CHAPTER 409. COMPENSATION PROCEDURES
LABOR CODE
TITLE 5. WORKERS' COMPENSATION
SUBTITLE A. TEXAS WORKERS' COMPENSATION ACT
CHAPTER 409. COMPENSATION PROCEDURES
SUBCHAPTER A. INJURY REPORTS, CLAIMS, AND RECORDS
Sec. 409.001. NOTICE OF INJURY TO EMPLOYER. (a) An employee or
a person acting on the employee's behalf shall notify the
employer of the employee of an injury not later than the 30th day
after the date on which:
(1) the injury occurs; or
(2) if the injury is an occupational disease, the employee knew
or should have known that the injury may be related to the
employment.
(b) The notice required under Subsection (a) may be given to:
(1) the employer; or
(2) an employee of the employer who holds a supervisory or
management position.
(c) If the injury is an occupational disease, for purposes of
this section, the employer is the person who employed the
employee on the date of last injurious exposure to the hazards of
the disease.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 409.002. FAILURE TO FILE NOTICE OF INJURY. Failure to
notify an employer as required by Section 409.001(a) relieves the
employer and the employer's insurance carrier of liability under
this subtitle unless:
(1) the employer, a person eligible to receive notice under
Section 409.001(b), or the employer's insurance carrier has
actual knowledge of the employee's injury;
(2) the division determines that good cause exists for failure
to provide notice in a timely manner; or
(3) the employer or the employer's insurance carrier does not
contest the claim.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.134, eff. September 1, 2005.
Sec. 409.003. CLAIM FOR COMPENSATION. An employee or a person
acting on the employee's behalf shall file with the division a
claim for compensation for an injury not later than one year
after the date on which:
(1) the injury occurred; or
(2) if the injury is an occupational disease, the employee knew
or should have known that the disease was related to the
employee's employment.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.135, eff. September 1, 2005.
Sec. 409.004. EFFECT OF FAILURE TO FILE CLAIM FOR COMPENSATION.
Failure to file a claim for compensation with the division as
required under Section 409.003 relieves the employer and the
employer's insurance carrier of liability under this subtitle
unless:
(1) good cause exists for failure to file a claim in a timely
manner; or
(2) the employer or the employer's insurance carrier does not
contest the claim.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.136, eff. September 1, 2005.
Sec. 409.005. REPORT OF INJURY; MODIFIED DUTY PROGRAM NOTICE;
ADMINISTRATIVE VIOLATION. (a) An employer shall report to the
employer's insurance carrier if:
(1) an injury results in the absence of an employee of that
employer from work for more than one day; or
(2) an employee of the employer notifies that employer of an
occupational disease under Section 409.001.
(b) The report under Subsection (a) must be made not later than
the eighth day after:
(1) the employee's absence from work for more than one day due
to an injury; or
(2) the day on which the employer receives notice under Section
409.001 that the employee has contracted an occupational disease.
(c) The employer shall deliver a written copy of the report
under Subsection (a) to the injured employee at the time that the
report is made to the insurance carrier.
(d) The insurance carrier shall file the report of the injury on
behalf of the policyholder. Except as provided by Subsection
(e), the insurance carrier must electronically file the report
with the division not later than the seventh day after the date
on which the carrier receives the report from the employer.
(e) The commissioner may waive the electronic filing requirement
under Subsection (d) and allow an insurance carrier to mail or
deliver the report to the division not later than the seventh day
after the date on which the carrier receives the report from the
employer.
(f) A report required under this section may not be considered
to be an admission by or evidence against an employer or an
insurance carrier in a proceeding before the division or a court
in which the facts set out in the report are contradicted by the
employer or insurance carrier.
(g) In addition to any information required under Subsection
(h), the report provided to the injured employee under Subsection
(c) must contain a summary written in plain language of the
employee's statutory rights and responsibilities under this
subtitle.
(h) The commissioner may adopt rules relating to:
(1) the information that must be contained in a report required
under this section, including the summary of rights and
responsibilities required under Subsection (g); and
(2) the development and implementation of an electronic filing
system for injury reports under this section.
(i) An employer and insurance carrier shall file subsequent
reports as required by commissioner rule.
(j) The employer shall, on the written request of the employee,
a doctor, the insurance carrier, or the division, notify the
employee, the employee's treating doctor if known to the
employer, and the insurance carrier of the existence or absence
of opportunities for modified duty or a modified duty
return-to-work program available through the employer. If those
opportunities or that program exists, the employer shall identify
the employer's contact person and provide other information to
assist the doctor, the employee, and the insurance carrier to
assess modified duty or return-to-work options.
(k) This section does not prohibit the commissioner from
imposing requirements relating to return-to-work under other
authority granted to the division in this subtitle.
(l) A person commits an administrative violation if the person
fails to comply with this section unless good cause exists.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.29, eff. Sept.
1, 1995; Acts 2001, 77th Leg., ch. 1456, Sec. 3.01, eff. June 17,
2001.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.137, eff. September 1, 2005.
Sec. 409.006. RECORD OF INJURIES; ADMINISTRATIVE VIOLATION. (a)
An employer shall maintain a record of each employee injury as
reported by an employee or otherwise made known to the employer.
(b) The record shall be available to the division at reasonable
times and under conditions prescribed by the commissioner.
(c) The commissioner may adopt rules relating to the information
that must be contained in an employer record under this section.
(d) Information contained in a record maintained under this
section is not an admission by the employer that:
(1) the injury did in fact occur; or
(2) a fact maintained in the record is true.
(e) A person commits an administrative violation if the person
fails to comply with this section.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.138, eff. September 1, 2005.
Sec. 409.007. DEATH BENEFIT CLAIMS. (a) A person must file a
claim for death benefits with the division not later than the
first anniversary of the date of the employee's death.
(b) Failure to file in the time required by Subsection (a) bars
the claim unless:
(1) the person is a minor or incompetent; or
(2) good cause exists for the failure to file a claim under this
section.
(c) A separate claim must be filed for each legal beneficiary
unless the claim expressly includes or is made on behalf of
another person.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.139, eff. September 1, 2005.
Sec. 409.008. FAILURE TO FILE EMPLOYER REPORT OF INJURY;
LIMITATIONS TOLLED. If an employer or the employer's insurance
carrier has been given notice or has knowledge of an injury to or
the death of an employee and the employer or insurance carrier
fails, neglects, or refuses to file the report under Section
409.005, the period for filing a claim for compensation under
Sections 409.003 and 409.007 does not begin to run against the
claim of an injured employee or a legal beneficiary until the day
on which the report required under Section 409.005 has been
furnished.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 409.009. SUBCLAIMS. A person may file a written claim with
the division as a subclaimant if the person has:
(1) provided compensation, including health care provided by a
health care insurer, directly or indirectly, to or for an
employee or legal beneficiary; and
(2) sought and been refused reimbursement from the insurance
carrier.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.140, eff. September 1, 2005.
Sec. 409.0091. REIMBURSEMENT PROCEDURES FOR CERTAIN ENTITIES.
(a) In this section, "health care insurer" means an insurance
carrier and an authorized representative of an insurance carrier,
as described by Section 402.084(c-1).
(b) This section applies only to a request for reimbursement by
a health care insurer.
(c) Health care paid by a health care insurer may be
reimbursable as a medical benefit.
(d) Except as provided by Subsection (e), this section does not
prohibit or limit a substantive defense by a workers'
compensation insurance carrier that the health care paid for by
the health care insurer was not a medical benefit or not a
correct payment. A subclaimant may not be reimbursed for payment
for any health care that was previously denied by a workers'
compensation insurance carrier under:
(1) a preauthorization review of the specific service or medical
procedure; or
(2) a medical necessity review that determined the service was
not medically necessary for the treatment of a compensable
injury.
(e) It is not a defense to a subclaim by a health care insurer
that:
(1) the subclaimant has not sought reimbursement from a health
care provider or the subclaimant's insured;
(2) the subclaimant or the health care provider did not request
preauthorization under Section 413.014 or rules adopted under
that section; or
(3) the health care provider did not bill the workers'
compensation insurance carrier, as provided by Section 408.027,
before the 95th day after the date the health care for which the
subclaimant paid was provided.
(f) Subject to the time limits under Subsection (n), the health
care insurer shall provide, with any reimbursement request, the
tax identification number of the health care insurer and the
following to the workers' compensation insurance carrier, in a
form prescribed by the division:
(1) information identifying the workers' compensation case,
including:
(A) the division claim number;
(B) the name of the patient or claimant;
(C) the social security number of the patient or claimant; and
(D) the date of the injury; and
(2) information describing the health care paid by the health
care insurer, including:
(A) the name of the health care provider;
(B) the tax identification number of the health care provider;
(C) the date of service;
(D) the place of service;
(E) the ICD-9 code;
(F) the CPT, HCPCS, NDC, or revenue code;
(G) the amount charged by the health care provider; and
(H) the amount paid by the health care insurer.
(g) The workers' compensation insurance carrier shall reduce the
amount of the reimbursable subclaim by any payments the workers'
compensation insurance carrier previously made to the same
health care provider for the provision of the same health care on
the same dates of service. In making such a reduction in
reimbursement to the subclaimant, the workers' compensation
insurance carrier shall provide evidence of the previous payments
made to the provider.
(h) For each medical benefit paid, the workers' compensation
insurance carrier shall pay to the health care insurer the lesser
of the amount payable under the applicable fee guideline as of
the date of service or the actual amount paid by the health care
insurer. In the absence of a fee guideline for a specific
service paid, the amount per service paid by the health care
insurer shall be considered in determining a fair and reasonable
payment under rules under this subtitle defining fair and
reasonable medical reimbursement. The health care insurer may
not recover interest as a part of the subclaim.
(i) On receipt of a request for reimbursement under this
section, the workers' compensation insurance carrier shall
respond to the request in writing not later than the 90th day
after the date on which the request is received. If additional
information is requested under Subsection (j), the workers'
compensation insurance carrier shall respond not later than the
120th day unless the time is extended under Subsection (j).
(j) If the workers' compensation insurance carrier requires
additional information from the health care insurer, the workers'
compensation insurance carrier shall send notice to the health
care insurer requesting the additional information. The health
care insurer shall have 30 days to provide the requested
information. The workers' compensation insurance carrier and the
health care insurer may establish additional periods for
compliance with this subsection by written mutual agreement.
(k) Unless the parties have agreed to an extension of time under
Subsection (j), the health care insurer must file a written
subclaim under this section not later than the 120th day after:
(1) the workers' compensation insurance carrier fails to respond
to a request for reimbursement; or
(2) receipt of the workers' compensation insurance carrier's
notice of denial to pay or reduction in reimbursement.
(l) Any dispute that arises from a failure to respond to or a
reduction or denial of a request for reimbursement of services
that form the basis of the subclaim must go through the
appropriate dispute resolution process under this subtitle and
division rules. The commissioner of insurance and the
commissioner of workers' compensation shall modify rules under
this subtitle as necessary to allow the health care insurer
access as a subclaimant to the appropriate dispute resolution
process. Rules adopted or amended by the commissioner of
insurance and the commissioner of workers' compensation must
recognize the status of a subclaimant as a party to the dispute.
Rules modified or adopted under this section should ensure that
the workers' compensation insurance carrier is not penalized,
including not being held responsible for costs of obtaining the
additional information, if the workers' compensation insurance
carrier denies payment in order to move to dispute resolution to
obtain additional information to process the request.
(m) In a dispute filed under Chapter 410 that arises from a
subclaim under this section, a hearing officer may issue an order
regarding compensability or eligibility for benefits and order
the workers' compensation insurance carrier to reimburse health
care services paid by the health care insurer as appropriate
under this subtitle. Any dispute over the amount of medical
benefits owed under this section, including medical necessity
issues, shall be determined by medical dispute resolution under
Sections 413.031 and 413.032.
(n) Except as provided by Subsection (s), a health care insurer
must file a request for reimbursement with the workers'
compensation insurance carrier not later than six months after
the date on which the health care insurer received information
under Section 402.084(c-3) and not later than 18 months after the
health care insurer paid for the health care service.
(o) The commissioner and the commissioner of insurance shall
amend or adopt rules to specify the process by which an employee
who has paid for health care services described by Section
408.027(d) may seek reimbursement.
(p) Until September 1, 2011, a workers' compensation insurance
carrier is exempt from any department and division data reporting
requirements affected by a lack of information caused by
reimbursement requests or subclaims under this section. If data
reporting is required after that date, the requirement is
prospective only and may not require any data to be reported
between September 1, 2007, and the date required reporting is
reinstated. The department and the division may make legislative
recommendations to the 82nd Legislature for the collection of
reimbursement request and subclaim data.
(q) An action or failure to act by a workers' compensation
insurance carrier under this section may not serve as the basis
for an examination or administrative action by the department or
the division, or for any cause of action by any person, except
for judicial review under this subtitle.
(r) The commissioner of insurance and the commissioner of
workers' compensation may adopt additional rules to clarify the
processes required by, fulfill the purpose of, or assist the
parties in the proper adjudication of subclaims under this
section.
(s) On or after September 1, 2007, from information provided to
a health care insurer before January 1, 2007, under Section
402.084(c-3), the health care insurer may file not later than
March 1, 2008:
(1) a subclaim with the division under Subsection (l) if a
request for reimbursement has been presented and denied by a
workers' compensation insurance carrier; or
(2) a request for reimbursement under Subsection (f) if a
request for reimbursement has not previously been presented and
denied by the workers' compensation insurance carrier.
Added by Acts 2007, 80th Leg., R.S., Ch.
1007, Sec. 8, eff. September 1, 2007.
Sec. 409.010. INFORMATION PROVIDED TO EMPLOYEE OR LEGAL
BENEFICIARY. Immediately on receiving notice of an injury or
death from any person, the division shall mail to the employee or
legal beneficiary a clear and concise description of:
(1) the services provided by:
(A) the division; and
(B) the office of injured employee counsel, including the
services of the ombudsman program;
(2) the division's procedures; and
(3) the person's rights and responsibilities under this
subtitle.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.141, eff. September 1, 2005.
Sec. 409.011. INFORMATION PROVIDED TO EMPLOYER; EMPLOYER'S
RIGHTS. (a) Immediately on receiving notice of an injury or
death from any person, the division shall mail to the employer a
description of:
(1) the services provided by the division and the office of
injured employee counsel;
(2) the division's procedures; and
(3) the employer's rights and responsibilities under this
subtitle.
(b) The information must include a clear statement of the
following rights of the employer:
(1) the right to be present at all administrative proceedings
relating to an employee's claim;
(2) the right to present relevant evidence relating to an
employee's claim at any proceeding;
(3) the right to report suspected fraud;
(4) the right to contest the compensability of an injury if the
insurance carrier accepts liability for the payment of benefits;
(5) the right to receive notice, after making a written request
to the insurance carrier, of:
(A) a proposal to settle a claim; or
(B) an administrative or a judicial proceeding relating to the
resolution of a claim; and
(6) the right to contest the failure of the insurance carrier to
provide accident prevention services under Subchapter E, Chapter
411.
(c) The division is not required to provide the information to
an employer more than once during a calendar year.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.142, eff. September 1, 2005.
Sec. 409.012. VOCATIONAL REHABILITATION INFORMATION. (a) The
division shall analyze each report of injury received from an
employer under this chapter to determine whether the injured
employee would be assisted by vocational rehabilitation.
(b) If the division determines that an injured employee would be
assisted by vocational rehabilitation, the division shall notify:
(1) the injured employee in writing of the services and
facilities available through the Department of Assistive and
Rehabilitative Services and private providers of vocational
rehabilitation; and
(2) the Department of Assistive and Rehabilitative Services and
the affected insurance carrier that the injured employee has been
identified as one who could be assisted by vocational
rehabilitation.
(c) The division shall cooperate with the office of injured
employee counsel, the Department of Assistive and Rehabilitative
Services, and private providers of vocational rehabilitation in
the provision of services and facilities to employees by the
Department of Assistive and Rehabilitative Services.
(d) A private provider of vocational rehabilitation services may
register with the division.
(e) The commissioner by rule may require that a private provider
of vocational rehabilitation services maintain certain
credentials and qualifications in order to provide services in
connection with a workers' compensation insurance claim.
(f) The division and the Department of Assistive and
Rehabilitative Services shall report to the legislature not later
than August 1, 2006, on their actions to improve access to and
the effectiveness of vocational rehabilitation programs for
injured employees. The report must include:
(1) a description of the actions each agency has taken to
improve communication regarding and coordination of vocational
rehabilitation programs;
(2) an analysis identifying the population of injured employees
that have the poorest return-to-work outcomes and are in the
greatest need for vocational rehabilitation services;
(3) any changes recommended to improve the access to and
effectiveness of vocational rehabilitation programs for the
populations identified in Subdivision (2); and
(4) a plan to implement these changes.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1999, 76th Leg., ch. 956, Sec. 2, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.143, eff. September 1, 2005.
Sec. 409.013. PLAIN LANGUAGE INFORMATION; NOTIFICATION OF
INJURED EMPLOYEE. (a) The division shall develop information
for public dissemination about the benefit process and the
compensation procedures established under this chapter. The
information must be written in plain language and must be
available in English and Spanish.
(b) On receipt of a report under Section 409.005, the division
shall contact the affected employee by mail or by telephone and
shall provide the information required under Subsection (a) to
that employee, together with any other information that may be
prepared by the office of injured employee counsel or the
division for public dissemination that relates to the employee's
situation, such as information relating to back injuries or
occupational diseases.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.30, eff. Sept. 1,
1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.144, eff. September 1, 2005.
SUBCHAPTER B. PAYMENT OF BENEFITS
Sec. 409.021. INITIATION OF BENEFITS; INSURANCE CARRIER'S
REFUSAL; ADMINISTRATIVE VIOLATION. (a) An insurance carrier
shall initiate compensation under this subtitle promptly. Not
later than the 15th day after the date on which an insurance
carrier receives written notice of an injury, the insurance
carrier shall:
(1) begin the payment of benefits as required by this subtitle;
or
(2) notify the division and the employee in writing of its
refusal to pay and advise the employee of:
(A) the right to request a benefit review conference; and
(B) the means to obtain additional information from the
division.
(a-1) An insurance carrier that fails to comply with Subsection
(a) does not waive the carrier's right to contest the
compensability of the injury as provided by Subsection (c) but
commits an administrative violation subject to Subsection (e).
(a-2) An insurance carrier is not required to comply with
Subsection (a) if the insurance carrier has accepted the claim as
a compensable injury and income or death benefits have not yet
accrued but will be paid by the insurance carrier when the
benefits accrue and are due.
(b) An insurance carrier shall notify the division in writing of
the initiation of income or death benefit payments in the manner
prescribed by commissioner rules.
(c) If an insurance carrier does not contest the compensability
of an injury on or before the 60th day after the date on which
the insurance carrier is notified of the injury, the insurance
carrier waives its right to contest compensability. The
initiation of payments by an insurance carrier does not affect
the right of the insurance carrier to continue to investigate or
deny the compensability of an injury during the 60-day period.
(d) An insurance carrier may reopen the issue of the
compensability of an injury if there is a finding of evidence
that could not reasonably have been discovered earlier.
(e) An insurance carrier commits a violation if the insurance
carrier does not initiate payments or file a notice of refusal as
required by this section. A violation under this subsection shall
be assessed at $500 if the carrier initiates compensation or
files a notice of refusal within five working days of the date
required by Subsection (a), $1,500 if the carrier initiates
compensation or files a notice of refusal more than five and less
than 16 working days of the date required by Subsection (a),
$2,500 if the carrier initiates compensation or files a notice of
refusal more than 15 and less than 31 working days of the date
required by Subsection (a), or $5,000 if the carrier initiates
compensation or files a notice of refusal more than 30 days after
the date required by Subsection (a). The administrative penalties
are not cumulative.
Text of subsec. (f) as added by Acts 2003, 78th Leg., ch. 939,
Sec. 1
(f) For purposes of this section, "written notice" to a
certified self-insurer occurs only on written notice to the
qualified claims servicing contractor designated by the certified
self-insurer under Section 407.061(c).
Text of subsec. (f) as added by Acts 2003, 78th Leg., ch. 1100,
Sec. 1
(f) For purposes of this section:
(1) a certified self-insurer receives notice on the date the
qualified claims servicing contractor designated by the certified
self-insurer under Section 407.061(c) receives notice; and
(2) a political subdivision that self-insures under Section
504.011, either individually or through an interlocal agreement
with other political subdivisions, receives notice on the date
the intergovernmental risk pool or other entity responsible for
administering the claim for the political subdivision receives
notice.
(j) Each insurance carrier shall establish a single point of
contact in the carrier's office for an injured employee for whom
the carrier receives a notice of injury.
Added by Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1,
1993. Amended by Acts 2003, 78th Leg., ch. 939, Sec. 1, eff.
Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1100, Sec. 1, eff. Sept.
1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.145, eff. September 1, 2005.
Sec. 409.022. REFUSAL TO PAY BENEFITS; NOTICE; ADMINISTRATIVE
VIOLATION. (a) An insurance carrier's notice of refusal to pay
benefits under Section 409.021 must specify the grounds for the
refusal.
(b) The grounds for the refusal specified in the notice
constitute the only basis for the insurance carrier's defense on
the issue of compensability in a subsequent proceeding, unless
the defense is based on newly discovered evidence that could not
reasonably have been discovered at an earlier date.
(c) An insurance carrier commits an administrative violation if
the insurance carrier does not have reasonable grounds for a
refusal to pay benefits, as determined by the commissioner.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.146, eff. September 1, 2005.
Sec. 409.023. PAYMENT OF BENEFITS; ADMINISTRATIVE VIOLATION.
(a) An insurance carrier shall continue to pay benefits promptly
as and when the benefits accrue without a final decision, order,
or other action of the commissioner, except as otherwise
provided.
(b) Benefits shall be paid solely to the order of the employee
or the employee's legal beneficiary.
(c) An insurance carrier commits an administrative violation if
the insurance carrier fails to comply with this section.
(d) An insurance carrier that commits multiple violations of
this section commits an additional administrative violation and
is subject to:
(1) the sanctions provided under Section 415.023; and
(2) revocation of the right to do business under the workers'
compensation laws of this state.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.147, eff. September 1, 2005.
Sec. 409.0231. PAYMENT BY ELECTRONIC FUNDS TRANSFER. (a) An
insurance carrier shall offer employees entitled to the payment
of benefits for a period of sufficient duration the option of
receiving the payments by electronic funds transfer. The
insurance carrier shall provide the necessary forms to an
employee who requests that benefits be paid by electronic funds
transfer.
(b) The commissioner shall adopt rules in consultation with the
Texas Department of Information Resources as necessary to
implement this section, including rules prescribing a period of
benefits that is of sufficient duration to allow payment by
electronic funds transfer.
Added by Acts 1999, 76th Leg., ch. 690, Sec. 1, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.148, eff. September 1, 2005.
Sec. 409.0232. TIMELINESS OF PAYMENTS. An insurance carrier is
considered to have paid benefits in a timely manner if a payment:
(1) is made by electronic funds transfer and is deposited in the
employee's account on or before the benefit payment due date;
(2) is made by mail and is mailed in time for the payment to be
postmarked on or before the benefit payment due date; or
(3) is to be picked up by the employee and the payment is made
available to the employee during regular business hours not later
than the opening of business on the benefit payment due date.
Added by Acts 1999, 76th Leg., ch. 690, Sec. 1, eff. June 18,
1999.
Sec. 409.024. TERMINATION OR REDUCTION OF BENEFITS; NOTICE;
ADMINISTRATIVE VIOLATION. (a) An insurance carrier shall file
with the division a notice of termination or reduction of
benefits, including the reasons for the termination or reduction,
not later than the 10th day after the date on which benefits are
terminated or reduced.
(b) An insurance carrier commits an administrative violation if
the insurance carrier does not have reasonable grounds to
terminate or reduce benefits, as determined by the commissioner.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 3.149, eff. September 1, 2005.