reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.2 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
(a) The following words and terms are defined
				in the Texas Labor Code §
									407.001, and are used
				in this chapter:
(1) Association;
(2) Impaired employer;
(3) Incurred liabilities for compensation;
				and
(4) Qualified claims servicing
				contractor.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.3 - Application Form and Financial Information Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Employers shall submit an application by
				filing a completed and signed application in the form and manner prescribed by
				the commissioner and must include:
(1) if
				required to file a Form 10-K by the U.S. Securities and Exchange Commission
				(SEC), the applicant's Form 10-K for the preceding three fiscal years;
				and
(2) the applicant's
				independently audited financial statements according to Generally Accepted
				Auditing Standards of the American Institute of Certified Public Accountants
				with the accompanying footnotes and the auditor's opinion for the preceding
				three fiscal years.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.4 - Security Deposit Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A security
				deposit shall be one or a combination of any of the following:
(1) surety bond. The surety bond must be
				issued by a company authorized to conduct such business in Texas and possess
				either a current A.M. Best rating of B+ or better or a Standard & Poor's
				rating of claims paying ability of A or better;
(2) cash, bonds or other evidence of
				indebtedness issued, assumed or guaranteed by the United States of America or
				the State of Texas. Any such securities shall be deposited with the Comptroller
				of Public Accounts pursuant to a trust agreement prescribed by the
				commissioner; or
(3) irrevocable
				letter of credit issued by a Texas state chartered bank or a federally
				chartered bank with a branch office in Texas. The bank shall have a long-term
				debt rating of at least A or better in the current monthly edition of "Moody's
				Statistical Handbook" or a long-term investment grade rating of at least A or
				better in the current edition of "Global Ratings Handbook" prepared by Standard
				& Poor's Corporation. If the bank's rating subsequent to issuing the letter
				of credit falls below the acceptable rating, the certified self-insurer shall
				replace the letter of credit within 60 days with a new letter of credit issued
				by a bank with an acceptable rating.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.5 - Excess Insurance Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) The upper
				limit of liability for a contract or policy of excess insurance shall be in the
				amount required by the commissioner. The minimum amount the commissioner may
				require is $5 million per occurrence.
(b) A contract or policy of excess insurance
				must be issued by an insurance company authorized by the State of Texas to
				transact such business and shall include the following provisions:
(1) cancellation requires notice to the
				division in the form and manner prescribed by the commissioner at least 60 days
				before termination;
(2) non-renewal
				requires notice to the division, in the form and manner prescribed by the
				commissioner at least 60 days before the end of the policy;
(3) the Association must be named as an
				additional insured on the excess policy and may assume the rights and
				responsibilities of the certified self-insurer under the policy when the
				certified self-insurer is declared to be impaired; and
(4) all of the following benefits to which
				the injured employee is entitled under the Texas Workers' Compensation Act must
				be applied toward reaching the retention amount:
(A) payments made by the certified
				self-insured employer;
(B) payments
				due and owing by the certified self-insured employer;
(C) payments made on behalf of the certified
				self-insured employer by any form of security as required by the Act or
				division rules; and
(D) payments
				made by the Association pursuant to Texas Labor Code §
											407.121 and
				§
											407.127.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.6 - Safety Program Requirements

Current through Reg. 49, No. 28; July 12, 2024
To qualify as an effective safety program under Texas Labor
				  Code §
									407.061(d),
				  an applicant's safety program must include the following components at a
				  minimum:
(1) A management component
				that includes:
(A) a clearly written safety
				policy distributed to all employees;
(B) a written assignment of safety
				responsibilities and delegation of authority which includes oversight of
				implementation of the safety program and the authority to communicate directly
				with the employer's top management regarding health and safety
				issues;
(C) a method of receiving,
				evaluating, and responding to employee input regarding workplace health and
				safety; and
(D) a process to ensure
				review and revision of the safety program when changes in processes,
				procedures, operations, or equipment are implemented or anticipated, to ensure
				continued effectiveness of the safety program.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.7 - Certification Process

Current through Reg. 49, No. 28; July 12, 2024
(a) The division
				shall request review and approval of the Association by forwarding a summary of
				the relevant application information after the division deems the application
				complete and finds the applicant's financial information required under §
									114.3
				of this title (relating to Application Form and Financial Information
				Requirements) reflects one of the following qualifying financial ratings:
(1) Dun & Bradstreet rating of 3A1 or
				better;
(2) Standard & Poor's
				rating of BBB or better;
(3)
				Moody's rating of Baa or better; or
(4) minimum tangible net worth of $5 million
				with a ratio of tangible net worth to long term debt of 1.5 to one or
				greater.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.8 - Refusal to Certify an Employer

Current through Reg. 49, No. 28; July 12, 2024
(a) When the
				commissioner determines an application should be denied, the applicant will be
				notified of the following:
(1) the specific
				reasons for the denial;
(2) the
				specific conditions, if any, the applicant must meet to become
				certified;
(3) that the applicant
				has a 30-day period from the date the applicant receives the notice to meet the
				conditions required or provide compelling information to the division to rebut
				the reasons for denial; and
(4) the
				form and format required to notify the division of the actions taken by the
				applicant to overcome the denial.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.9 - Required Safety Program Inspections

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				employer seeking to obtain a certificate shall have its safety program reviewed
				or inspected by the division before the issuance of its initial certificate and
				thereafter, as appropriate, to demonstrate the existence of an effective safety
				program for each location.
(b) To
				facilitate the review or inspection process, the employer shall provide the
				division with access to all of the documents related to its safety program and
				its workers' compensation claims and shall permit the inspection of any of its
				work sites during working hours. Unreasonable refusal to provide access to the
				required information or facilities may be considered as:
(1) submission of an incomplete application
				or grounds for revocation of a certificate; and
(2) an administrative penalty with each day
				of noncompliance constituting a separate violation.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.10 - Claims Contractor Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Claims
				administration must be performed by an adjuster licensed in Texas to handle
				workers' compensation claims.
(b)
				Each proposed contract to provide claims services to a certified self-insurer
				must be approved by the division prior to recommending approval of an
				application to self-insure or, if a certified self-insurer is changing from one
				claims contractor to another, prior to the effective date of the new
				contract.
(c) An applicant must
				ensure that a current signed claims administration contract remain on file with
				the division at all times.
(d) The
				claims contractor must promptly investigate each reportable injury and either
				pay benefits or controvert, as required by the Texas Workers' Compensation Act
				and division rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.11 - Audit Program

Current through Reg. 49, No. 28; July 12, 2024
(a) The division
				shall audit certified self-insurers as frequently as necessary to assure
				compliance with the Texas Workers' Compensation Act and division rules, but
				shall audit each certified self-insurer at least once every three
				years.
(b) An audit may include,
				but not be limited to:
(1) any representation
				made on an application or in an annual report required by §
										114.15(b)
				of this title (relating to Revocation of Certificate of Authority to
				Self-Insure);
(2) payroll and
				classification;
(3) loss
				history;
(4) claims
				administration;
(5) loss
				reserves;
(6) interviews of the
				certified self-insurer, its agents, or employees regarding any matter within
				their knowledge and pertaining to the obligations of the certified self-insurer
				under the Act or division rules; and
(7) any other issue deemed appropriate by the
				division.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.12 - Required Reporting

Current through Reg. 49, No. 28; July 12, 2024
(a) Each certified
				self-insurer shall file with the division an annual application or, if required
				by §
									114.15(b)
				of this title (relating to Revocation of Certificate of Authority to
				Self-Insure), an annual report, according to a schedule established by the
				division. The division may require an annual application or annual report to
				include the following:
(1) claims
				information, such as loss run information, in the form and manner prescribed by
				the commissioner;
(2) an
				information report, in the manner prescribed by the commissioner, that includes
				an analysis of accident trends which:
(A)
				identifies losses by location, occupation, or job function; and
(B) provides an analysis of those losses
				based on:
(i) nature, source, and severity of
				the injury;
(ii) cause of the
				injury;
(iii) parts of the body
				affected;
(iv) equipment involved
				in the injury;
(v) number of
				injuries and fatalities other than occupational diseases; and
(vi) identification of the number of
				occupational diseases;
(3) independently audited financial
				statements according to Generally Accepted Auditing Standards of the American
				Institute of Certified Public Accountants; and
(4) any substantive policy or procedure
				changes in the certified self-insurer's safety program.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.13 - Required Notices to the Division

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				certified self-insurer that amends its charter, articles of incorporation, or
				partnership agreement to change its identity or business structure, or in any
				other manner materially alters its status as it existed at the time of issuance
				of its certificate shall, within 30 days after the amendment or other action,
				notify the division of such action in the form and manner prescribed by the
				commissioner and provide the division with a copy of such amendment or other
				action.
(b) A certified
				self-insurer that ceases doing business entirely, ceases doing business in
				Texas, or disposes of, by sale or otherwise, the controlling interest of the
				business for which the certificate was issued, shall immediately notify the
				division in the form and manner prescribed by the commissioner of such action
				and the division will act on the notice pursuant to Texas Labor Code, §
									407.045.
(c) A certified self-insurer shall give
				notice to the division in the form and manner prescribed by the commissioner of
				any change in contact person within 10 working days of this change. The notice
				shall include the name, title, office address, and telephone number, facsimile
				number and e-mail address of the new contact person.
(d) A certified self-insurer shall give
				notice to the division in the form and manner prescribed by the commissioner at
				least 30 days prior to any change in the claims contractor. The notice shall
				include the name, title, office address, and telephone number, facsimile number
				and e-mail address of the person or persons appointed to administer both the
				existing cases and the new cases and the location or locations of records
				required to be kept and maintained pursuant to Texas Labor Code, §
									407.082.
(e) A certified self-insurer shall notify the
				division in the form and manner prescribed by the commissioner of any change or
				expected change which will significantly alter the liability or solvency of the
				certified self-insurer within 30 days of the certified self-insurer's knowledge
				of the change.
(f) For purposes of
				§
									406.006
				of the Texas Labor Code, coverage takes effect upon approval by the
				commissioner. Approval by the commissioner fulfills the certified
				self-insurer's requirement to file notice of coverage and claim administration
				contact information as required by §406.006.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.14 - Impaired Employer

Current through Reg. 49, No. 28; July 12, 2024
If a certified self-insurer becomes an impaired employer, the
				  commissioner shall protect the employees of such employer by promptly:
(1) calling the security deposit and placing
				the funds in an account for the impaired employer;
(2) notifying the Association or other entity
				designated by the commissioner to assume the liabilities of the impaired
				employer; to begin paying, pursuant to Texas Labor Code §
									407.127,
				benefits out of the impaired employer's account; and, if necessary, to notify
				the Association to begin paying benefits out of its trust fund; and
(3) estimating the amount of any additional
				funds needed to supplement the security deposit and available assets of the
				impaired employer and advise the Association of the amount the Association will
				need to assess each certified self-insurer to cover the estimated liabilities
				once the impaired employer's security account has been expended.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.15 - Revocation or Suspension of Certificate of Authority to Self-Insure

Current through Reg. 49, No. 28; July 12, 2024
(a) The commissioner may revoke the
				certificate of a certified self-insurer who fails to comply with requirements
				or conditions established by Chapter 407 of the Texas Labor Code or any rule
				within Chapter 114 of this title (regarding Self-Insurance), including:
(1) failure to maintain financial
				strength;
(2) failure to implement
				and maintain an effective safety program;
(3) failure to maintain acceptable claim
				services;
(4) failure to obtain and
				maintain the required security deposit;
(5) failure to obtain and maintain excess
				insurance as required by the commissioner;
(6) failure to file any required information
				under §
										114.12 of this
				title (relating to Required Reporting);
(7) unreasonable refusal to make information
				available as required under §
										114.11
				of this title (relating to Audit Program);
(8) failure to provide notice as required in
				§
										114.13
				of this title (relating to Required Notices to the division); or
(9) failure to comply with any provision of
				the Texas Workers' Compensation Act or with any division
				rule.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 114 - SELF-INSURANCE › Section 114.16 - Withdrawal from Self-Insurance

Current through Reg. 49, No. 28; July 12, 2024
(a) Insuring
				agreements under Labor Code §
									407.045(a-1)
				filed for the commissioner's approval as a part of an adequate program to
				withdraw from self-insurance must meet the following criteria:
(1) The form of an insuring agreement must be
				that of a standard workers' compensation policy providing statutory limits with
				an approved company specific endorsement under Texas Insurance Code §
										2052.002(b)
				providing coverage for all open, reopened, and incurred but not reported claims
				against the self-insured employer for the entire period of time it operated as
				a certified self-insurer.
(2) The
				insurance policy must be issued by an insurance company as defined by Texas
				Labor Code §
										401.011(28)
				that has not been determined to be in hazardous financial condition by the
				commissioner of insurance pursuant to Chapter 8 of this title (relating to
				Hazardous Condition).
(3) The
				policy period must be retrospective providing coverage for the entire period of
				time the employer operated as a certified self-insurer.
(4) The policy as endorsed must be
				noncancelable by either the insurance company or the certified self-insured
				employer for any reason.
(5) The
				insurance company issuing an insuring agreement that covers all the workers'
				compensation liabilities of a certified self-insurer becomes the workers'
				compensation insurance carrier for the liabilities covered for all purposes of
				the Texas Workers' Compensation Act and division rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 116 - GENERAL PROVISIONS-SUBSEQUENT INJURY FUND › Section 116.12 - Subsequent Injury Fund Payment/Reimbursement Schedule

Current through Reg. 49, No. 28; July 12, 2024
(a) Claims against the Subsequent Injury Fund
				(SIF) shall be paid in the following priority:
(1) claims by insurance carriers for
				reimbursement made pursuant to Labor Code §
										403.007
				and §
										132.10(g)
				of this title (relating to Payment of Death Benefits to the Subsequent Injury
				Fund);
(2) claims by injured
				employees for lifetime benefits, as provided by Labor Code §
										408.162;
(3) claims by insurance carriers for
				reimbursement, made pursuant to Labor Code §§
										408.0041,
				410.209,
				and
				413.055
				and §
										116.11
				of this title (relating to Request for Reimbursement from the Subsequent Injury
				Fund); and
(4) claims by insurance
				carriers for reimbursement made pursuant to Labor Code §
										408.042(g)
				relating to multiple employment and those in accordance with division rule(s)
				adopted pursuant to Labor Code §
										413.0141.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 120 - COMPENSATION PROCEDURE - EMPLOYERS › Section 120.1 - Employer's Record of Injuries

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				employer shall keep a record of all injuries and fatal injuries to employees as
				reported to an employer, or otherwise made known to an employer. The record
				shall include:
(1) the name, address, date of
				birth, sex, wage, length of service, social security number, and occupation of
				the employee;
(2) the reported
				cause and nature of the injury, the part of the body affected, and a
				description of any equipment involved;
(3) the date, time, and location where the
				injury occurred;
(4) the name of
				the employee's immediate supervisor;
(5) the names of any witnesses (if
				known);
(6) the name and address of
				the treating health care provider, if known; and
(7) any voluntary benefits paid by the
				employer under the Texas Workers' Compensation Act (Act), §4.06.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 120 - COMPENSATION PROCEDURE - EMPLOYERS › Section 120.2 - Employer's First Report of Injury and Notice of Injured Employee Rights and Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				employer shall report to the employer's insurance carrier each death, each
				occupational disease of which the employer has received notice of injury or has
				knowledge, and each injury that results in more than one day's absence from
				work for the injured employee. As used in this section, the term "knowledge"
				includes receipt of written or oral information regarding diagnosis of an
				occupational disease, or the diagnosis of an occupational disease through
				direct examination or testing by a doctor employed by the employer.
(b) The Division shall prescribe the form,
				format, and manner of the employer's first report of injury (report). The
				report shall contain:
(1) the information
				required by §
										120.1(a)
				of this title (relating to Employer's Record of Injuries);
(2) any additional information prescribed by
				the Division in accordance with the Labor Code §
										402.00128(b)(10);
				and
(3) the information necessary
				for an insurance carrier to electronically transmit a first report of injury to
				the Division.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 120 - COMPENSATION PROCEDURE - EMPLOYERS › Section 120.3 - Employer's Supplemental Report of Injury

Current through Reg. 49, No. 28; July 12, 2024
(a) As used in this section, the term
				"employer" means the employer for whom the injured employee (employee) was
				working when injured and the filing requirements apply during the time the
				employee is entitled to temporary income benefits. The employer's duty to file
				reports required by this section continues until the employee reaches maximum
				medical improvement (MMI) or is no longer employed by the employer and the
				employer has made the report required by subsection (b) of this section. The
				employer may contact the insurance carrier (carrier) for information regarding
				the employee's MMI status.
(b) As
				provided in §
									129.4
				of this title (relating to Adjustment of Temporary Income Benefit Amount), the
				employer shall file the Supplemental Report of Injury, in the form, format and
				manner prescribed by the Commission. The report shall be filed with the
				employer's carrier and provided to the employee within ten days after the end
				of each pay period in which the employee has a change in earnings as a result
				of the injury or within ten days after the employee resigns or is terminated.
				The requirement to report a change of earnings under this subsection includes
				reporting all post-injury earnings as that term is used in Chapter 129 of this
				title (relating to Temporary Income Benefits).
(c) For injuries requiring an Employer's
				First Report of Injury, unless the information required in this subsection is
				provided on the Employer's First Report of Injury, the employer shall file the
				Supplemental Report of Injury with the employer's carrier and provide a copy to
				the employee within three days after:
(1) the
				employee begins to lose time from work as a result of the injury;
(2) the employee returns to work;
				or
(3) the employee, after
				returning to work, experiences an additional day(s) of disability as a result
				of the injury.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 120 - COMPENSATION PROCEDURE - EMPLOYERS › Section 120.4 - Employer's Wage Statement

Current through Reg. 49, No. 28; July 12, 2024
(a) The employer is
				required to timely file a complete wage statement in the form and manner
				prescribed by the commission. As used in this section, the term "filed" means
				"received."
(1) The wage statement shall be
				filed with the carrier, the claimant, and the claimant's representative (if
				any) within 30 days of the earliest of:
(A)
				the date the employer is notified that the employee is entitled to income
				benefits;
(B) the date of the
				employee's death as a result of a compensable injury.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 122 - COMPENSATION PROCEDURE-CLAIMANTS › Subchapter A - CLAIMS PROCEDURE FOR INJURED EMPLOYEES › Section 122.1 - Notice to Employer of Injury or Occupational Disease

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as provided in subsection (b) of
				  this section, an injured employee, or a person acting on that employee's
				  behalf, shall notify an employer of an injury not later than the 30th day after
				  the date on which the injury occurs. The notice of injury should include the
				  following information:
(1) the name, address,
				  and telephone number (if any) of the injured employee;
(2) the date, time, and place the injury
				  occurred;
(3) a description of the
				  circumstances and the nature of the injury;
(4) the names of any witnesses (if
				  known);
(5) the name and location
				  of the health provider that has treated the employee for the injury;
				  and
(6) the name of the person (if
				  any) acting on behalf of the injured employee.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 122 - COMPENSATION PROCEDURE-CLAIMANTS › Subchapter A - CLAIMS PROCEDURE FOR INJURED EMPLOYEES › Section 122.2 - Injured Employee's Claim for Compensation

Current through Reg. 49, No. 28; July 12, 2024
(a) An injured employee, or a person acting
				  on the injured employee's behalf, shall file with the commission a written
				  claim for compensation within one year after the date of the injury's
				  occurrence, except as provided in subsection (b) of this section.
(b) An employee whose injury results from an
				  occupational disease, or a person acting on that employee's behalf, shall file
				  with the commission a written claim for compensation within one year after the
				  date the employee knew or should have known that the disease was related to the
				  employment.
(c) The claim should be
				  submitted to the commission either on paper or via electronic transmission, in
				  the form, format, and manner prescribed by the commission, and should include
				  the following:
(1) the name, address,
				  telephone number (if any), occupation, wage, and social security number of the
				  injured employee;
(2) the length of
				  time the employee worked for the employer prior to the date of
				  injury;
(3) the date, time, and
				  location the injury occurred (or the date the employee knew or should have
				  known that the occupational disease was related to the employment);
(4) a description of the circumstances and
				  nature of the injury;
(5) the names
				  of witnesses (if any);
(6) the name
				  and location of the employer at the time of the injury (or, if the injury
				  claimed is an occupational disease, the name and location of the employer at
				  the time of the last injurious exposure to the hazards of the occupational
				  disease);
(7) the name of the
				  employee's immediate supervisor;
(8) the name and address of at least one
				  health care provider that has treated the employee for the injury;
				  and
(9) the identity of the person
				  (if any) acting on behalf of the injured employee.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 122 - COMPENSATION PROCEDURE-CLAIMANTS › Subchapter A - CLAIMS PROCEDURE FOR INJURED EMPLOYEES › Section 122.3 - Exposure to Communicable Diseases: Reporting and Testing Requirements for Emergency Responders

Current through Reg. 49, No. 28; July 12, 2024
(a) This section
				  applies to all law enforcement officers, fire fighters, emergency medical
				  service employees, paramedics, and correctional officers who are either state
				  employees or employees covered under workers' compensation insurance (to
				  include those who are providing services as a volunteer and are covered by
				  workers' compensation insurance).
(b) For purposes of this section "reportable
				  disease" means communicable diseases and health conditions required to be
				  reported to the Texas Department of Health by the Texas Health and Safety Code,
				  §
										81.041, as
				  amended, including: acquired immune deficiency syndrome (AIDS); amebiasis;
				  anthrax; botulism--adult and infant; brucellosis; campylobacteriosis;
				  chancroid; chickenpox; Chlamydia trachomatis infection; cholera;
				  cryptosporidiosis; dengue; diphtheria; ehrlichiosis; encephalitis; Escherichia
				  coli 0157:H7; gonorrhea; Hansen's disease (leprosy); Heamophilus influenzae
				  type b infection, invasive; hantavirus infection; hemolytic uremic syndrome
				  (HUS); hepatitis, acute viral; human immunodeficiency virus (HIV) infection;
				  legionellosis; listeriosis; Lyme disease; malaria; measles (Rubeola);
				  meningitis; meningococcal infection, invasive; mumps; pertussis; plague;
				  poliomyelitis, acute paralytic; rabies in man; relapsing fever; Rocky Mountain
				  spotted fever; rubella (including congenital); salmonellosis, including typhoid
				  fever; shigellosis; streptococcal disease, invasive Group A; syphilis; tetanus;
				  trichinosis; tuberculosis; tuberculosis infection in persons less than 15 years
				  of age; typhus; Vibrio infection; viral hemorrhagic fevers; and yellow fever.
				  This list of diseases may change from time to time. To determine the most
				  current list of reportable diseases and exposure criteria refer to Texas
				  Department of Health rules, 25 TAC Chapter 97, Communicable Diseases.
(c) An employee listed in subsection (a) of
				  this section will not be entitled to workers' compensation benefits for a
				  reportable disease unless the employee:
(1)
				  had a test performed within 10 days of an exposure to the reportable disease
				  that indicated the absence of the reportable disease (Exposure criteria and
				  testing protocol must conform to Texas Department of Health requirements. This
				  rule does not prohibit a decision-maker's consideration of other factors.);
				  and
(2) provided the employer with
				  a sworn affidavit of the date and circumstances of the exposure and a copy of
				  the results of the test required by paragraph (1) of this subsection.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 122 - COMPENSATION PROCEDURE-CLAIMANTS › Subchapter A - CLAIMS PROCEDURE FOR INJURED EMPLOYEES › Section 122.4 - State Employees Exposed to Human Immunodeficiency Virus (HIV): Reporting and Testing Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) This
				  section applies to all employees of the state of Texas.
(b) A state employee shall not be entitled to
				  workers' compensation benefits for a work-related exposure to human
				  immunodeficiency virus (HIV) infection unless the employee:
(1) had a test performed within 10 days of an
				  exposure to HIV that indicated the absence of HIV infection (Exposure criteria
				  and testing protocol must conform to Texas Department of Health requirements.);
				  and
(2) provided the employer with
				  a written statement of the date and circumstances of the exposure to HIV and a
				  copy of the results of the test required by paragraph (1) of this
				  subsection.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 122 - COMPENSATION PROCEDURE-CLAIMANTS › Subchapter A - CLAIMS PROCEDURE FOR INJURED EMPLOYEES › Section 122.5 - Employee's Multiple Employment Wage Statement

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions. The following words and
				  terms, when used in this subchapter, will have the following meanings, unless
				  the context clearly indicates otherwise.
(1)
				  Claim Employer -- Employer with whom the claimant filed a claim for workers'
				  compensation benefits and for whom the injured employee (employee) was working
				  at the time of the on-the-job injury.
(2) Non-Claim Employers -- Employers other
				  than the claim employer by whom the employee was employed at the time of the
				  on-the-job injury.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 122 - COMPENSATION PROCEDURE-CLAIMANTS › Subchapter B - CLAIMS PROCEDURE FOR BENEFICIARIES OF INJURED EMPLOYEES › Section 122.100 - Claim for Death Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) Filing. For
				  a legal beneficiary, other than the subsequent injury fund, to receive the
				  benefits available because of the death of an employee that results from a
				  compensable injury, a person must file a written claim for death benefits
				  within one year after the date of the employee's death.
(b) An insurance carrier that receives a
				  claim for death benefits under this section must comply with §
										124.8 of this title (relating to
				  Receipt, Records, and Notice of Death or Claim for Death Benefits).
(c) Form and information requirements. The
				  claim should be submitted to the division or insurance carrier either on paper
				  or via electronic transmission, in the form, format, and manner prescribed by
				  the division, and should include the following:
(1) the potential beneficiary's name,
				  address, telephone number (if any), Social Security number, and relationship to
				  the deceased employee;
(2) the
				  deceased employee's name, last address, Social Security number (if known), and
				  workers' compensation claim number (if any); and
(3) other information, as follows:
(A) a description of the circumstances and
				  nature of the injury (if known);
(B) the name and location of the employer at
				  the time of the injury;
(C) the
				  date of the compensable injury, and date of death; and
(D) other known legal
				  beneficiaries.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING › Subchapter A - INSURANCE CARRIERS: REQUIRED NOTICES AND MODES OF PAYMENT › Section 124.1 - Notice of Injury

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  provided in subsections (b) and (c) of this section, written notice of injury,
				  as used in the Texas Workers' Compensation Act, §409.021, consists of the
				  insurance carrier's earliest receipt of:
(1)
				  the Employer's First Report of Injury as described in §
											120.2
				  of this title (relating to Employer's First Report of Injury);
(2) the notification provided by the
				  Commission under subsection (e) of this section; or
(3) if no Employer's First Report of Injury
				  has been filed, any other communication regardless of source, which fairly
				  informs the carrier of the name of the injured employee, the identity of the
				  employer, the approximate date of the injury and information which asserts the
				  injury is work related.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING › Subchapter A - INSURANCE CARRIERS: REQUIRED NOTICES AND MODES OF PAYMENT › Section 124.2 - Insurance Carrier Notification Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) An insurance
				  carrier must notify the division and the claimant of actions taken on or events
				  occurring in a claim as required by this title.
(b) The insurance carrier must electronically
				  file, as that term is used in §
										102.5(e)
				  of this title (concerning General Rules for Written Communications to and from
				  the Division ), with the division, according to the requirements in Subchapter
				  B of this title (concerning Insurance Carrier Claim Electronic Data Interchange
				  Reporting to the Division):
(1) the
				  information from the original Employer's First Report of Injury; the insurance
				  carrier's Federal Employer Identification Number (FEIN); and the policy number,
				  policy effective date, and policy expiration date reported under §
											110.1
				  of this title (concerning Insurance Carrier Requirements for Notifying the
				  Division of Insurance Coverage) for the employer associated with the claim, not
				  later than the seventh day after the later of:
(A) receipt of a required report where there
				  is lost time from work, an occupational disease, or a fatality; or
(B) notification of lost time if the employer
				  made the Employer's First Report of Injury before the employee experienced
				  absence from work as a result of the injury;
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING › Subchapter A - INSURANCE CARRIERS: REQUIRED NOTICES AND MODES OF PAYMENT › Section 124.5 - Mode of Payment Made by Insurance Carriers

Current through Reg. 49, No. 28; July 12, 2024
(a) The insurance carrier shall make all
				  medical benefit and burial payments by:
(1)
				  check or other readily negotiable instrument; or
(2) electronic transfer by mutual agreement
				  to an account designated in writing by the payee.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING › Subchapter A - INSURANCE CARRIERS: REQUIRED NOTICES AND MODES OF PAYMENT › Section 124.6 - Electronic Transfer Payments Made Through an Access Card

Current through Reg. 49, No. 28; July 12, 2024
(a) Access card. In this chapter, access card
				  means any card or other payment method that may be used by a claimant to
				  initiate an electric fund transfer from an insurance carrier's bank account.
				  The term "access card" does not include stored value cards or prepaid cards
				  that store funds directly on the card and that are not linked to an insurance
				  carrier's bank account.
(b) Mutual
				  agreement. An insurance carrier may pay income or death benefits through an
				  access card to a claimant if there is written mutual agreement signed by the
				  insurance carrier and the claimant. The insurance carrier shall maintain
				  accurate records of the mutual agreement for, at a minimum, 401 weeks from the
				  date of injury. The written mutual agreement shall contain an acknowledgement
				  that the claimant received and agreed to the written disclosure in subsection
				  (f) of this section.
(c) Agent of
				  the insurance carrier. Any person with whom an insurance carrier utilizes or
				  contracts for the purpose of providing service or fulfilling duties under this
				  section is an agent of the insurance carrier under §
										180.1(3)
				  of this title (relating to Definitions).
(d) Requirements and prohibited fees. An
				  insurance carrier shall:
(1) permit the
				  claimant to withdraw the entire amount of the balance of an access card in one
				  transaction;
(2) not reduce income
				  or death benefits paid to a claimant through an access card for the following
				  fees, surcharges, and adjustments:
(A)
				  overdraft services under which a financial institution pays a transaction
				  (including a check or other item) when the claimant has insufficient or
				  unavailable funds in the account;
(B) ATM withdrawal or a point of sale
				  purchase for more than the card holds and the transaction is denied;
(C) ATM balance inquiries;
(D) withdrawing money from network
				  ATMs;
(E) withdrawing money from a
				  teller;
(F) customer service
				  calls;
(G) activating the
				  card;
(H) fees for card
				  inactivity;
(I) closing
				  account;
(J) access card
				  replacement through standard mail;
(K) withdrawing the entire payment in one
				  transaction;
(L) point of sale
				  purchases; or
(M) any other fees or
				  charges that are not authorized under subsection (e) of this section.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING › Subchapter A - INSURANCE CARRIERS: REQUIRED NOTICES AND MODES OF PAYMENT › Section 124.7 - Initial Payment of Temporary Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) As used in this section, the following
				  terms have the following meanings, unless the context clearly indicates
				  otherwise: "Accrual date" means the day an injured worker's income benefits
				  begin to accrue. "Day of disability" means a day when the worker is unable to
				  obtain and retain employment at wages equivalent to the pre-injury wage because
				  of a compensable injury. Intermittent days of disability shall be cumulated to
				  calculate the accrual date.
(b) An
				  injured worker's accrual date is the worker's eighth day of
				  disability.
(c) A carrier who has
				  received written notice of an injury and has not disputed the claim shall
				  initiate income benefits no later than the seventh day after the accrual
				  date.
(d) Nothing in this section
				  is intended to limit a carrier's discretion to initiate payment of temporary
				  income benefits before the time limit established in subsection (c) of this
				  section.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING › Subchapter A - INSURANCE CARRIERS: REQUIRED NOTICES AND MODES OF PAYMENT › Section 124.8 - Receipt, Records, and Notice of Death or Claim for Death Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) Definition. In this section, "claim for
				  death benefits" means a claim that is filed under Chapter 122, Subchapter B,
				  §
										122.100 of this title.
(b) General requirements. An insurance
				  carrier that receives a notice of death in accordance with §
										132.17 of this title, or a claim
				  for death benefits must comply with all of the requirements in this
				  chapter.
(c) Recordkeeping and
				  notice. An insurance carrier in subsection (b) of this section must:
(1) send the division a copy of the
				  plain-language notice that the insurance carrier must provide to the potential
				  beneficiary under §
											132.17 of this title.
(2) on receiving a claim for death benefits,
				  create and maintain a record documenting receipt of the claim for death
				  benefits. The record must include all of the information in the claim for death
				  benefits. The insurance carrier must maintain the record in accordance with
				  Chapter 102, §
											102.4 of this title.
(3) send the division a copy of a claim for
				  death benefits the insurance carrier receives from the potential beneficiary
				  not later than the seventh day after receiving it and include any other
				  documents and information the insurance carrier received.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING › Subchapter B - INSURANCE CARRIER CLAIM ELECTRONIC DATA INTERCHANGE REPORTING TO THE DIVISION › Section 124.100 - Applicability

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter
				  applies to any claim transactions required to be reported to the division under
				  § 124.105 of this title on or after July 26, 2023.
(b) This subchapter applies to all insurance
				  carriers as defined in Labor Code §
										401.011(27).
				  All insurance carriers are required to report information prescribed by the
				  commissioner under Labor Code §§
										401.024,
				  402.082,
				  411.012,
				  411.031,
				  411.032,
				  and
				  411.033 for
				  each workers' compensation claim. All insurance carriers are required to notify
				  injured employees and the division about claim actions as provided in §
										124.2
				  of this title (concerning Insurance Carrier Notification
				  Requirements).
(c) This subchapter
				  is effective July 26, 2023. Insurance carriers and trading partners must
				  continue to submit claim EDI records to the division in the International
				  Association of Industrial Accident Boards and Commissions (IAIABC) Claims
				  Electronic Data Interchange (EDI) Release 1.0 standard before this effective
				  date.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING › Subchapter B - INSURANCE CARRIER CLAIM ELECTRONIC DATA INTERCHANGE REPORTING TO THE DIVISION › Section 124.101 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to prescribe the
					 reporting requirements for information and data submitted to the division and
					 adopt by reference the implementation guide and specifications necessary for
					 successful EDI transaction processing. The reporting of information and data is
					 necessary to maintain information on every compensable injury; maintain a
					 repository for statistical information on workers' health and safety; and
					 compile, maintain, and use statistical data to detect practices or patterns of
					 misconduct by system participants as required by Labor Code §§
										402.082,
					 411.033, and
					 414.003.