SUBCHAPTER A GENERAL PROVISIONS
- Texas Section 408.001 - Exclusive Remedy; Exemplary Damages
(a) Recovery of workers' compensation benefits is the exclusive remedy of an employee covered by workers' compensation insurance coverage or a legal beneficiary against the...
- Texas Section 408.002 - Survival Of Cause Of Action
A right of action survives in a case based on a compensable injury that results in the employee's death. Acts 1993, 73rd Leg., ch. 269,...
- Texas Section 408.003 - Reimbursable Employer Payments; Salary Continuation; Offset Against Income Benefits; Limits
(a) After an injury, an employer may: (1) initiate benefit payments, including medical benefits; or (2) on the written request or agreement of the employee,...
- Texas Section 408.004 - Required Medical Examinations; Administrative Violation
(a) The commissioner may require an employee to submit to medical examinations to resolve any question about the appropriateness of the health care received by...
- Texas Section 408.0041 - Designated Doctor Examination
(a) At the request of an insurance carrier or an employee, or on the commissioner's own order, the commissioner may order a medical examination to...
- Texas Section 408.0042 - Medical Examination By Treating Doctor To Define Compensable Injury
(a) The division shall require an injured employee to submit to a single medical examination to define the compensable injury on request by the insurance...
- Texas Section 408.0043 - Professional Specialty Certification Required For Certain Review
(a) This section applies to a person, other than a chiropractor or a dentist, who performs health care services under this title as: (1) a...
- Texas Section 408.0044 - Review Of Dental Services
(a) This section applies to a dentist who performs dental services under this title as: (1) a doctor performing peer review of dental services; (2)...
- Texas Section 408.0045 - Review Of Chiropractic Services
(a) This section applies to a chiropractor who performs chiropractic services under this title as: (1) a doctor performing peer review of chiropractic services; (2)...
- Texas Section 408.0046 - Rules
The commissioner may adopt rules as necessary to determine which professional health practitioner specialties are appropriate for treatment of certain compensable injuries. The rules adopted...
- Texas Section 408.005 - Settlements And Agreements
(a) A settlement may not provide for payment of benefits in a lump sum except as provided by Section 408.128. (b) An employee's right to...
- Texas Section 408.006 - Mental Trauma Injuries
(a) It is the express intent of the legislature that nothing in this subtitle shall be construed to limit or expand recovery in cases of...
- Texas Section 408.007 - Date Of Injury For Occupational Disease
For purposes of this subtitle, the date of injury for an occupational disease is the date on which the employee knew or should have known...
SUBCHAPTER B MEDICAL BENEFITS
- Texas Section 408.008 - Compensability Of Heart Attacks
A heart attack is a compensable injury under this subtitle only if: (1) the attack can be identified as: (A) occurring at a definite time...
- Texas Section 408.021 - Entitlement To Medical Benefits
(a) An employee who sustains a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when...
- Texas Section 408.022 - Selection Of Doctor
(a) Except in an emergency, the division shall require an employee to receive medical treatment from a doctor chosen from a list of doctors approved...
- Texas Section 408.0221 - Request For Description Of Employment
(a) This section applies only to an employee of an employer who has 10 or more employees. (b) To facilitate an injured employee's return to...
- Texas Section 408.023 - List Of Approved Doctors; Duties Of Treating Doctors
(a) The division shall develop a list of doctors licensed in this state who are approved to provide health care services under this subtitle. A...
- Texas Section 408.0231 - Maintenance Of List Of Approved Doctors; Sanctions And Privileges Relating To Health Care
(a) The commissioner shall delete from the list of approved doctors a doctor: (1) who fails to register with the division as provided by this...
- Texas Section 408.024 - Noncompliance With Selection Requirements
Except as otherwise provided, and after notice and an opportunity for hearing, the commissioner may relieve an insurance carrier of liability for health care that...
- Texas Section 408.025 - Reports And Records Required From Health Care Providers
(a) The commissioner by rule shall adopt requirements for reports and records that are required to be filed with the division or provided to the...
- Texas Section 408.0251 - Electronic Billing Requirements
(a) The commissioner, by rule and in cooperation with the commissioner of insurance, shall adopt rules regarding the electronic submission and processing of medical bills...
- Texas Section 408.0252 - Underserved Areas
The commissioner by rule may identify areas of this state in which access to health care providers is less available and may adopt appropriate standards,...
- Texas Section 408.026 - Spinal Surgery
Except in a medical emergency, an insurance carrier is liable for medical costs related to spinal surgery only as provided by Section 413.014 and commissioner...
- Texas Section 408.027 - Payment Of Health Care Provider
(a) A health care provider shall submit a claim for payment to the insurance carrier not later than the 95th day after the date on...
- Texas Section 408.0271 - Reimbursement By Health Care Provider
(a) If the health care services provided to an injured employee are determined by the insurance carrier to be inappropriate, the insurance carrier shall: (1)...
- Texas Section 408.0272 - Certain Exceptions For Untimely Submission Of Claim
(a) In this section: (1) "Group accident and health insurance" has the meaning assigned by Chapter 1251, Insurance Code. (2) "Health maintenance organization" has the...
- Texas Section 408.028 - Pharmaceutical Services
(a) A physician providing care to an employee under this subchapter shall prescribe for the employee any necessary prescription drugs, and order over-the-counter alternatives to...
- Texas Section 408.0281 - Reimbursement For Pharmaceutical Services; Administrative Violation
(a) In this section: (1) "Informal network" means a network that: (A) is established under a contract between an insurance carrier or an insurance carrier's...
- Texas Section 408.0282 - Requirements For Certain Informal Or Voluntary Networks
(a) Each informal or voluntary network described by Section 408.0281 or 408.0284 shall, not later than the 30th day after the date the network is...
- Texas Section 408.0284 - Reimbursement For Durable Medical Equipment And Home Health Care Services; Administrative Violation
(a) In this section: (1) "Durable medical equipment" includes prosthetics and orthotic devices and related medical equipment and supplies. The term does not include: (A)...
- Texas Section 408.029 - Nurse First Assistant Services
An insurance carrier may not refuse to reimburse a health care practitioner solely because that practitioner is a nurse first assistant, as defined by Section...
- Texas Section 408.030 - Reports Of Physician Violations
If the division discovers an act or omission by a physician that may constitute a felony, a misdemeanor involving moral turpitude, a violation of a...
- Texas Section 408.031 - Workers' Compensation Health Care Networks
(a) Notwithstanding any other provision of this chapter, an injured employee may receive benefits under a workers' compensation health care network established under Chapter 1305,...
SUBCHAPTER C COMPUTATION OF AVERAGE WEEKLY WAGE
- Texas Section 408.032 - Study On Interdisciplinary Pain Rehabilitation Program And Facility Accreditation Requirement
The division shall study the issue of required accreditation of interdisciplinary pain rehabilitation programs or interdisciplinary pain rehabilitation treatment facilities that provide services to injured...
- Texas Section 408.041 - Average Weekly Wage
(a) Except as otherwise provided by this subtitle, the average weekly wage of an employee who has worked for the employer for at least the...
- Texas Section 408.042 - Average Weekly Wage For Part-time Employee Or Employee With Multiple Employment
(a) The average weekly wage of a part-time employee who limits the employee's work to less than a full-time workweek as a regular course of...
- Texas Section 408.043 - Average Weekly Wage For Seasonal Employee
(a) For determining the amount of temporary income benefits of a seasonal employee, the average weekly wage of the employee is computed as provided by...
- Texas Section 408.044 - Average Weekly Wage For Minor, Apprentice, Trainee, Or Student
(a) For computing impairment income benefits, supplemental income benefits, lifetime income benefits, or death benefits, the average weekly wage of an employee shall be adjusted...
- Texas Section 408.0445 - Average Weekly Wage For Members Of State Military Forces And Texas Task Force 1
(a) For purposes of computing income benefits or death benefits under Section 437.227, Government Code, the average weekly wage of a member of the state...
- Texas Section 408.0446 - Average Weekly Wage; School District Employee
(a) For determining the amount of temporary income benefits of a school district employee under Chapter 504, the average weekly wage is computed on the...
- Texas Section 408.045 - Nonpecuniary Wages
The division may not include nonpecuniary wages in computing an employee's average weekly wage during a period in which the employer continues to provide the...
- Texas Section 408.046 - Similar Employees, Services, Or Employment
For purposes of this subchapter and Subchapter D, the determination as to whether employees, services, or employment are the same or similar must include consideration...
SUBCHAPTER D COMPUTATION OF BENEFITS
- Texas Section 408.047 - State Average Weekly Wage
(a) On and after October 1, 2006, the state average weekly wage is equal to 88 percent of the average weekly wage in covered employment...
- Texas Section 408.061 - Maximum Weekly Benefit
(a) A weekly temporary income benefit may not exceed 100 percent of the state average weekly wage under Section 408.047 rounded to the nearest whole...
- Texas Section 408.062 - Minimum Weekly Income Benefit
(a) The minimum weekly income benefit is 15 percent of the state average weekly wage as determined under Section 408.047, rounded to the nearest whole...
- Texas Section 408.063 - Wage Presumptions; Administrative Violation
(a) To expedite the payment of income benefits, the commissioner may by rule establish reasonable presumptions relating to the wages earned by an employee, including...
SUBCHAPTER E INCOME BENEFITS IN GENERAL
- Texas Section 408.064 - Interest On Accrued Benefits
(a) An order to pay income or death benefits accrued but unpaid must include interest on the amount of compensation due at the rate provided...
- Texas Section 408.081 - Income Benefits
(a) An employee is entitled to timely and accurate income benefits as provided in this chapter. (b) Except as otherwise provided by this section or...
- Texas Section 408.0815 - Resolution Of Overpayment Or Underpayment Of Income Benefits
(a) The commissioner by rule shall establish a procedure by which an insurance carrier: (1) may recoup an overpayment of income benefits from future income...
- Texas Section 408.082 - Accrual Of Right To Income Benefits
(a) Income benefits may not be paid under this subtitle for an injury that does not result in disability for at least one week. (b)...
- Texas Section 408.083 - Termination Of Right To Temporary Income, Impairment Income, And Supplemental Income Benefits
(a) Except as provided by Subsection (b), an employee's eligibility for temporary income benefits, impairment income benefits, and supplemental income benefits terminates on the expiration...
- Texas Section 408.084 - Contributing Injury
(a) At the request of the insurance carrier, the commissioner may order that impairment income benefits and supplemental income benefits be reduced in a proportion...
- Texas Section 408.085 - Advance Of Benefits For Hardship
(a) If there is a likelihood that income benefits will be paid, the commissioner may grant an employee suffering financial hardship advances as provided by...
SUBCHAPTER F TEMPORARY INCOME BENEFITS
- Texas Section 408.086 - Division Determination Of Extended Unemployment Or Underemployment
(a) During the period that impairment income benefits or supplemental income benefits are being paid to an employee, the commissioner shall determine at least annually...
- Texas Section 408.101 - Temporary Income Benefits
(a) An employee is entitled to temporary income benefits if the employee has a disability and has not attained maximum medical improvement. (b) On the...
- Texas Section 408.102 - Duration Of Temporary Income Benefits
(a) Temporary income benefits continue until the employee reaches maximum medical improvement. (b) The commissioner by rule shall establish a presumption that maximum medical improvement...
- Texas Section 408.103 - Amount Of Temporary Income Benefits
(a) Subject to Sections 408.061 and 408.062, the amount of a temporary income benefit is equal to: (1) 70 percent of the amount computed by...
- Texas Section 408.104 - Maximum Medical Improvement After Spinal Surgery
(a) On application by either the employee or the insurance carrier, the commissioner by order may extend the 104-week period described by Section 401.011(30)(B) if...
SUBCHAPTER G IMPAIRMENT INCOME BENEFITS
- Texas Section 408.105 - Salary Continuation In Lieu Of Temporary Income Benefits
(a) In lieu of payment of temporary income benefits under this subchapter, an employer may continue to pay the salary of an employee who sustains...
- Texas Section 408.121 - Impairment Income Benefits
(a) An employee's entitlement to impairment income benefits begins on the day after the date the employee reaches maximum medical improvement and ends on the...
- Texas Section 408.122 - Eligibility For Impairment Income Benefits
A claimant may not recover impairment income benefits unless evidence of impairment based on an objective clinical or laboratory finding exists. If the finding of...
- Texas Section 408.1225 - Designated Doctor
(a) To be eligible to serve as a designated doctor, a doctor must maintain an active certification by the division. (a-1) The commissioner by rule...
- Texas Section 408.123 - Certification Of Maximum Medical Improvement; Evaluation Of Impairment Rating
(a) After an employee has been certified by a doctor as having reached maximum medical improvement, the certifying doctor shall evaluate the condition of the...
- Texas Section 408.124 - Impairment Rating Guidelines
(a) An award of an impairment income benefit, whether by the commissioner or a court, must be based on an impairment rating determined using the...
- Texas Section 408.125 - Dispute As To Impairment Rating
(a) If an impairment rating is disputed, the commissioner shall direct the employee to the next available doctor on the division's list of designated doctors,...
- Texas Section 408.126 - Amount Of Impairment Income Benefits
Subject to Sections 408.061 and 408.062, an impairment income benefit is equal to 70 percent of the employee's average weekly wage. Acts 1993, 73rd Leg.,...
- Texas Section 408.127 - Reduction Of Impairment Income Benefits
(a) An insurance carrier shall reduce impairment income benefits to an employee by an amount equal to employer payments made under Section 408.003 that are...
- Texas Section 408.128 - Commutation Of Impairment Income Benefits
(a) An employee may elect to commute the remainder of the impairment income benefits to which the employee is entitled if the employee has returned...
SUBCHAPTER H SUPPLEMENTAL INCOME BENEFITS
- Texas Section 408.129 - Acceleration Of Impairment Income Benefits
(a) On approval by the commissioner of a written request received from an employee, an insurance carrier shall accelerate the payment of impairment income benefits...
- Texas Section 408.141 - Award Of Supplemental Income Benefits
An award of a supplemental income benefit, whether by the commissioner or a court, shall be made in accordance with this subchapter. Acts 1993, 73rd...
- Texas Section 408.1415 - Work Search Compliance Standards
(a) The commissioner by rule shall adopt compliance standards for supplemental income benefit recipients that require each recipient to demonstrate an active effort to obtain...
- Texas Section 408.142 - Supplemental Income Benefits
(a) An employee is entitled to supplemental income benefits if on the expiration of the impairment income benefit period computed under Section 408.121(a)(1) the employee:...
- Texas Section 408.143 - Employee Statement
(a) After the commissioner's initial determination of supplemental income benefits, the employee must file a statement with the insurance carrier stating: (1) that the employee...
- Texas Section 408.144 - Computation Of Supplemental Income Benefits
(a) Supplemental income benefits are calculated quarterly and paid monthly. (b) Subject to Section 408.061, the amount of a supplemental income benefit for a week...
- Texas Section 408.145 - Payment Of Supplemental Income Benefits
An insurance carrier shall pay supplemental income benefits beginning not later than the seventh day after the expiration date of the employee's impairment income benefit...
- Texas Section 408.146 - Termination Of Supplemental Income Benefits; Reinitiation
(a) If an employee earns wages that are at least 80 percent of the employee's average weekly wage for at least 90 days during a...
- Texas Section 408.147 - Contest Of Supplemental Income Benefits By Insurance Carrier; Attorney's Fees
(a) An insurance carrier may request a benefit review conference to contest an employee's entitlement to supplemental income benefits or the amount of supplemental income...
- Texas Section 408.148 - Employee Discharge After Termination
The commissioner may reinstate supplemental income benefits to an employee who is discharged within 12 months of the date of losing entitlement to supplemental income...
- Texas Section 408.149 - Status Review; Benefit Review Conference
(a) Not more than once in each period of 12 calendar months, an employee and an insurance carrier each may request the commissioner to review...
- Texas Section 408.150 - Vocational Rehabilitation
(a) The division shall refer an employee to the Department of Assistive and Rehabilitative Services with a recommendation for appropriate services if the division determines...
SUBCHAPTER I LIFETIME INCOME BENEFITS
- Texas Section 408.151 - Medical Examinations For Supplemental Income Benefits
(a) On or after the second anniversary of the date the commissioner makes the initial award of supplemental income benefits, an insurance carrier may not...
- Texas Section 408.161 - Lifetime Income Benefits
(a) Lifetime income benefits are paid until the death of the employee for: (1) total and permanent loss of sight in both eyes; (2) loss...
SUBCHAPTER J DEATH AND BURIAL BENEFITS
- Texas Section 408.162 - Subsequent Injury Fund Benefits
(a) If a subsequent compensable injury, with the effects of a previous injury, results in a condition for which the injured employee is entitled to...
- Texas Section 408.181 - Death Benefits
(a) An insurance carrier shall pay death benefits to the legal beneficiary if a compensable injury to the employee results in death. (b) Subject to...
- Texas Section 408.182 - Distribution Of Death Benefits
(a) If there is an eligible child or grandchild and an eligible spouse, half of the death benefits shall be paid to the eligible spouse...
- Texas Section 408.183 - Duration Of Death Benefits
(a) Entitlement to death benefits begins on the day after the date of an employee's death. (b) An eligible spouse is entitled to receive death...
- Texas Section 408.184 - Redistribution Of Death Benefits
(a) If a legal beneficiary dies or otherwise becomes ineligible for death benefits, benefits shall be redistributed to the remaining legal beneficiaries as provided by...
- Texas Section 408.185 - Effect Of Beneficiary Dispute; Attorney's Fees
On settlement of a case in which the insurance carrier admits liability for death benefits but a dispute exists as to the proper beneficiary or...
- Texas Section 408.186 - Burial Benefits
(a) If the death of an employee results from a compensable injury, the insurance carrier shall pay to the person who incurred liability for the...
SUBCHAPTER K PROTECTION OF RIGHTS TO BENEFITS
- Texas Section 408.187 - Autopsy
(a) If in a claim for death benefits based on an occupational disease an autopsy is necessary to determine the cause of death, the commission...
- Texas Section 408.201 - Benefits Exempt From Legal Process
Benefits are exempt from: (1) garnishment; (2) attachment; (3) judgment; and (4) other actions or claims. Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff....
- Texas Section 408.202 - Assignability Of Benefits
Benefits are not assignable, except a legal beneficiary may, with the commissioner's approval, assign the right to death benefits. Acts 1993, 73rd Leg., ch. 269,...
SUBCHAPTER L ATTORNEY'S FEES IN WORKERS' COMPENSATION BENEFIT MATTERS
- Texas Section 408.203 - Allowable Liens
(a) An income or death benefit is subject only to the following lien or claim, to the extent the benefit is unpaid on the date...
- Texas Section 408.221 - Attorney's Fees Paid To Claimant's Counsel
(a) An attorney's fee, including a contingency fee, for representing a claimant before the division or court under this subtitle must be approved by the...
- Texas Section 408.222 - Attorney's Fees Paid To Defense Counsel
(a) The amount of an attorney's fee for defending an insurance carrier in a workers' compensation action brought under this subtitle must be approved by...