reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter B - MEDICAL BENEFIT REGULATION › Section 180.23 - Division-Required Training for Doctors

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability.
				  This section governs authorization relating to certification of maximum medical
				  improvement (MMI), determination of permanent impairment, and assignment of
				  impairment ratings in the event that a doctor finds permanent impairment
				  exists.
(b) Authorization. Full
				  authorization to assign an impairment rating and certify MMI in an instance
				  where the injured employee is found to have permanent impairment requires a
				  doctor to obtain division certification by completing the division-prescribed
				  impairment rating training and passing the test or meeting the training and
				  testing requirements for designated doctor certification under §
										127.100 of this title (relating to
				  Designated Doctor Certification). To remain certified, a doctor is required to
				  complete follow-up training at least every two years.
(c) Training. A doctor who has not completed
				  the required training under subsection (b) of this section but who has had
				  similar training in the American Medical Association Guides from a
				  division-approved vendor within the prior two years may submit the syllabus and
				  training materials from that course to the division for review. If the division
				  determines that the training is substantially the same as the division-required
				  training and the doctor passes the division-required test, the doctor is fully
				  authorized under this section. The ability to substitute training only applies
				  to the initial training requirement.
(d) Exceptions. Notwithstanding any other
				  provision of this section, a doctor who has not successfully completed training
				  and testing required by this section for authorization to assign impairment
				  ratings and certify MMI when there is permanent impairment may receive
				  permission by exception to do so from the division on a specific case-by-case
				  basis.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter B - MEDICAL BENEFIT REGULATION › Section 180.24 - Financial Disclosure

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) Compensation arrangement--Any arrangement
				  involving any remuneration between a health care practitioner (or a member of a
				  health care practitioner's immediate family) and a health care
				  provider.
(2) Financial interest
				  means:
(A) an interest of a health care
				  practitioner, including an interest of the health care provider who employs the
				  health care practitioner, or an interest of an immediate family member of the
				  health care practitioner, which constitutes a direct or indirect ownership or
				  investment interest in a health care provider; or
(B) a direct or indirect compensation
				  arrangement between the health care practitioner, the health care provider who
				  employs the referring health care practitioner, or an immediate family member
				  of the health care practitioner and a health care provider.
(3) Immediate family
				  member--Immediate family member or member of a doctor's immediate family means
				  husband or wife; birth or adoptive parent, child, or sibling; stepparent,
				  stepchild, stepbrother, or stepsister; father-in-law, mother-in-law,
				  son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or
				  grandchild; and spouse of a grandparent or grandchild.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter B - MEDICAL BENEFIT REGULATION › Section 180.25 - Improper Inducements, Influence and Threats

Current through Reg. 49, No. 28; July 12, 2024
(a) Pursuant to Labor Code §
										415.0036,
				  offering, paying, soliciting, or receiving an improper inducement relating to
				  the delivery of benefits to an injured employee is prohibited. Improper
				  attempts to influence the delivery of benefits to an injured employee,
				  including the making of improper threats. This section applies to all system
				  participants in the workers' compensation system who have authority under Labor
				  Code, Title 5 to request the performance of a service affecting the delivery of
				  benefits to an injured employee or who actually performs such a service,
				  including peer reviews, performance of designated doctor examinations,
				  performance of required medical examinations, or case management.
(b) The following specific acts will be
				  deemed to be an improper inducement, attempt to influence or threat:
(1) Soliciting or receiving any remuneration
				  (including, but not limited to, any kickback, bribe, or rebate) in return for
				  referring an injured employee to a person (either the person soliciting or
				  receiving the inducement or another person):
(A) for the furnishing or arranging for the
				  furnishing of any item, treatment, or service constituting a medical benefit
				  for which payment may be made in whole or in part under Labor Code, Title 5 or
				  rules; or
(B) in return for
				  purchasing, leasing, ordering, or arranging for or recommending purchasing,
				  leasing, or ordering any good, facility, service, treatment or item
				  constituting a medical benefit for which payment may be made in whole or in
				  part under Labor Code, Title 5 or rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter B - MEDICAL BENEFIT REGULATION › Section 180.26 - Criteria for Imposing, Recommending and Determining Sanctions; Other Remedies

Current through Reg. 49, No. 28; July 12, 2024
(a) The division
				  may impose sanctions on any system participant if that system participant
				  commits an administrative violation.
(b) The division may impose the following
				  sanctions against a doctor or insurance carrier for any reason listed in Labor
				  Code §
										408.0231(c)
				  or any other criteria the commissioner considers relevant:
(1) reduction of allowable reimbursement to a
				  doctor (such as an automatic percentage reduction on all or some types of
				  health care);
(2) mandatory
				  preauthorization or utilization review of all or certain health care treatments
				  and services (such as mandatory treatment plans);
(3) required supervision or peer review
				  monitoring, reporting, and audit (by the insurance carrier, the division, or an
				  independent auditor or reviewer);
(4) deletion or suspension from the
				  designated doctor list;
(5)
				  restrictions on appointments or reviews;
(6) conditions or restrictions on an
				  insurance carrier regarding actions by insurance carriers under the Act and
				  rules, that are not inconsistent with a memorandum of understanding adopted
				  between the commissioner and the commissioner of insurance regarding the
				  regulation of insurance carriers and utilization review agents as necessary to
				  ensure that appropriate health care decisions are reached under applicable
				  regulations by the department and the division, the Act, and Chapter 4201,
				  Insurance Code; and
(7) mandatory
				  participation in training classes or other courses as established or certified
				  by the division.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter B - MEDICAL BENEFIT REGULATION › Section 180.27 - Restoration

Current through Reg. 49, No. 28; July 12, 2024
(a) In accordance with Labor Code §
										408.0231(d)(2)
				  a doctor, other than a doctor to which Labor Code §
										408.023(r)
				  applies, may apply for the restoration of a doctor privilege removed under
				  Labor Code §
										408.0231
				  by sending a letter of consideration to the Medical Advisor.
(b) The request shall be evaluated by the
				  Medical Advisor and /or members of the Medical Quality Review Panel. The
				  requestor shall be liable for the cost of the review, which may include an
				  audit of the records of the requestor.
(1) If,
				  in the Medical Advisor's opinion, the doctor:
(A) has all the appropriate unrestricted
				  licenses/certifications;
(B) has
				  overcome the conditions that resulted in the sanction;
(C) meets all the division's qualification
				  standards and conditions for restoration of some or all of the practice
				  privileges removed; and
(D) is not
				  out of compliance with the Labor Code, Insurance Code, a department rule, or a
				  rule, order, or decision of the commissioner the Medical Advisor may recommend
				  that the commissioner lift the sanction(s) or restore some or all of the
				  privileges removed or restricted by the sanction(s).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter B - MEDICAL BENEFIT REGULATION › Section 180.28 - Peer Review Requirements, Reporting, and Sanctions

Current through Reg. 49, No. 28; July 12, 2024
(a) A peer reviewer's report, including a
				  report used to deny preauthorization, shall document the objective medical
				  findings and evidence-based medicine that supports the opinion and include:
(1) the peer reviewer's name and professional
				  Texas license number;
(2)
				  certification that the peer reviewer holds the appropriate credentials as
				  defined in §
											180.1 of
				  this title (relating to Definitions);
(3) a summary of the reviewer's
				  qualifications;
(4) a list of all
				  medical records and other documents reviewed by the peer reviewer, including
				  dates of those documents;
(5) a
				  summary of the clinical history; and
(6) an analysis and explanation for the peer
				  review recommendation, including the findings and conclusions used to support
				  the recommendations.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter B - MEDICAL BENEFIT REGULATION › Section 180.50 - Severability

Current through Reg. 49, No. 28; July 12, 2024
Where any provisions of this chapter are determined by a
					 court of competent jurisdiction to be inconsistent with any statutes of this
					 state, or to be unconstitutional, the remaining provisions of this chapter
					 shall remain in effect.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.60 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following terms, when used in this subchapter, shall
					 have the following meanings:
(1)
				  Doctor--As defined by Labor Code §
										401.011(17),
				  a doctor of medicine, osteopathic medicine, optometry, dentistry, podiatry, or
				  chiropractic who is licensed and authorized to practice.
(2) Medical Case Review--A review of a
				  particular case by a Medical Quality Review Panel (MQRP) member regarding
				  professional medical services, delivery of health care, or the quality of a
				  health care practitioner's opinion, recommendation or report. Medical case
				  review includes but it is not limited to review of a treating doctor, peer
				  review doctor, designated doctor, another health care practitioner, an
				  independent review organization, an insurance carrier, or a utilization review
				  agent.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.62 - Medical Quality Review Panel

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose. The
				  purpose of the Medical Quality Review Panel (MQRP) is to assist the medical
				  advisor in the performance of the medical advisor's duties under Labor Code
				  §
										413.0511 in
				  accordance with the provisions of Labor Code §§
										413.0512,
				  413.05121,
				  and
				  413.05122.
(b) Experts. Members of the MQRP who prepare
				  reports for medical case review will be known as MQRP Experts.
(c) Composition. Applicants may be selected
				  and appointed to the MQRP at the discretion of the medical advisor and the
				  commissioner of workers' compensation (commissioner) in accordance with this
				  section. The MQRP must be composed of health care practitioners appointed by
				  the medical advisor and the commissioner in accordance with this section.
(1) The MQRP must have at least 25
				  members.
(2) The MQRP must, at a
				  minimum, have members in the following health care specialty fields:
(A) Orthopedic Surgery--A medical doctor (MD)
				  or a doctor of osteopathy (DO) with board certification in orthopedic
				  surgery.
(B) Neurosurgery--An MD or
				  DO with board certification in neurological surgery.
(C) Chiropractic--A licensed doctor of
				  chiropractic.
(D) Occupational
				  Medicine--An MD or DO with board certification in occupational
				  medicine.
(E) Pain Medicine--An MD
				  or DO with a board certification in a subspecialty of anesthesiology,
				  neurology, or physical medicine.
(3) The MQRP may have members that include
				  other types of health care practitioners determined to be necessary by the
				  medical advisor and the commissioner.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.64 - MQRP Application Process

Current through Reg. 49, No. 28; July 12, 2024
(a) To
				  apply to the MQRP, a person must submit an application in the form and manner
				  required by the division demonstrating compliance with the required
				  qualifications. The application must contain complete information as provided
				  by subsection (b) of this section. The medical advisor and the Commissioner may
				  select and appoint only qualified applicants to the division's MQRP but are not
				  required to accept all applicants who meet the requirements specified in this
				  subchapter.
(b) The division's
				  required application form for the MQRP, at a minimum, shall include:
(1) contact information for the health care
				  practitioner;
(2) information about
				  the health care practitioner's education;
(3) a description of the health care
				  practitioner's license(s), certifications, and professional specialty, if
				  any;
(4) a description of the
				  health care practitioner's work history and hospital or other health care
				  practitioner affiliations;
(5) a
				  description of any affiliations the health care practitioner has with a
				  workers' compensation health care network certified under Chapter 1305 of the
				  Insurance Code or a political subdivision as described in Labor Code §
											504.053(b)(2);
(6) identification of and a description of
				  all current and past medical review affiliations, including but not limited to
				  an independent review organization (IRO), utilization review agent (URA),
				  licensing board, and insurance carrier;
(7) information regarding the health care
				  practitioner's current practice locations;
(8) disclosure regarding the health care
				  practitioner's professional background, education, training, and fitness to
				  perform the duties of an MQRP member, including disclosure of any disciplinary
				  actions or other sanctions taken against the health care practitioner by any
				  state licensing board, state or federal agency, and hospital or other health
				  care institution, as well as disclosure of any voluntary relinquishments, drug
				  and alcohol misuse, malpractice claims history and criminal history;
(9) a description of all ownership interests
				  or other financial arrangements, such as salaried or contract employment,
				  involving a person or their agent subject to the Act or a rule, order, or
				  decision of the commissioner;
(10)
				  an authorization for third parties to release information relevant to the
				  verification of the information provided on the application to the
				  division;
(11) an affirmation that
				  all information provided in the application is accurate and complete to the
				  best of the health care practitioner's knowledge; and
(12) an affirmation of understanding of the
				  legal requirements, including confidentiality provisions, for MQRP
				  members.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.66 - Medical Case Review

Current through Reg. 49, No. 28; July 12, 2024
The MQRP may perform medical case review for the medical
					 advisor. Medical case review may be performed for the purposes of the medical
					 quality review process, designated doctor certification and renewal,
					 performance-based oversight, or any other medical case review necessary to
					 assist the medical advisor in performing the medical advisor's duties under the
					 Labor Code.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.68 - Medical Quality Review Process

Current through Reg. 49, No. 28; July 12, 2024
(a) The medical
				  quality review process is medical case review initiated on the basis of
				  complaints, plan-based audits, or monitoring as a result of a consent order and
				  performed in accordance with criteria adopted under Labor Code §
										413.05115. The medical
				  quality review process does not include medical case review performed for the
				  purpose of:
(1) certification and renewal of
				  designated doctors;
(2)
				  performance-based oversight;
(3)
				  administrative violations that do not require an expert medical opinion;
				  or
(4) complaints about
				  professionalism that do not require an expert medical opinion.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.70 - MQRP Training

Current through Reg. 49, No. 28; July 12, 2024
An MQRP member must receive training by the division prior
					 to any assignments and at least every two years thereafter on the following
					 topics:
(1) The requirements of this
				  subchapter concerning the medical quality review process under §
										180.68
				  of this title (relating to Medical Quality Review Process);
(2) The division's goals regarding the
				  medical quality review process;
(3)
				  Administrative violations that affect the delivery of appropriate medical
				  care;
(4) Confidentiality
				  requirements of Labor Code §§
										402.083,
				  402.091,
				  402.092
				  and
				  413.0513;
(5) Immunity from liability under Labor Code
				  §
										413.054;
(6) The medical quality review criteria
				  adopted under Labor Code §
										413.05115;
(7) The current division adopted edition of
				  the American Medical Association Guides to the Evaluation of Permanent
				  Impairment and the division's adopted treatment and return-to-work guidelines;
				  and
(8) Other topics as determined
				  by the medical advisor and commissioner.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.72 - Conflict of Interest

Current through Reg. 49, No. 28; July 12, 2024
(a) If the selected
				  MQRP member has a conflict of interest in a case under medical review, that
				  member may not review the case or serve as an arbiter. If all MQRP members in a
				  particular health care specialty field as the subject of a medical case review
				  have conflicts of interest in a case under medical case review, and the
				  division is unable to enter into an interagency agreement pursuant to
				  subsection (e) of this section, then the division may refer the case to the
				  appropriate licensing authority.
(b) A conflict of interest exists if the
				  selected MQRP member:
(1) has a familial
				  relationship within the third degree of affinity with any party or witness
				  related to the case;
(2) has a
				  relationship with the subject beyond a mere acquaintance;
(3) has ever treated the injured employee
				  whose records are being reviewed;
(4) in regard to a particular injured
				  employee's claim, has served as a:
(A) peer
				  review doctor;
(B) designated
				  doctor; or
(C) required medical
				  examination doctor.
(5)
				  has a financial interest in a matter as set forth in §
											180.24 of
				  this title (relating to Financial Disclosure);
(6) is a medical director for an Insurance
				  Carrier, Utilization Review Agent, or a workers' compensation health care
				  network certified under Chapter 1305 of the Insurance Code or a political
				  subdivision as described in Labor Code §
											504.053(b)(2).
				  Medical directors can perform all functions of the MQRP and the QAP except
				  performing individual medical case reviews or serving as Arbiters in a informal
				  settlement conference (ISC); or
(7)
				  has other issues deemed to be a conflict of interest by the medical
				  advisor.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.74 - MQRP Notification of Case Status

Current through Reg. 49, No. 28; July 12, 2024
The division shall notify MQRP panel members in writing at
					 least quarterly of the status of and enforcement outcomes resulting from cases
					 in the medical quality review process. A MQRP panel member shall comply with
					 all confidentiality laws that apply to information provided under this section
					 including Labor Code §§
										402.083
					 -
					 402.086,
					 402.091, 402.092 and 413.0513.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 180 - MONITORING AND ENFORCEMENT › Subchapter C - MEDICAL QUALITY REVIEW PANEL › Section 180.76 - Rights and Responsibilities of Persons Involved in the Medical Quality Review Process

Current through Reg. 49, No. 28; July 12, 2024
(a) The person
				  subject to the medical quality review process has the right:
(1) to be notified that the person has been
				  selected for the medical quality review process;
(2) to be notified of the disposition of the
				  medical quality review process;
(3)
				  to communicate with the office of the medical advisor at any time during the
				  medical quality review process;
(4)
				  to be represented by legal counsel, including legal counsel at the informal
				  settlement conference (ISC);
(5) to
				  receive written notice of an ISC at least 45 days before the ISC, including the
				  time and place of the ISC and the nature of the allegations; and
(6) to an ISC in accordance with the
				  provisions of this section. The ISC provides persons subject to the medical
				  quality review process an opportunity to discuss and resolve their medical case
				  review with arbiters. The division may, at its discretion, conduct an ISC
				  remotely or in person. An ISC is available under the following conditions:
(A) The case has been referred to
				  enforcement.
(B) The request for an
				  ISC must be in writing.
(C) The
				  division will notify the requester of the scheduled date of the ISC.
(D) The requester has the right to receive
				  copies of all documents that pertain to the substance of the case and that were
				  given to the arbiters for review for that particular case.
(E) All information the requester wishes the
				  arbiters to consider at the ISC must be received by the division no later than
				  15 days before the ISC. The arbiters may refuse to consider any information not
				  timely received by the division.
(F) The requester may request to reschedule
				  the scheduled date of the ISC for good cause shown, in writing, as determined
				  by the division's presiding attorney. Good cause means circumstances beyond the
				  requester's control that reasonably prevent the requester from attending the
				  ISC and requesting that the ISC be rescheduled any sooner.
(G) If a requester fails to attend an ISC as
				  scheduled, the requester loses the right to an ISC. But failure to attend the
				  ISC does not affect the requester's rights to:
(i) communicate with the office of the
				  medical advisor as paragraph (3) of this subsection provides;
(ii) enter into a consent order with the
				  division; or
(iii) defend an
				  enforcement case at the State Office of Administrative Hearings.
Texas Administrative Code › Title 28 - INSURANCE › Part 3 - TEXAS CERTIFIED SELF-INSURER GUARANTY ASSOCIATION › Chapter 181 - BYLAWS › Section 181.1 - Bylaws of the Texas Certified Self-Insurer Guaranty Association

Current through Reg. 49, No. 28; July 12, 2024
(a) The membership of the Texas Certified
				Self-Insurer Guaranty Association (the Association) shall consist of all
				certified self-insurers (members) that hold a certificate of authority to
				self-insure issued by the Commissioner of Workers' Compensation of the Texas
				Department of Insurance, Division of Workers' Compensation (the Commissioner).
				Only certified self-insurers may be members of the Association.
(1) Membership shall begin on the date the
				certificate of authority to self-insure takes effect and each member shall
				designate a representative to receive notices from the association.
(2) The members of the Association shall meet
				annually at a place and time designated by the Board of Directors. At the
				Annual Meeting, the members shall conduct any necessary and proper
				business.
(3) The association shall
				have a president and vice-president and may have other officers as necessary to
				conduct the business of the association.
(4) Special meetings of the association may
				be called by the president of the association on 30 days notice to the members
				of the association.
(5) A majority
				of the members present either in person or by proxy at any meeting of the
				association shall constitute a quorum.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter A - DEFINITION OF TERMS › Section 251.1 - 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) Commission--The Texas
				  Workers' Compensation Commission.
(2) Director--The director of the State
				  Office of Risk Management.
(3)
				  Division--The Workers' Compensation Division of the Office of the Attorney
				  General.
(4) Employee--Any person
				  who is an "employee" as defined by the Texas Labor Code, Chapter 501,
				  §501.001(5) and §501.024, or is otherwise considered under Texas law
				  to be a state employee for purposes of that chapter.
(5) Employing agency--The agency, department,
				  office, board, commission, body, or entity of the state by which the injured
				  person is employed.
(6)
				  Insured--The State of Texas.
(7)
				  Insurer--The director, State Office of Risk Management.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.20 - Compliance

Current through Reg. 49, No. 28; July 12, 2024
Any party seeking action by the director shall comply with
					 these sections, unless in the director's judgment, compliance in a particular
					 case would result in injustice to any party.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.201 - Employing Agency's Cooperation

Current through Reg. 49, No. 28; July 12, 2024
All employing agencies shall cooperate with the State
					 Office of Risk Management in all actions required for the proper administration
					 of the Texas Labor Code, Chapter 501, and any amendments
					 thereto.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.202 - Posting Proposed Changes

Current through Reg. 49, No. 28; July 12, 2024
Proposed changes in rules will be posted on the public
					 bulletin board in the director's office in Austin and in the Texas Register.
					 Each rule adopted shall take effect after expiration of the statutory period
					 except that any emergency rule concerning health or safety will take effect
					 immediately on issuance.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.203 - Filing of Instruments

Current through Reg. 49, No. 28; July 12, 2024
Any reference in this chapter to a specific form to be used
					 for giving notices, making reports, or otherwise transmitting information to
					 the commission is meant to include the form or forms prescribed for that
					 particular purpose by the commission's executive director, pursuant to the
					 Texas Workers' Compensation Act, as of the time that the notice, report, or
					 transmittal is required to be made. The following shall be filed with the State
					 Office of Risk Management in Austin:
(1) Employer's First Report of Injury or
				  Illness (Form TWCC-1S);
(2) any
				  supplemental report of injury by the employing agency (Form TWCC-6);
(3) any special reports required by the
				  director;
(4) any other forms
				  prescribed or required from the employing agency by the commission will be
				  submitted to the director who will be responsible for filing with the
				  commission.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.204 - Communicating with Commission

Current through Reg. 49, No. 28; July 12, 2024
Nothing contained in §
										251.203 of
					 this title (relating to Filing of Instruments) is to be taken as precluding an
					 injured employee from communicating directly with the commission in person or
					 in any other manner.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.205 - Medical Reports

Current through Reg. 49, No. 28; July 12, 2024
Any health care provider, as defined in the Texas Workers'
					 Compensation Act, Labor Code, §
										401.011(22),
					 rendering care to an injured employee must render reports to the director in
					 keeping with that Act and commission rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.206 - Employing Agency's Records

Current through Reg. 49, No. 28; July 12, 2024
Every employing agency shall keep a record of all injuries
					 sustained by an employee.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.207 - Requirement for Submitting Form TWCC-1S

Current through Reg. 49, No. 28; July 12, 2024
Reports are to be submitted to the director on Form TWCC-1S
					 (Employer's First Report of Injury or Illness) for any injury which
					 necessitates the expenditure of monies for any medical treatment or service or
					 if there is as much as one day's lost time from work.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.208 - Two-Year Retention of Records

Current through Reg. 49, No. 28; July 12, 2024
Above reports and records as set forth in §
										251.203 of
					 this title (relating to Filing of Instruments) and §
										251.206
					 of this title (relating to Employing Agency's Records) are to be retained by
					 the employing agency on each case for a minimum of two years.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.209 - Time Limit on Submitting Form TWCC-1S

Current through Reg. 49, No. 28; July 12, 2024
Form TWCC-1S is to be completed and submitted by the
					 employing agency to the director no later than the next working day after the
					 employing agency receives its first notice of injury or work-related illness of
					 an employee. This form shall be completed by the employing agency's claims
					 coordinator or designee, and not by the injured employee.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.210 - Form TWCC-6

Current through Reg. 49, No. 28; July 12, 2024
In case of lost time injury, Form TWCC-6 is to be completed
					 and submitted to the director immediately after an injured employee returns to
					 work.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.211 - Absence of More Than 60 Days

Current through Reg. 49, No. 28; July 12, 2024
If an injured employee is absent from work for more than 60
					 days, the employing agency will immediately file Form TWCC-6 with the director
					 and will do so at end of each 60-day period as long as the employee remains
					 unable to resume work.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.212 - Immediate Notice of Injury

Current through Reg. 49, No. 28; July 12, 2024
Immediately after the employing agency learns of any
					 serious injury or work-related illness or injury resulting in death to an
					 employee, the employing agency must give notice to the director by telephone.
					 Form TWCC-1S must still be filed as required.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.213 - Claims Coordinator

Current through Reg. 49, No. 28; July 12, 2024
Each employing agency will designate one or more claims
					 coordinators, as may be necessary, who will be responsible for receiving notice
					 of injury from fellow employees and for completion of all required reports and
					 submission to the director. The employing agency will report to the director
					 any change in personnel designated as claims coordinator.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.214 - Duties of Claims Coordinator

Current through Reg. 49, No. 28; July 12, 2024
Claims coordinators will serve as the liaison between an
					 injured employee and the State Office of Risk Management (SORM). Claims
					 coordinators will submit the required injury reports to SORM.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.215 - Employee Report

Current through Reg. 49, No. 28; July 12, 2024
Upon request, agencies will prepare a report reflecting the
					 total number of employees by county within the agency. Forms will be provided
					 by the State Office of Risk Management at the time request is
					 made.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.216 - Legal Responsibilities of Injured Employee

Current through Reg. 49, No. 28; July 12, 2024
Nothing contained in this chapter is intended to limit,
					 expand, or otherwise alter any of the requirements relating to giving notice of
					 injury and filing a claim for compensation placed upon an injured employee, nor
					 the consequences established for a failure to fulfill those requirements, by
					 the provisions of the Texas workers' compensation statutes or commission
					 rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.217 - Agency Policies Regarding Workers' Compensation

Current through Reg. 49, No. 28; July 12, 2024
In formulating agency personnel policies, no agency should
					 disseminate any guidelines or instructions at variance with the Texas workers'
					 compensation statutes or State Office of Risk Management
					 rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.218 - Correspondence

Current through Reg. 49, No. 28; July 12, 2024
All correspondence with the State Office of Risk Management
					 concerning a claim must contain the following information:
(1) the name of the injured
				  employee;
(2) the social security
				  number of the injured employee;
(3)
				  the date of injury;
(4) the name of
				  the employing agency;
(5) the
				  director's claim number and the commission number, if known.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.219 - Reconsideration of Claim

Current through Reg. 49, No. 28; July 12, 2024
Where a claim has been rejected by the director and a
					 hearing has not been held by the commission, the employee may request
					 reconsideration of a claim by letter to the director. A hearing by the
					 commission may be requested by the injured employee in accordance with
					 commission rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.220 - Request for Inspection or Copying in Writing

Current through Reg. 49, No. 28; July 12, 2024
Requests for the inspection or copying of records or
					 documents of the State Office of Risk Management must be made in
					 writing.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.221 - Officer for Public Records

Current through Reg. 49, No. 28; July 12, 2024
For the purposes of the Texas Open Records Act, the
					 director is the officer for public records of the State Office of Risk
					 Management.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter B - PROCEDURES › Section 251.222 - Legal Authorization for Access

Current through Reg. 49, No. 28; July 12, 2024
For a request to be acted upon, the person who applies for
					 inspection or copying must be authorized by law to receive a copy or inspect
					 the records.
(1) Charges for copying
				  records will be in keeping with Texas Civil Statutes, Article 3913, or as set
				  by the General Services Commission.
(2) Nothing required by this section shall
				  conflict with the Texas Open Records Act.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.301 - Utilization of Sick Leave

Current through Reg. 49, No. 28; July 12, 2024
For purposes of this chapter, "sick leave" includes sick
					 leave regularly earned and accumulated by the employee because of employment
					 with the state, extended sick leave with pay authorized by the administrative
					 head or heads of any state agency, and sick leave with pay granted to the
					 employee from any sick leave pool. When sick leave is used, it will be utilized
					 as follows.
(1) For each work day an
				  injured employee is unable to work as a result of occupational injury or
				  illness, a day of sick leave will be charged.
(2) As long as sick leave is available,
				  authorized "days off" (Saturday, Sunday, legal holiday, or days used in place
				  of Saturday and Sunday for those who work other than regular five-day week)
				  will not count against sick leave.
(3) While utilizing sick leave, if an
				  additional day accrues due to change of month, it will be credited to the
				  employee and not utilized.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.302 - No Waiting Period

Current through Reg. 49, No. 28; July 12, 2024
There is no waiting period for the utilization of sick
					 leave.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.303 - Waiting Period

Current through Reg. 49, No. 28; July 12, 2024
If a state employee has less than 40 hours of sick leave,
					 the payment of compensation for the statutory waiting period will be adjusted
					 according to the number of hours of sick leave used.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.304 - Computing Sick Leave

Current through Reg. 49, No. 28; July 12, 2024
Sick leave of four hours or more, but less than eight, will
					 be counted as one day's sick leave for compensation purposes.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.305 - Right to Compensation

Current through Reg. 49, No. 28; July 12, 2024
If an employee sustains an injury in the course of his or
					 her employment, he or she may be entitled to compensation.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.306 - Effect of Sick Leave

Current through Reg. 49, No. 28; July 12, 2024
Should the employee qualify for weekly compensation, he or
					 she may elect to utilize sick leave before receiving weekly payments of
					 compensation. If the employee elects to utilize sick leave, the employee is not
					 entitled to weekly payments of compensation under Texas workers' compensation
					 statutes until sick leave is exhausted.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.307 - Payment of Compensation

Current through Reg. 49, No. 28; July 12, 2024
Once sick leave has been exhausted or the employee has
					 elected not to use sick leave, the employee will be paid weekly compensation in
					 accordance with Texas workers' compensation statutes.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.308 - Effect of Emergency Leave

Current through Reg. 49, No. 28; July 12, 2024
If, in accordance with the General Appropriations Act, the
					 administrative head or heads of an agency or institution authorize payment for
					 emergency leave to an employee receiving workers' compensation benefits, the
					 payments may not exceed an amount equal to the difference between the basic
					 monthly wage of the employee and the amount of benefits received and may not
					 extend beyond six months from the date on which compensation payments begin. In
					 authorizing these payments for emergency leave, the administrative head or
					 heads of the agency or institution must review the merits of each case
					 individually. If payment for emergency leave is authorized, the agency or
					 institution shall attach a statement of the reasons for the authorization to
					 its duplicate payroll voucher for the first payroll period affected by the
					 leave.
Texas Administrative Code › Title 28 - INSURANCE › Part 4 - STATE OFFICE OF RISK MANAGEMENT › Chapter 251 - STATE EMPLOYEES - WORKERS' COMPENSATION › Subchapter C - EMPLOYEE ENTITLEMENT TO COMPENSATION › Section 251.309 - Communications Concerning Sick and Emergency Leave

Current through Reg. 49, No. 28; July 12, 2024
The director will mail to the employing agency's claims
					 coordinator a copy of all initiations, terminations, reductions, or resumptions
					 of compensation (Form TWCC-21). The employing agency shall immediately notify
					 the director when an injured employee elects to utilize accrued sick leave
					 before receiving weekly payments of compensation, or when extended sick leave,
					 pool sick leave, or emergency leave is granted to an employee injured in the
					 course of employment.