount or
				  duration of payments (1974).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 51 - AWARD OF THE BOARD › Section 51.50 - Payments of Attorney's Fees

Current through Reg. 49, No. 28; July 12, 2024
The parties may agree after the board's award, and with the
				  approval of the board, to a different method of payment of attorney's fees as
				  provided by law. Any such agreement shall be submitted to the board in writing,
				  and when approved, shall be binding on all parties (1968).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 51 - AWARD OF THE BOARD › Section 51.65 - Attorney Fees

Current through Reg. 49, No. 28; July 12, 2024
(a) As used in this
				section, executive director means the executive director of the Texas Workers'
				Compensation Commission, or designee.
(b) Attorneys representing claimants will be
				authorized to receive fees and expenses only when a power of attorney, contract
				of employment, or other document signed by the claimant is filed with the
				executive director. The attorneys' fees for representing the claimant shall be
				specified in the power of attorney, contract of employment, or other signed
				document, and the fees shall not exceed 25% of the total recovery. All
				attorneys' fees for representing claimants shall be subject to the approval of
				the executive director as provided in Texas Civil Statutes, Article 8306,
				§7(c). When a dispute arises as to the representation of the claimant by
				two or more attorneys, the executive director will require a signed and dated
				power of attorney or employment contract from each attorney, and the attorney
				first retained will be deemed to be the attorney of record, unless the
				executive director determines that the claimant has effected a change of
				attorneys.
(c) Payment for
				representation of multiple beneficiaries with adverse claims for benefits is
				not allowed.
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 53.5 - Payment of Benefits Without Prejudice

Current through Reg. 49, No. 28; July 12, 2024
It being the policy of the Industrial Accident Board to
				  encourage the prompt delivery of compensation and medical benefits to an
				  injured worker, neither the payment of periodic benefits nor of the health
				  provider care shall be considered an admission of liability by the insurance
				  carrier.
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 53.10 - Written Notice of Injury Defined

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Written notice of injury as used in Texas Civil Statutes, Article 8306,
				§18a, shall consist of either:
(1) an
				employer's first report of injury (IAB Form E-1); or
(2) any other instrument in writing,
				regardless of its source, which fairly informs the carrier of the name of the
				injured worker, the identity of the employer, the approximate date of injury,
				and facts showing compensable lost time or the probability of compensable lost
				time.
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 53.15 - Board Notice to Carrier of Injury

Current through Reg. 49, No. 28; July 12, 2024
The board shall furnish a dated written notification of any
				  injury which may produce compensable lost time to the carrier's designated
				  Austin representative. This notice shall begin the 20-day period for
				  commencement of the payment of compensation, or the filing of the statement of
				  controversion, as required in Texas Civil Statutes, Article 8306, §18a,
				  unless the carrier has already received earlier written notice thereof from
				  another source (effective January 1, 1984).
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 53.20 - Notice of Initiation of Compensation; Mode of Payment of Compensation

Current through Reg. 49, No. 28; July 12, 2024
(a) Every insurance carrier shall report to
				the Industrial Accident Board and to the claimant or the claimant's attorney on
				Form A-1 the initial payment of compensation to the claimant within 10 days
				from the date of:
(1) issuance of a draft,
				check, or other evidence of payment; or
(2) transfer of funds electronically to the
				claimant's account.
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 53.22 - Application To Change the Benefits Payment Period

Current through Reg. 49, No. 28; July 12, 2024
(a) While a claim is pending before the
				board, the claimant and the carrier, with board authorization, may agree to
				change the weekly payment of benefits to one of the following payment periods:
				every two weeks, every four weeks, monthly, or quarterly.
(b) Application for board authorization shall
				be made in writing on a form approved by 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 53.25 - Contents of Statement of Controversion or Statement of Position

Current through Reg. 49, No. 28; July 12, 2024
A statement of position or a statement of controversion as
				  provided for in Texas Civil Statutes, Article 8306, §18a(a), shall state
				  fully and in writing the grounds for refusal to commence paying compensation.
				  These grounds must be based on actual investigation of the claim and stated in
				  sufficient detail so as to be compared with the position taken by the carrier
				  at the prehearing conference. It is insufficient to simply state a conclusion,
				  for example, "liability in question," "compensability in dispute," or "under
				  investigation." When a carrier files an insufficient statement of controversion
				  or statement of position, the board will issue a complaint report to the
				  carrier through its designated Austin Industrial Accident Board representative.
				  The carrier will have 30 days from the date of receipt of the complaint report
				  to respond in writing to the charge. The board will evaluate the carrier's
				  response. If a majority of the board members determine that a violation has
				  occurred, the violation may be used to establish a record of general business
				  practice, in accordance with Texas Civil Statutes, Article 8306, §18a(d).
				  A failure to respond to the complaint report within 30 days will constitute an
				  automatic violation.
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 53.30 - Filing of Wage Statement

Current through Reg. 49, No. 28; July 12, 2024
(a) In cases in
				which the reported weekly compensation rate is less than the maximum prescribed
				by law, the insurance carrier shall file with the board and the claimant or his
				attorney a wage statement reporting the wages upon which the compensation rate
				is based. The wage statement shall accompany the Form A-1, report of initial
				payment of compensation, or in the event a wage statement is not available at
				the time of filing Form A-1, the carrier shall indicate on Form A-1 that a wage
				statement has been requested and shall file said form within a reasonable time,
				not to exceed 30 days from the date of initial payment of
				compensation.
(b) When an employer
				fails or refuses to promptly complete and return the wage statement to the
				carrier, the carrier shall notify the board of that fact and additionally shall
				supply the employer's current address to the board. The board will thereafter
				contact the employer pursuant to the provisions of Texas Civil Statutes,
				Article 8307, §7, and of these rules, and may impose appropriate sanctions
				against the employer for a continuing unexcused failure to respond to the
				request.
(c) If the carrier does
				not notify the board of the employer's failure to comply within 30 days of the
				carrier's first request for a wage statement, the board shall set the
				compensation rate based upon evidence in the file, and the carrier shall be
				required to pay the rate determined by the board beginning with the date that
				the initial payment of compensation was due and continuing until the wage
				statement is filed with the board or until the carrier is authorized to stop or
				suspend compensation.
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 53.35 - Notice of Suspension of Compensation

Current through Reg. 49, No. 28; July 12, 2024
(a) In every instance in which an insurance
				carrier has paid compensation to a claimant, the carrier shall report to the
				board and to the claimant or his attorney on Form A-2 (notice of suspension of
				compensation payments) within 10 calendar days from the date of last payment.
				The reasons for suspension of payment shall be stated fully on the notice. When
				Form A-2 is filed stating compensation suspended because case settled with
				third party, the carrier shall accompany the notice with a copy of the
				judgment(s) or settlement papers.
(b) If a carrier suspends or stops the
				payments of indemnity compensation or medical benefits, and notifies the board
				in writing thereof pursuant to Texas Civil Statutes, Article 8306,
				§18a(b), and Article 8307, §11, such notice shall state fully the
				reason(s) for suspending or stopping such payments. This statement must contain
				sufficient substantive information to enable the board to evaluate the
				carrier's position on the claim. It is insufficient to simply state the
				carrier's position with such phrases as abandoned medical treatment, disability
				in dispute, etc. When a carrier files an insufficient statement of reasons for
				suspension of payment of benefits, the board will issue a complaint report to
				the carrier through its designated Austin Industrial Accident Board
				representative. The carrier will have 30 days from the date of receipt of the
				complaint report to respond in writing to the charge. The board will evaluate
				the carrier's response. If a majority of the board members determine that a
				violation has occurred, the violation may be used to establish a record of
				general business practice, in accordance with Texas Civil Statutes, Article
				8306, §18a(d). A failure to respond to the complaint report within 30 days
				will constitute an automatic violation.
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 53.40 - Transmittal Letters

Current through Reg. 49, No. 28; July 12, 2024
In cases where the carrier tenders a lump sum payment to
				  claimant based upon medical disability, the carrier shall accompany the payment
				  with the A-2 and a transmittal letter which shall read as follows:
(1) Enclosed is our payment of compensation
				$_____ for injuries received on __________. This payment is based on the
				medical reports contained in our file. Your case remains open before the
				Industrial Accident Board. This payment does not represent a settlement of your
				compensation claim. However, there are certain requirements of the law and of
				the Industrial Accident Board rules with which you must comply in order to
				protect your claim in the future. Please call our office or the board if you
				require additional medical treatment or become further disabled as a result of
				your injury.
(2) The insurance
				carrier shall file an amended A-2 not later than 10 days after the carrier has
				received a rejected lump sum payment from the claimant or has itself cancelled
				for any reason the lump sum payment.
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 53.45 - Maximum Payment to Minor

Current through Reg. 49, No. 28; July 12, 2024
In cases of specific injury or injuries resulting in death,
				  permanent total incapacity, or a high degree of permanent partial disability,
				  where the injured employee is a minor, the compensation rate per week shall be
				  fixed at the maximum allowed by the law unless the evidence clearly dictates
				  the contrary.