Texas Labor Code - Section 401.011. General Definitions
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§ 401.011. GENERAL DEFINITIONS. In this subtitle:
(1) "Adjuster" means a person licensed under Chapter
4101, Insurance Code.
(2) "Administrative violation" means a violation of
this subtitle, a rule adopted under this subtitle, or an order or
decision of the commissioner that is subject to penalties and
sanctions as provided by this subtitle.
(3) "Agreement" means the resolution by the parties to
a dispute under this subtitle of one or more issues regarding an
injury, death, coverage, compensability, or compensation. The term
does not include a settlement.
(4) "Alien" means a person who is not a citizen of the
United States.
(5) "Benefit" means a medical benefit, an income
benefit, a death benefit, or a burial benefit based on a compensable
injury.
(5-a) "Case management" means a collaborative process
of assessment, planning, facilitation, and advocacy for options and
services to meet an individual's health needs through communication
and application of available resources to promote quality,
cost-effective outcomes.
(6) "Certified self-insurer" means a private employer
granted a certificate of authority to self-insure, as authorized by
this subtitle, for the payment of compensation.
(7) "Child" means a son or daughter. The term includes
an adopted child or a stepchild who is a dependent of the employee.
(8) "Commissioner" means the commissioner of workers'
compensation.
(9) "Commute" means to pay in a lump sum.
(10) "Compensable injury" means an injury that arises
out of and in the course and scope of employment for which
compensation is payable under this subtitle.
(11) "Compensation" means payment of a benefit.
(12) "Course and scope of employment" means an
activity of any kind or character that has to do with and originates
in the work, business, trade, or profession of the employer and that
is performed by an employee while engaged in or about the
furtherance of the affairs or business of the employer. The term
includes an activity conducted on the premises of the employer or at
other locations. The term does not include:
(A) transportation to and from the place of
employment unless:
(i) the transportation is furnished as a
part of the contract of employment or is paid for by the employer;
(ii) the means of the transportation are
under the control of the employer; or
(iii) the employee is directed in the
employee's employment to proceed from one place to another place;
or
(B) travel by the employee in the furtherance of
the affairs or business of the employer if the travel is also in
furtherance of personal or private affairs of the employee unless:
(i) the travel to the place of occurrence of
the injury would have been made even had there been no personal or
private affairs of the employee to be furthered by the travel; and
(ii) the travel would not have been made had
there been no affairs or business of the employer to be furthered by
the travel.
(13) "Death benefit" means a payment made under this
subtitle to a legal beneficiary because of the death of an employee.
(13-a) "Department" means the Texas Department of
Insurance.
(14) "Dependent" means an individual who receives a
regular or recurring economic benefit that contributes
substantially to the individual's welfare and livelihood if the
individual is eligible for distribution of benefits under Chapter
408.
(15) "Designated doctor" means a doctor appointed by
mutual agreement of the parties or by the division to recommend a
resolution of a dispute as to the medical condition of an injured
employee.
(16) "Disability" means the inability because of a
compensable injury to obtain and retain employment at wages
equivalent to the preinjury wage.
(16-a) "Division" means the division of workers'
compensation of the department.
(17) "Doctor" means a doctor of medicine, osteopathic
medicine, optometry, dentistry, podiatry, or chiropractic who is
licensed and authorized to practice.
(18) "Employer" means, unless otherwise specified, a
person who makes a contract of hire, employs one or more employees,
and has workers' compensation insurance coverage. The term
includes a governmental entity that self-insures, either
individually or collectively.
(18-a) "Evidence-based medicine" means the use of
current best quality scientific and medical evidence formulated
from credible scientific studies, including peer-reviewed medical
literature and other current scientifically based texts, and
treatment and practice guidelines in making decisions about the
care of individual patients.
(19) "Health care" includes all reasonable and
necessary medical aid, medical examinations, medical treatments,
medical diagnoses, medical evaluations, and medical services. The
term does not include vocational rehabilitation. The term
includes:
(A) medical, surgical, chiropractic, podiatric,
optometric, dental, nursing, and physical therapy services
provided by or at the direction of a doctor;
(B) physical rehabilitation services performed
by a licensed occupational therapist provided by or at the
direction of a doctor;
(C) psychological services prescribed by a
doctor;
(D) the services of a hospital or other health
care facility;
(E) a prescription drug, medicine, or other
remedy; and
(F) a medical or surgical supply, appliance,
brace, artificial member, or prosthesis, including training in the
use of the appliance, brace, member, or prosthesis.
(20) "Health care facility" means a hospital,
emergency clinic, outpatient clinic, or other facility providing
health care.
(21) "Health care practitioner" means:
(A) an individual who is licensed to provide or
render and provides or renders health care; or
(B) a nonlicensed individual who provides or
renders health care under the direction or supervision of a doctor.
(22) "Health care provider" means a health care
facility or health care practitioner.
(22-a) "Health care reasonably required" means health
care that is clinically appropriate and considered effective for
the injured employee's injury and provided in accordance with best
practices consistent with:
(A) evidence-based medicine; or
(B) if that evidence is not available, generally
accepted standards of medical practice recognized in the medical
community.
(23) "Impairment" means any anatomic or functional
abnormality or loss existing after maximum medical improvement that
results from a compensable injury and is reasonably presumed to be
permanent.
(24) "Impairment rating" means the percentage of
permanent impairment of the whole body resulting from a compensable
injury.
(25) "Income benefit" means a payment made to an
employee for a compensable injury. The term does not include a
medical benefit, death benefit, or burial benefit.
(26) "Injury" means damage or harm to the physical
structure of the body and a disease or infection naturally
resulting from the damage or harm. The term includes an
occupational disease.
(27) "Insurance carrier" means:
(A) an insurance company;
(B) a certified self-insurer for workers'
compensation insurance;
(C) a certified self-insurance group under
Chapter 407A; or
(D) a governmental entity that self-insures,
either individually or collectively.
(28) "Insurance company" means a person authorized and
admitted by the Texas Department of Insurance to do insurance
business in this state under a certificate of authority that
includes authorization to write workers' compensation insurance.
(29) "Legal beneficiary" means a person entitled to
receive a death benefit under this subtitle.
(30) "Maximum medical improvement" means the earlier
of:
(A) the earliest date after which, based on
reasonable medical probability, further material recovery from or
lasting improvement to an injury can no longer reasonably be
anticipated;
(B) the expiration of 104 weeks from the date on
which income benefits begin to accrue; or
(C) the date determined as provided by Section
408.104.
(31) "Medical benefit" means payment for health care
reasonably required by the nature of a compensable injury and
intended to:
(A) cure or relieve the effects naturally
resulting from the compensable injury, including reasonable
expenses incurred by the employee for necessary treatment to cure
and relieve the employee from the effects of an occupational
disease before and after the employee knew or should have known the
nature of the disability and its relationship to the employment;
(B) promote recovery; or
(C) enhance the ability of the employee to return
to or retain employment.
(31-a) "Network" or "workers' compensation health care
network" means an organization that is:
(A) formed as a health care provider network to
provide health care services to injured employees;
(B) certified in accordance with Chapter 1305,
Insurance Code, and rules of the commissioner of insurance; and
(C) established by, or operates under contract
with, an insurance carrier.
(32) "Objective" means independently verifiable or
confirmable results that are based on recognized laboratory or
diagnostic tests, or signs confirmable by physical examination.
(33) "Objective clinical or laboratory finding" means
a medical finding of impairment resulting from a compensable
injury, based on competent objective medical evidence, that is
independently confirmable by a doctor, including a designated
doctor, without reliance on the subjective symptoms perceived by
the employee.
(34) "Occupational disease" means a disease arising
out of and in the course of employment that causes damage or harm to
the physical structure of the body, including a repetitive trauma
injury. The term includes a disease or infection that naturally
results from the work-related disease. The term does not include an
ordinary disease of life to which the general public is exposed
outside of employment, unless that disease is an incident to a
compensable injury or occupational disease.
(35) "Penalty" means a fine established by this
subtitle.
(36) "Repetitive trauma injury" means damage or harm
to the physical structure of the body occurring as the result of
repetitious, physically traumatic activities that occur over time
and arise out of and in the course and scope of employment.
(37) "Representative" means a person, including an
attorney, authorized by the commissioner to assist or represent an
employee, a person claiming a death benefit, or an insurance
carrier in a matter arising under this subtitle that relates to the
payment of compensation.
(38) "Research center" means the research functions of
the Texas Department of Insurance required under Chapter 405.
(39) "Sanction" means a penalty or other punitive
action or remedy imposed by the commissioner on an insurance
carrier, representative, employee, employer, or health care
provider for an act or omission in violation of this subtitle or a
rule, order, or decision of the commissioner.
(40) "Settlement" means a final resolution of all the
issues in a workers' compensation claim that are permitted to be
resolved under the terms of this subtitle.
(41) "Subjective" means perceivable only by an
employee and not independently verifiable or confirmable by
recognized laboratory or diagnostic tests or signs observable by
physical examination.
(42) "Treating doctor" means the doctor who is
primarily responsible for the employee's health care for an injury.
(42-a) "Violation" means an administrative violation
subject to penalties and sanctions as provided by this subtitle.
(43) "Wages" includes all forms of remuneration
payable for a given period to an employee for personal services.
The term includes the market value of board, lodging, laundry,
fuel, and any other advantage that can be estimated in money that
the employee receives from the employer as part of the employee's
remuneration.
(44) "Workers' compensation insurance coverage"
means:
(A) an approved insurance policy to secure the
payment of compensation;
(B) coverage to secure the payment of
compensation through self-insurance as provided by this subtitle;
or
(C) coverage provided by a governmental entity to
secure the payment of compensation.
Acts 1993, 73rd Leg., ch. 269, § 1, eff. Sept. 1, 1993. Amended
by Acts 1997, 75th Leg., ch. 1443, § 1, eff. Sept. 1, 1997; Acts
2003, 78th Leg., ch. 275, § 2, eff. Sept. 1, 2003; Acts 2005,
79th Leg., ch. 265, § 3.003, eff. Sept. 1, 2005; Acts 2005, 79th
Leg., ch. 728, § 11.131, eff. Sept. 1, 2005.
Section: 311.001 311.002 311.003 311.004 311.005 401.001 401.003 401.011 401.012 401.013 401.021 401.022 401.023 401.024 401.025
Last modified: August 10, 2007
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