CHAPTER 409. COMPENSATION PROCEDURES - Texas Statutes

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.