reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 63 - PROMPTNESS OF FIRST PAYMENT › Section 63.10 - Sanctions for Late Payment

Current through Reg. 49, No. 28; July 12, 2024
Any insurance carrier writing workers' compensation insurance
				  under the provisions of the Texas Workers' Compensation Act who, on the
				  average, shall fail to make compensation payments due claimants within a
				  reasonable length of time after the same become due and payable, but in no
				  event later than 30 days on the average from the date of incapacity, shall be
				  subject to appropriate sanctions to be invoked by the Texas Industrial Accident
				  Board (1970) (Rev.1973).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 64 - REPRESENTING CLAIMANTS BEFORE THE BOARD › Section 64.25 - Discharged Attorney

Current through Reg. 49, No. 28; July 12, 2024
(a) A claimant may
				discharge an attorney at any time. The claimant shall notify the board in
				writing, and explain the reasons for the discharge.
(b) When a dispute arises between or among
				two or more attorneys employed by a claimant, the attorney presenting the
				earliest executed attorney contract will be deemed the attorney of record
				unless the claimant or a subsequently retained attorney establishes good cause
				for discharge.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 64 - REPRESENTING CLAIMANTS BEFORE THE BOARD › Section 64.30 - Adverse Representation in Claims for Death Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) An attorney may not represent two or more
				beneficiaries with adverse claims for death benefits, since such representation
				constitutes a conflict of interest.
(b) An attorney who violates this section
				will be ordered to withdraw entirely, and may be subjected to disciplinary
				action.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 65 - UNETHICAL OR FRAUDULENT CLAIMS PRACTICES › Section 65.5 - Practicing before the Board

Current through Reg. 49, No. 28; July 12, 2024
Whenever the board receives evidence that a person practicing
				  before the board is guilty of unethical or fraudulent conduct, such person
				  shall be cited by certified mail to appear before the board in person to show
				  cause why he or she should not be barred from practicing before the board
				  because of such conduct. In all such cases, the board's citation shall contain
				  a detailed description of charges to be considered at such hearing and a
				  reasonable time to secure and prepare evidence shall be given any such person
				  as cited (November 14, 1955) (Rev.1973).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 65 - UNETHICAL OR FRAUDULENT CLAIMS PRACTICES › Section 65.15 - Filing of Violation Report

Current through Reg. 49, No. 28; July 12, 2024
Whenever an authorized representative of the board believes
				  any party to a compensation claim has been or is in violation of either the
				  Workers' Compensation Act, or any part thereof, or of these board rules, a
				  written violation report shall be sent to the executive director with a copy to
				  the party concerned. Said party shall promptly report in writing and shall
				  direct his reply to the executive director. This board may impose sanctions for
				  failure of said party to respond to the violation report within 30 days from
				  receipt thereof.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 67 - ALLEGATIONS OF FRAUD › Section 67.5 - Referral to Attorney General

Current through Reg. 49, No. 28; July 12, 2024
The board, upon its findings of probable cause, shall
				  promptly refer any written allegation of fraud regarding an employer, employee,
				  attorney, person or facility furnishing medical services, insurance company or
				  its representative to the attorney general (Rev.1979)
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.5 - Application of Chapter

Current through Reg. 49, No. 28; July 12, 2024
(a) This chapter
				shall not apply to medical examinations ordered pursuant to Texas Civil
				Statutes, Article 8309b, §10, and Article 8309d, §10.
(b) Nothing in this chapter shall be
				construed to limit the rights of the parties to agree on treatment or an
				examination by a mutually agreed health care provider. The agreement must be in
				writing if either party intends to take advantage of the protections offered by
				this chapter.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.10 - 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) Carrier's prior choice
				of health care provider--A health care provider who has examined the claimant
				in regard to the injury in question as provided in Texas Civil Statutes,
				Article 8307, §4, because:
(A) the board
				ordered the claimant to be examined by a health care provider of the carrier's
				choice; or
(B) the claimant granted
				permission for an examination by a carrier's tendered choice of a health care
				provider.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.15 - Carrier May Apply for Order from Board

Current through Reg. 49, No. 28; July 12, 2024
It shall be the policy of the board to issue an order for an
				  examination by a health care provider of the carrier's choice within 30 days
				  after initial date of filing with the board a combination form entitled
				  carrier's request for permission or requested medical examination order.
(1) The carrier shall send the properly
				completed combination form to the claimant or his attorney by certified mail,
				with a copy to the board.
(2) The
				claimant or attorney is required to respond to the request for permission
				within 10 days from receipt of the request in the space provided at the bottom
				of the combination form. The response by claimant's attorney shall be returned
				to the carrier by certified mail with a copy forwarded to the board. An
				unrepresented claimant may use a return envelope provided by the carrier, and
				the carrier shall immediately file the claimant's response with the
				board.
(3) An order will not be
				necessary if the claimant or his attorney agrees to the examination. An
				examination by agreement will have the same force and effect as a formal board
				order. If permission is neither granted nor refused within 10 days from receipt
				by the claimant or his attorney, the board shall enter a formal order directing
				the examination as requested by the carrier.
(4) All examinations available under this
				section must be scheduled as soon as possible, with at least 10 days notice to
				the claimant or his attorney.
(5)
				If the examiner of the carrier's choice finds that the claimant is able to
				return to work and compensation is being paid, the case will be set on the next
				available prehearing docket, but in no event will the scheduled prehearing
				conference be more than 30 days from receipt of the carrier's request for
				prehearing conference if the request is accompanied by the carrier's examiner's
				report.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.20 - Application

Current through Reg. 49, No. 28; July 12, 2024
The application for permission or order shall be made on a
				  combination form approved by the board and shall contain all information
				  required by the board as detailed on the form.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.25 - Bases for Denial

Current through Reg. 49, No. 28; July 12, 2024
(a) Time limit
				after injury. No examination shall be ordered if the combination form is signed
				or submitted 60 or fewer days after the date of an injury.
(b) Health care providers limited. No
				examination shall be ordered if the license of the health care provider is
				under suspension by the appropriate licensing agency on the date of
				application.
(c) Ability to travel.
				No examination will be ordered unless a statement is attached to the request
				setting out whether the claimant's condition will allow travel to and
				attendance at the examination. The statement shall affirm that travel expenses
				will be tendered to the claimant in advance of any travel.
(d) One hundred eighty-day period. No
				examination shall be ordered if the claimant has been examined by the carrier's
				prior choice of health care provider in a 180-day period.
(e) Same health care provider. No examination
				shall be ordered if the claimant has been examined for the injury by the
				carrier's choice of health care provider and the prior health care provider is
				not the same as the requested health care provider.
(f) Good cause. The board may waive any of
				the bases for denial in subsections (a)-(e) of this section or deny an
				application for a medical examination order if the board determines that good
				cause exists.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.30 - Appeal

Current through Reg. 49, No. 28; July 12, 2024
The carrier or the claimant may appeal a decision by the
				  board staff in writing to the executive director or the full board. The appeal
				  must be received no later than 10 days after the order or denial is mailed or
				  delivered to the parties.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.33 - Claimant's Medical Records

Current through Reg. 49, No. 28; July 12, 2024
A claimant's health care provider shall timely release any
				  and all medical records relating to the injury or disease in question,
				  including x-rays and results of other diagnostic tests, when requested by the
				  carrier pursuant to this chapter. A carrier shall report to the board the
				  provider's name and the circumstances surrounding a refusal to release
				  records.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.35 - Claimant's Expenses

Current through Reg. 49, No. 28; July 12, 2024
Prior to the date the claimant attends an examination ordered
				  by the board or permitted by the claimant, the carrier shall tender to the
				  claimant travel expenses in accordance with § 41.155 of this title
				  (relating to Transportation Costs as Medical Expenses).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.40 - Attendance of Claimant's Health Care Provider

Current through Reg. 49, No. 28; July 12, 2024
In accordance with Texas Civil Statutes, Article 8307,
				  §4, the claimant shall have the right to have a health care provider of
				  his or her choice present at the examination at the carrier's
				  expense.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.45 - Unreasonable Delay

Current through Reg. 49, No. 28; July 12, 2024
The claimant shall be entitled to a prompt examination. Any
				  examination that fails to commence within two hours after the claimant timely
				  reports for the examination should be reported to the executive
				  director.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.50 - Reports of Examinations

Current through Reg. 49, No. 28; July 12, 2024
The carrier's choice of health care provider shall
				  immediately submit a written report of the results of the examination to all
				  parties.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 69 - MEDICAL EXAMINATION ORDERS › Section 69.55 - Failure To Attend Examination

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				claimant who agrees or is ordered to submit to an examination as requested by
				the carrier under this chapter is required to attend the examination.
(b) When a claimant fails to attend an
				examination permitted or ordered under this chapter, the carrier may notify the
				board in writing on a board approved form and request a formal hearing. The
				board shall set the hearing on the first Friday following 10 days from receipt
				of the carrier's written request, and shall provide written notice to all
				parties.
(c) The claimant may be
				heard at this hearing by:
(1) making a
				personal appearance in Austin;
(2)
				appearing by telephone conference call; or
(3) filing a written brief.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 102 - PRACTICES AND PROCEDURES-GENERAL PROVISIONS › Section 102.2 - Gifts, Grants, and Donations

Current through Reg. 49, No. 28; July 12, 2024
(a) The division
				may accept and use gifts, grants, and donations in accordance with applicable
				law, including the Labor Code and the Government Code.
(b) On receiving a gift, grant, or donation
				of $500 or more, the division will post on the public website for at least five
				years from the date it was received:
(1) The
				date the division received the gift, grant, or donation.
(2) The identity of the donor.
(3) The amount of the gift, grant, or
				donation.
(4) If applicable, the
				stated purpose of the gift, grant, or donation.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 102 - PRACTICES AND PROCEDURES-GENERAL PROVISIONS › Section 102.3 - Computation of Time

Current through Reg. 49, No. 28; July 12, 2024
(a) Due dates and
				time periods under this Act shall be computed as follows:
(1) computing a period of days. In counting a
				period of time measured by days, the first day is excluded and the last day is
				included.
(2) computing a period of
				months. If a number of months is to be computed by counting the months from a
				particular day, the period ends on the same numerical day in the concluding
				month as the day of the month from which the computation is begun, unless there
				are not that many days in the concluding month, in which case the period ends
				on the last day of that month.
(3)
				unless otherwise specified, if the last day of any period is not a working day,
				the period is extended to include the next day that is a working day.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 102 - PRACTICES AND PROCEDURES-GENERAL PROVISIONS › Section 102.7 - Abbreviations

Current through Reg. 49, No. 28; July 12, 2024
When used in this title, the following terms may be
				  abbreviated as follows:
(1) Additional
				Lost Time - ALT;
(2) Average Weekly
				Wage - AWW;
(3) Benefit Review
				Conference - BRC;
(4) Contested
				Case Hearing (also Benefit Contested Case Hearing) - CCH.
(5) Death Benefits - DBs;
(6) Texas Department of Insurance, Division
				of Workers' Compensation - division or DWC;
(7) Electronic Data Interchange -
				EDI
(8) Health Care Provider -
				provider or HCP;
(9) Impairment
				Income Benefits - IIBs;
(10)
				Impairment Rating - IR;
(11)
				Injured Employee - employee;
(12)
				Insurance Carrier - carrier;
(13)
				Lifetime Income Benefits - LIBs;
(14) Maximum Medical Improvement -
				MMI;
(15) Office of Injured
				Employee Counsel - OIEC;
(16) Post
				Injury Earnings (also Weekly Earnings After the Injury) - PIE;
(17) Required Medical Exam - RME;
(18) Return to Work - RTW;
(19) Supplemental Income Benefits -
				SIBs;
(20) Temporary Income
				Benefits - TIBs;
(21) Texas
				Workers' Compensation Act - the Act or the Statute; and
(22) Texas Workers' Compensation Commission -
				TWCC or the Commission.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 102 - PRACTICES AND PROCEDURES-GENERAL PROVISIONS › Section 102.8 - Information Requested on Written Communications to the Division

Current through Reg. 49, No. 28; July 12, 2024
(a) Unless the division-prescribed form,
				format, or manner of a written communication specifies otherwise, all written
				communications to the division about an injured employee or claim for benefits
				must include the following information, if known:
(1) the injured employee's full name, date of
				injury, address, and Social Security number. If no Social Security number has
				been assigned, insert the numerical digits "999" followed by the claimant's
				birth date or if unknown, the claimant's date of injury listed by the month,
				day, and year (MMDDYY). Do not use "999" in place of a valid Social Security
				number to meet timeliness of reporting requirements.
(2) the name and address of the claimant, if
				other than the injured employee;
(3) the workers' compensation number assigned
				to the claim by the division;
(4)
				the employer's name and address;
(5) the employer's Federal Employer's
				Identification Number;
(6) the
				insurance carrier's name;
(7) the
				insurance carrier's policy number; and
(8) the insurance carrier's claim
				number.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 102 - PRACTICES AND PROCEDURES-GENERAL PROVISIONS › Section 102.9 - Submission of Information Requested by the Commission

Current through Reg. 49, No. 28; July 12, 2024
(a) In addition to information required by
				the Act or Commission rules, the Commission shall require those subject to the
				Act to provide information at such times and in such manner and format as
				necessary to effectively and efficiently administer the Act or Commission
				rules. This request for information shall:
(1) be communicated by telephone,
				electronically, or in writing;
(2)
				inform the participant of:
(A) where the
				information is to be sent;
(B) when
				the information must be submitted; and
(C) the specific information to be
				submitted.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 102 - PRACTICES AND PROCEDURES-GENERAL PROVISIONS › Section 102.10 - Interest, General

Current through Reg. 49, No. 28; July 12, 2024
Unless otherwise specified by law, the term "interest" when
				  applied to workers' compensation benefits shall mean simple interest (interest
				  computed on the same amount of principal for each interest
				  period).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 102 - PRACTICES AND PROCEDURES-GENERAL PROVISIONS › Section 102.11 - Electronic Formats for Electronic Claim Data Request and Report

Current through Reg. 49, No. 28; July 12, 2024
(a) The Division
				prescribes standard electronic formats by utilizing implementation guides for
				data requests and data reports for the purpose of exchanging data between the
				Division and insurance carriers, as defined in Labor Code §
									402.084.
(b) In this section, the following
				definitions apply:
(1) Claim Data Request and
				Report Implementation Guide (Guide)--The division specification document for
				the Claim Data Request and the Claim Data Report that defines specific data
				requirements, data set transactions, data mapping, data edits, and fees per
				record available at
www.tdi.texas.gov/wc
.
(2) Claim Data Report--The electronic report
				generated by the Division in the format specified by the Guide. The report
				contains data for claims meeting confidence match criteria defined in the
				Guide.
(3) Claim Data Request--The
				electronic request submitted by a requester in the format specified by the
				Division in the Guide.
(4)
				Record--An electronic representation of one insured person containing a set of
				unique identifiers including the full name, date of birth, gender, and social
				security number, if available. Each set of individual identifiers included in a
				Claim Data Request represents a separate record.
(5) Requester--An insurance carrier that has
				adopted an antifraud plan under Labor Code §
										402.084(b)(8)
				and qualifies as an insurance carrier under Labor Code §
										402.084(c-1)
				or its authorized representative.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 104 - GENERAL PROVISIONS - RULE-MAKING › Section 104.1 - Contents of Rulemaking Petitions

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Changes or additions to the Texas Administrative Code, Title 28, Part 2 may be
				petitioned by an interested person under Government Code, §
									2001.021(d).
				Rulemaking petitions shall be in the form of a letter that contains the
				following:
(1) a brief statement summarizing
				the proposed section;
(2) the text
				of the proposed section, in the exact form proposed for adoption;
(3) a statement setting forth the statutory
				reference that authorizes the proposed rule;
(4) a suggested effective date;
(5) any other matter which may be required by
				law;
(6) the petitioner's name,
				mailing address, and telephone number; and
(7) a statement that the petitioner is an
				interested person under Government Code, §
										2001.021(d).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 109 - WORKERS' COMPENSATION COVERAGE FOR STATE EMPLOYEES › Section 109.1 - State Agencies: General Provisions

Current through Reg. 49, No. 28; July 12, 2024
(a) In
				administering and enforcing the applicable provisions of the Texas Labor Code
				as set out in §501.002, a state agency shall act in the capacity of
				employer.
(b) In administering and
				enforcing the applicable provisions of the Texas Labor Code as set out in
				§501.002, the State Office of Risk Management shall act in the capacity of
				insurance carrier.
(c) As an
				employer, each state agency shall file, in the form and manner prescribed by
				the Texas Workers' Compensation Commission (commission), a single
				administrative address with the commission for the purpose of administering
				workers' compensation claims. All workers' compensation claim notices or
				written communications to the agency as an employer will be sent to the
				agency's single administrative address, unless otherwise specified by rule.
				When the state agency's single administrative address changes, the sate agency
				shall submit the new address at least 30 days prior to the change, in the form
				and manner prescribed by the commission.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 110 - REQUIRED NOTICES OF COVERAGE › Subchapter A - CARRIER NOTICES › Section 110.7 - Self-Insured Political Subdivision Requirements for Notifying the Division of Election to Provide Medical Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  health plan, for purposes of this section, is defined as a political
				  subdivision contracting with health care providers under Labor Code §
										504.053(b)(2).
(b) A political subdivision as defined by
				  Labor Code §
										504.001(3)
				  that self-insures either individually or collectively and that pursuant to
				  Labor Code §
										504.053(b)(2)
				  elects to provide medical benefits to its injured employees by directly
				  contracting with health care providers or by contracting through a health
				  benefits pool established under Local Government Code Chapter 172 shall provide
				  to the division notice of the method by which its employees will receive
				  medical benefits. Political subdivisions are also subject to requirements
				  specified in §
										110.1
				  of this title (relating to Insurance Carrier Requirements for Notifying the
				  Division of Insurance Coverage).
(c) The notice of the method by which its
				  employees will receive medical benefits required by subsection (b) of this
				  section shall be filed with the division in writing or electronically and in
				  the form and manner prescribed by the division. The notice shall include:
(1) the name, address, and the federal
				  employer identification number (FEIN) of the political subdivision;
(2) the political subdivision's contact
				  information;
(3) the name of the
				  health plan elected under Labor Code §
											504.053(b)(2)
				  for the political subdivision;
(4)
				  the contact information for the health plan elected under Labor Code §
											504.053(b)(2);
				  and
(5) the beginning and ending
				  date(s) of the election under subsection (b) of this section, as
				  applicable.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 110 - REQUIRED NOTICES OF COVERAGE › Subchapter B - EMPLOYER NOTICES › Section 110.101 - Covered and Non-Covered Employer Notices to Employees

Current through Reg. 49, No. 28; July 12, 2024
(a) In addition to the posted notice required
				  by subsection (e) of this section, employers, as defined by Labor Code §
										406.001, shall notify
				  their employees of workers' compensation insurance coverage status, in writing.
				  This additional notice:
(1) shall be provided
				  at the time an employee is hired, meaning when the employee is required by
				  federal law to complete both a W-4 form and an I-9 form or when a break in
				  service has occurred and the employee is required by federal law to complete a
				  W-4 form on the first day the employee reports back to duty;
(2) shall be provided to each employee, by an
				  employer whose workers' compensation insurance coverage is terminated or
				  cancelled, not later than the 15th day after the date on which the termination
				  or cancellation of coverage takes effect;
(3) shall be provided to each employee, by an
				  employer who obtains workers' compensation insurance coverage, not later than
				  the 15th day after the date on which coverage takes effect, as necessary to
				  allow the employee to elect to retain common law rights under Labor Code
				  Chapter 406;
(4) shall include the
				  text required in the posted notice; and
(5) if the employer is covered by workers'
				  compensation insurance (subscriber) or becomes covered, whether by commercial
				  insurance or through self-insurance as provided by the Texas Workers'
				  Compensation Act (Act), shall include the following statement: "You may elect
				  to retain your common law right of action if, no later than five days after you
				  begin employment or within five days after receiving written notice from the
				  employer that the employer has obtained workers' compensation insurance
				  coverage, you notify your employer in writing that you wish to retain your
				  common law right to recover damages for personal injury. If you elect to retain
				  your common law right of action, you cannot obtain workers' compensation income
				  or medical benefits if you are injured."
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 110 - REQUIRED NOTICES OF COVERAGE › Subchapter B - EMPLOYER NOTICES › Section 110.103 - Employer Requirements for Notifying the Division of Non-Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability. This subsection applies to
				  notices required to be submitted by non-subscribing employers to the division
				  before January 1, 2013. An employer, as defined by Labor Code §
										406.001, that does not
				  have workers' compensation insurance coverage (non-subscriber) and whose
				  employees are not exempt from coverage under the Workers' Compensation Act
				  (Act) shall provide the division a notice of non-coverage, in the form and
				  manner prescribed by the division. The notice required by this subsection shall
				  be provided, the earlier of the following:
(1)
				  30 days after receiving a division request for the filing of a notice of
				  non-coverage and annually thereafter on the anniversary date of the original
				  filing; or
(2) 30 days after hiring
				  an employee who is subject to coverage under the Act, and annually thereafter
				  on the anniversary date of the original filing.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 110 - REQUIRED NOTICES OF COVERAGE › Subchapter B - EMPLOYER NOTICES › Section 110.105 - Employer Requirements for Notifying the Division of Termination of Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a) An employer, as
				  defined by Labor Code §
										406.001, who
				  terminates workers' compensation insurance coverage shall file written notice
				  of the termination of coverage with the division not later than the 10th day
				  after the date on which the employer notified the insurance carrier under Labor
				  Code §
										406.007
				  to terminate the coverage.
(b) The
				  employer shall file the notice of termination required by subsection (a) of
				  this section in the form and manner prescribed by the division. The notice
				  shall contain:
(1) a statement of no workers'
				  compensation insurance coverage, including policy termination effective date,
				  policy number, insurance company name, date the termination notice was sent to
				  the insurance company, and date employees were or will be notified;
(2) a statement of whether the employer had a
				  death, injuries that resulted in the injured employee's absence from work for
				  more than one day, or knowledge of an occupational disease since the last
				  report of no coverage;
(3) the
				  employer business name;
(4) the
				  federal employer identification number (FEIN);
(5) the employer's business mailing
				  address;
(6) the employer's
				  business type;
(7) the employer's
				  North American Industry Classification System (NAICS) code;
(8) additional business locations (including
				  name, FEIN, and address concerning each additional location); and
(9) the signature date and the name, title,
				  telephone number, email address, and signature of the person providing the
				  information required by this subsection.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 110 - REQUIRED NOTICES OF COVERAGE › Subchapter B - EMPLOYER NOTICES › Section 110.108 - Employer Notice Regarding Work-Related Exposure to Communicable Disease/HIV: Posting Requirements; Payment for Tests

Current through Reg. 49, No. 28; July 12, 2024
(a) Each employer covered by workers'
				  compensation insurance, including state and political subdivision employers,
				  which employ emergency medical service employees, paramedics, fire fighters,
				  law enforcement officers or correctional officers must post the notice
				  contained in subsection (d) of this section, in its workplace to inform
				  employees about Health and Safety Code requirements which may affect qualifying
				  for workers' compensation benefits following a work-related exposure to a
				  reportable communicable disease. The notice shall be posted in the personnel
				  office, if the employer has a personnel office, and in the workplace where
				  employees are likely to read the notice on a regular basis. Specific guidance
				  for employers and employees covered by this subsection is found in §
										122.3
				  of this title (relating to Exposure to Communicable Diseases: Reporting and
				  Testing Requirements for Emergency Responders).
(b) Each state agency must post the notice
				  contained in subsection (d) of this section, in its workplace to inform
				  employees about requirements which may affect qualifying for workers'
				  compensation benefits following a work-related exposure to human
				  immunodeficiency virus (HIV). The notice shall be posted in the personnel
				  office and in the workplace where employees are likely to read the notice on a
				  regular basis. Specific guidance for state employers and employees covered by
				  this subsection is found in §
										122.4
				  of this title (relating to State Employees: Exposed to Human Immunodeficiency
				  Virus (HIV): Reporting and Testing Requirements).
(c) The cost of testing for exposure to a
				  reportable communicable disease for emergency medical service employees,
				  paramedics, fire fighters, law enforcement officers and correctional officers
				  shall be paid by the employer's workers' compensation insurance carrier,
				  including state and political subdivision employers.
(d) The following notice shall be printed
				  with a title in at least 15 point bold type and the text in at least 14 point
				  normal type, in English and Spanish or in English and any other language common
				  to the employer's affected employee population. The text of the notice shall be
				  as follows without any additional words or changes:
Attached
					 Graphic
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 110 - REQUIRED NOTICES OF COVERAGE › Subchapter B - EMPLOYER NOTICES › Section 112.101 - Agreement Regarding Workers' Compensation Insurance Coverage between General Contractors and Subcontractors

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				  agreement between a general contractor and a subcontractor made in accordance
				  with Texas Labor Code §
										406.123(a),
				  (d), (e), or (l) must:
(1) be in writing;
(2) state that the subcontractor and the
				  subcontractor's employees are employees of the general contractor for the sole
				  purpose of workers' compensation coverage;
(3) indicate whether the general contractor will make a deduction
				  for the premiums;
(4) specify
				  whether this is a blanket agreement or if it applies to a specific job location
				  and, if so, list the location;
(5)
				  contain the signatures of both parties;
(6) indicate the date the agreement was made,
				  the term the agreement will be effective, and estimated number of workers
				  affected by the agreement.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 110 - REQUIRED NOTICES OF COVERAGE › Subchapter B - EMPLOYER NOTICES › Section 112.102 - Agreements between Motor Carriers and Owner Operators

Current through Reg. 49, No. 28; July 12, 2024
(a) A motor carrier and an owner operator may
				  enter into an agreement which requires the owner operator to assume the
				  responsibilities of an employer for the performance of work.
(b) An agreement made under subsection (a) of
				  this section must be made at or before the time the contract for the work is
				  made and must:
(1) be in writing;
(2) state that the owner operator assumes
				  the responsibilities of an employer for the performance of work;
(3) contain the signatures of both parties;
(4) indicate the date the
				  agreement was made, the term the agreement will be effective, the estimated
				  number of workers affected by the agreement, the federal tax identification
				  number of the parties; and
(5) be
				  provided to the insurance carrier of the motor carrier within 10 days of
				  execution.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 112 - SCOPE OF LIABILITY FOR COMPENSATION › Subchapter C - APPLICATION TO CERTAIN BUILDING AND CONSTRUCTION WORKERS › Section 112.200 - Definition of Residential Structures

Current through Reg. 49, No. 28; July 12, 2024
For purposes of the Texas Workers' Compensation Act (the
					 Act), §406.142, "residential structures" are buildings used as a family
					 dwelling or multi-family dwelling, limited to a single-family residence, a
					 duplex, a triplex, and a quadraplex. All other types of structures used for
					 living purposes shall be considered commercial structures, and shall only be
					 included within the scope of the Act, §406.142, if they do not exceed
					 three stories or 20,000 square feet.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 112 - SCOPE OF LIABILITY FOR COMPENSATION › Subchapter C - APPLICATION TO CERTAIN BUILDING AND CONSTRUCTION WORKERS › Section 112.201 - Agreement to Establish Employer-Employee Relationship for Certain Building and Construction Workers

Current through Reg. 49, No. 28; July 12, 2024
(a) This
				  section applies only to building and construction projects as provided by the
				  Texas Labor Code, §
										406.142.
(b) An independent contractor and a hiring
				  contractor, as defined in the Texas Labor Code, §
										406.141, may enter
				  into a written agreement:
(1) to allow the
				  hiring contractor to withhold the cost of workers' compensation insurance from
				  the contract price; and
(2) to
				  stipulate that, for the sole purpose of providing workers' compensation
				  insurance, the hiring contractor will be the employer of the independent
				  contractor and the independent contractor's employees.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 112 - SCOPE OF LIABILITY FOR COMPENSATION › Subchapter C - APPLICATION TO CERTAIN BUILDING AND CONSTRUCTION WORKERS › Section 112.202 - Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				  independent subcontractor and a hiring contractor may enter into an agreement
				  which states that the subcontractor is an independent contractor and is not an
				  employee of the hiring contractor.
(b) The agreement shall be filed in the form
				  and manner prescribed by the division and shall:
(1) be in writing;
(2) state that the subcontractor meets the
				  qualifications of an independent contractor under the Texas Labor Code, §
											406.141(2);
(3) state that the subcontractor is an
				  independent contractor and is not an employee of the hiring
				  contractor;
(4) contain the
				  signatures of both parties;
(5)
				  indicate the date the agreement was made; and
(6) state that: "Once this agreement is
				  signed, the subcontractor and the subcontractor's employees shall not be
				  entitled to workers' compensation coverage from the hiring contractor unless a
				  subsequent written agreement is executed, and filed according to division
				  rules, expressly stating that this agreement does not apply."
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 112 - SCOPE OF LIABILITY FOR COMPENSATION › Subchapter C - APPLICATION TO CERTAIN BUILDING AND CONSTRUCTION WORKERS › Section 112.203 - Exception to Application of Agreement to Affirm Independent Relationship for Certain Building and Construction Workers

Current through Reg. 49, No. 28; July 12, 2024
(a) If a subsequent hiring agreement is made
				  that expressly states that the joint statement made under §
										112.202
				  of this title (relating to Joint Agreement To Affirm Independent Relationship
				  for Certain Building and Construction Workers) does not apply to that hiring
				  agreement, the hiring contractor must maintain the original and file a legible
				  copy of the agreement with the hiring contractor's insurance carrier. Nothing
				  in this section otherwise nullifies the joint statement as it applies to other
				  hiring agreements made during the term of the joint statement.
(b) The notification must be filed in the
				  form and manner prescribed by the division and must:
(1) specify the date the agreement to affirm
				  an independent relationship was made;
(2) specify the parties to the agreement and
				  the location of the job site(s);
(3) specify the date this agreement was
				  made;
(4) contain the signatures of
				  both parties.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 112 - SCOPE OF LIABILITY FOR COMPENSATION › Subchapter D - APPLICATION TO FARM OR RANCH EMPLOYEES › Section 112.301 - Labor Agent's Notification of Coverage to Certain Farm or Ranch Employees

Current through Reg. 49, No. 28; July 12, 2024
(a) A labor agent
				  must notify each person the labor agent contracts with to provide the services
				  of migrant and seasonal workers whether or not the labor agent has workers'
				  compensation insurance coverage.
(b) The notification must be in writing and
				  must be given at the time the contract for the services of the migrant or
				  seasonal workers is made. The notification must be signed and dated by both
				  parties and each party must retain a copy of the notice.
(c) If the labor agent does have workers'
				  compensation insurance coverage, the labor agent must present evidence of the
				  workers' compensation insurance coverage to each person the agent contracts
				  with to provide the services of migrant and seasonal workers. The evidence of
				  coverage must [shall] be in writing and must be presented at the time the
				  notification of coverage is made. Each party must retain a copy of the evidence
				  of coverage with the copy of the notice. A certificate of insurance is
				  considered adequate evidence of coverage.
(d) The notice and evidence of coverage, if
				  applicable, must be given each time a labor agent makes a contract with a
				  person to provide migrant or seasonal workers. Any notice and evidence of
				  coverage provided for a prior contract between the parties is considered
				  insufficient to meet the requirements of this section.
(e) If coverage is terminated during the
				  period of the contract for employment, the labor agent must notify:
(1) the person with whom the agent contracted
				  to provide the services of migrant and seasonal workers; and
(2) the migrant and seasonal workers affected
				  that the workers' compensation insurance coverage has been
				  terminated.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 112 - SCOPE OF LIABILITY FOR COMPENSATION › Subchapter E - PROFESSIONAL ATHLETES ELECTION OF COVERAGE › Section 112.401 - Election of Coverage by Certain Professional Athletes

Current through Reg. 49, No. 28; July 12, 2024
(a) A professional athlete employed by a
				  franchise with workers' compensation insurance coverage and subject to Texas
				  Labor Code §
										406.095 must elect to
				  receive either the benefits available under the Act or the equivalent benefits
				  available under the athlete's contract or collective bargaining agreement. The
				  election must be made not later than the 15th day after the athlete sustains an
				  injury in the course and scope of employment. If the athlete fails to make an
				  election, the athlete will be presumed to have elected the option which
				  provides the highest benefits.
(b)
				  When a contract is signed by a professional athlete, the employer must give the
				  athlete a copy of the following statement: "(Name of employer) has workers'
				  compensation coverage from (name of insurance carrier). If the benefits
				  available to you under your contract and any applicable collective bargaining
				  agreement are equivalent to or greater than those available to you under Texas
				  Labor Code §
										406.095, you are required
				  to elect whether to receive the benefits available to you under the Act or the
				  benefits available to you under your contract and any applicable collective
				  bargaining agreement. You must make this election no later than 15 days after
				  sustaining an injury. If you elect to receive the benefits available to you
				  under your contract and any applicable collective bargaining agreement, you
				  cannot obtain workers' compensation income or medical benefits if you are
				  injured. You can get more information about your workers' compensation rights
				  and the benefits available to you under the Act from any office of the Texas
				  Department of Insurance, Division of Workers' Compensation, or by calling
				  1-800-252-7031."
(c) The election
				  must be in writing and must:
(1) indicate the
				  date of the injury for which the election is being made;
(2) indicate whether the athlete elects to
				  receive the benefits available under the Act or the benefits provided under the
				  contract or agreement; and
(3) be
				  signed by the athlete and the employer.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 112 - SCOPE OF LIABILITY FOR COMPENSATION › Subchapter E - PROFESSIONAL ATHLETES ELECTION OF COVERAGE › Section 112.402 - Determination of Equivalent Benefits for Professional Athletes

Current through Reg. 49, No. 28; July 12, 2024
(a) Medical care available to a professional
				  athlete subject to the Texas Workers' Compensation Act (the Act), Texas Labor
				  Code, §
										406.095,
				  is equal to or greater than medical benefits under the Act if:
(1) the athlete is entitled to all health
				  care reasonably required by the nature of the work-related injury as and when
				  needed, including all health care that:
(A)
				  cures or relieves the effects naturally resulting from the work-related
				  injury;
(B) promotes recovery;
				  or
(C) enhances the ability of the
				  employee to return to or retain employment; and
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) The provisions of this chapter are
				promulgated pursuant to Texas Labor Code, Chapter 407, to explain and enforce
				provisions related to the self-insuring of liability and to guarantee full and
				timely payment of compensation benefits by certified self-insurers.
(b) The provisions of this chapter apply to
				private employers in the State of Texas. They do not apply to the state or to
				political subdivisions, as made clear by Texas Labor Code §
									401.011(6).
(c) These rules provide guidance and
				requirements in addition to those requirements imposed by the Texas Workers'
				Compensation Act and other division rules.