110.7
(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 […]
110.103
(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 […]
133.270
(a) An injured employee may request reimbursement from the insurance carrier when the injured employee has paid for health care provided for a compensable injury, unless the injured employee is liable for payment as specified in: (1) Insurance Code § 1305.451, or (2) Section 134.504 of this title (relating to Pharmaceutical Expenses Incurred by the […]
144.1
(a) The arbitrator is authorized but not limited to: (1) set the time and location of the arbitration proceeding pursuant to the applicable provisions of Labor Code § 410.005 and § 410.109; (2) compel the parties to exchange all pertinent medical reports and other documentary evidence, and proposals for resolving the issues in dispute; (3) […]
144.2
(a) On any substantive matter regarding facts, issues, law, or rules, an arbitrator may not communicate with any party outside the arbitration unless the communication is: (1) in writing; and (2) a copy is delivered to all parties to the arbitration. (b) Notwithstanding subsection (a) of this section, any party may communicate with the arbitrator […]
144.3
A party who sends a document relating to the arbitration proceeding to the division’s chief clerk of proceedings or the arbitrator shall also deliver copies of the document to all other parties, or their representatives or attorneys. Delivery shall be accomplished by presenting in person, mailing by certified mail, or electronic transmission. The document sent […]
144.4
(a) Following a benefit review conference where disputed benefit issue(s) remain unresolved, the parties may mutually agree to engage in arbitration on those issues. (b) Parties agreeing to engage in arbitration must complete and sign a form prescribed by the division and file it with the division’s chief clerk of proceedings not later than the […]
144.5
(a) Statement of disputes. The statement of disputes is a written description of the dispute(s) to be considered by the arbitrator. A dispute not expressly included in the statement of disputes will not be considered by the arbitrator. (b) Statement of disputes after a benefit review conference. The statement of disputes for an arbitration proceeding […]
144.6
(a) The division will maintain, in random name order, lists of qualified arbitrators established by the division. Not later than the 30th day after an election to engage in arbitration is filed, an arbitrator will be assigned from the appropriate list. Each party will be notified immediately either personally or by certified mail. (b) Assignment […]
144.7
(a) Following any rejections as set forth in §144.6 of this title (relating to Assignment of Arbitrator), the arbitrator shall schedule arbitration to be held not later than the 30th day following the assignment of the arbitrator. (b) The arbitrator shall notify, in writing, all parties and the employer of the time and place scheduled […]