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Texas Labor Code - Section 409.021. Initiation Of Benefits; Insurance Carrier's Refusal; Administrative Violation

Legal Research Home > Texas Lawyer > Labor Code > Texas Labor Code - Section 409.021. Initiation Of Benefits; Insurance Carrier's Refusal; Administrative Violation

§ 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, § 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, § 
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.
	(g)  to (i) Blank.                                                             
	(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, § 1, eff. Sept. 1, 1993.  
Amended by Acts 2003, 78th Leg., ch. 939, § 1, eff. Sept. 1, 
2003;  Acts 2003, 78th Leg., ch. 1100, § 1, eff. Sept. 1, 2003;  
Acts 2005, 79th Leg., ch. 265, § 3.145, eff. Sept. 1, 2005.

Last modified: August 10, 2007