129.5
(a) As used in this section: (1) the term “doctor” means either the treating doctor or a referral doctor, as defined by §180.22(c) and (e) of this title (relating to Health Care Provider Roles and Responsibilities); (2) “substantial change in activity restrictions” means a change in activity restrictions caused by a change in the injured […]
124.3
(a) Except as provided in subsection (b) of this section, upon receipt of written notice of injury as provided in 124.1 of this title (relating to Notice of Injury) the insurance carrier shall conduct an investigation relating to the compensability of the injury, the insurance carrier’s liability for the injury, and the accrual of benefits. […]
180.8
(a) A notice of violation (NOV) is a notice issued to a system participant when the division finds that the system participant has committed an administrative violation and the division seeks to impose a sanction under the Act or division rules. An NOV is not required to be issued before or after the issuance of […]
180.26
(a) The division may impose sanctions on any system participant if that system participant commits an administrative violation. (b) The division may impose the following sanctions against a doctor or insurance carrier for any reason listed in Labor Code §408.0231(c) or any other criteria the commissioner considers relevant. (c) In addition to a penalty or […]
134.150
(a) This section applies, regardless of the date of injury, to medical services provided on or after January 1, 2020, in a federal military treatment facility (FMTF) as defined in Labor Code §413.0112(a) (relating to Reimbursement of Federal Military Treatment Facility). (b) Reimbursement for medical services provided to an injured employee shall be the amount […]
134.155
(a) Disputes over charges billed by a federal military treatment facility (FMTF): (1) If an insurance carrier denies payment of a medical bill based on medical necessity, the medical necessity dispute shall be initiated under 133.308 of this title (concerning MDR of Medical Necessity Disputes): (A) Notwithstanding Chapter 133, Subchapter D, of this title (concerning […]
110.1
(a) An approved workers’ compensation insurance policy, as referenced in Labor Code § 401.011(44)(A), includes a binder, which serves as evidence of a temporary agreement that legally provides workers’ compensation insurance coverage until the approved insurance policy is issued or the binder is canceled. (b) As used in this section, “workers’ compensation insurance coverage information” […]
102.7
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 […]
140.1
The following words and terms, when used in this part, shall have the following meanings, unless the context clearly indicates otherwise. (1) Benefit dispute–A disputed issue arising under the Texas Workers’ Compensation Act (Act) in a workers’ compensation claim regarding compensability or eligibility for, or the amount of, income or death benefits. (2) Benefit proceeding–A […]
140.8
(a) Applicability. This section applies only to subclaims by a health care insurer based on information received under Labor Code §402.084(c-3). (b) Health care insurer. “Health care insurer” means an insurance carrier and an authorized representative of an insurance carrier, as described by Labor Code §402.084(c-1). (c) Request to Workers’ Compensation Insurance Carrier. A health […]