413.052
The commissioner by rule shall establish procedures to enable the division to compel the production of documents. Acts 1993, 73rd Leg., ch. 269, § 1, eff. Sept. 1, 1993. Amended by Acts 2005, 79th Leg., ch. 265, § 3.256, eff. Sept. 1, 2005.
413.053
The commissioner by rule shall establish standards of reporting and billing governing both form and content. Acts 1993, 73rd Leg., ch. 269, § 1, eff. Sept. 1, 1993. Amended by Acts 2005, 79th Leg., ch. 265, § 3.257, eff. Sept. 1, 2005.
413.055
(a) The commissioner may enter an interlocutory order for the payment of all or part of medical benefits. The order may address accrued benefits, future benefits, or both accrued benefits and future benefits. (b) The subsequent injury fund shall reimburse an insurance carrier for any overpayments of benefits made under an order entered under Subsection […]
414.002
(a) The division shall monitor for compliance with commissioner rules, this subtitle, and other laws relating to workers’ compensation the conduct of persons subject to this subtitle. Persons to be monitored include: (1) persons claiming benefits under this subtitle; (2) employers; (3) insurance carriers; (4) attorneys and other representatives of parties; and (5) health care […]
414.003
(a) The division shall compile and maintain statistical and other information as necessary to detect practices or patterns of conduct by persons subject to monitoring under this chapter that: (1) violate this subtitle, commissioner rules, or a commissioner order or decision; or (2) otherwise adversely affect the workers’ compensation system of this state. (b) The […]
414.007
The division shall review information concerning alleged violations of this subtitle regarding the provision of medical benefits, commissioner rules, or a commissioner order or decision, and, under Sections 414.005 and 414.006 and Chapters 415 and 416, may conduct investigations, make referrals to other authorities, and initiate administrative violation proceedings. Acts 1993, 73rd Leg., ch. 269, […]
415.001
A representative of an employee or legal beneficiary commits an administrative violation if the person: (1) fails without good cause to attend a dispute resolution proceeding within the division; (2) attends a dispute resolution proceeding within the division without complete authority or fails to exercise authority to effectuate an agreement or settlement; (3) commits an […]
415.002
(a) An insurance carrier or its representative commits an administrative violation if that person: (1) misrepresents a provision of this subtitle to an employee, an employer, a health care provider, or a legal beneficiary; (2) terminates or reduces benefits without substantiating evidence that the action is reasonable and authorized by law; (3) instructs an employer […]
415.003
A health care provider commits an administrative violation if the person: (1) submits a charge for health care that was not furnished; (2) administers improper, unreasonable, or medically unnecessary treatment or services; (3) makes an unnecessary referral; (4) violates the division’s fee and treatment guidelines; (5) violates a commissioner rule; or (6) fails to comply […]
415.005
(a) A health care provider commits a violation if the person charges an insurance carrier an amount greater than that normally charged for similar treatment to a payor outside the workers’ compensation system, except for mandated or negotiated charges. (b) A violation under this section is an administrative violation. A health care provider may be […]