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§102.2 Gifts, Grants, and Donations §102.3 Computation of Time §102.4 General Rules for Non-Commission Communications §102.5 General Rules for Written Communications to and from the Commission §102.7 Abbreviations §102.8 Information Requested on Written Communications to the Commission §102.9 Submission of Information Requested by the Commission §102.10 Interest, General §102.11 Electronic Formats for Electronic Claim Data Request and Report.
SUBCHAPTER A - Employee Training And Education Program §103.1 General Provisions §103.2 Employee Training and Education Program §103.3 No Effect on At-Will Status §103.100 Historically Underutilized Businesses
SUBCHAPTER B - Agency Contracts §103.101 Vendor Protest Procedures
SUBCHAPTER C - Resolution Of Contract Claims §103.300 Purpose §103.301 Applicability §103.302 Definitions §103.303 Prerequisites to Suit §103.304 Sovereign Immunity §103.305 Notice of Claim of Breach of Contract §103.306 Agency Counterclaim §103.307 Duty to Negotiate §103.308 Timetable §103.309 Conduct of Negotiation §103.310 Settlement Approval Procedures §103.311 Settlement Agreement §103.312 Costs of Negotiation §103.313 Request for Contested Case Hearing §103.314 Mediation Timetable §103.315 Mediation of Contract Disputes §103.316 Qualifications and Immunity of the Mediator §103.317 Confidentiality of Mediation and Final Settlement Agreement §103.318 Costs of Mediation §103.319 Settlement Approval Procedures §103.320 Initial Settlement Agreement §103.321 Final Settlement Agreement §103.322 Referral to the State Office of Administrative Hearings
SUBCHAPTER D - Facilities And Property Management §103.400 Fleet Vehicle Management Program
SUBCHAPTER A - Carrier Notices §110.1 Requirements for Notifying the Commission of Insurance Coverage
SUBCHAPTER B - Employer Notices §110.101 Covered and Non-Covered Employer Notices to Employees §110.108 Employer Notice Regarding Work-Related Exposure to Communicable Disease/HIV: Posting Requirements; Payment for Tests §110.110 Reporting Requirements for Building or Construction Projects for Governmental Entities
SUBCHAPTER B - Application To General Contractor/Subcontractor And Motor Carrier/Owner Operator §112.101 Agreement Regarding Workers' Compensation Insurance Coverage Between General Contractors and Subcontractors §112.102 Agreements between Motor Carriers and Owner Operators
SUBCHAPTER C - Application To Certain Building And Construction Workers §112.200 Definition of Residential Structures §112.201 Agreement To Establish Employer-Employee Relationship for Certain Building and Construction Workers §112.202 Joint Agreement To Affirm Independent Relationship for Certain Building and Construction Workers §112.203 Exception to Application of Agreement To Affirm Independent Relationship for Certain Building and Construction Workers
SUBCHAPTER D - Application To Farm Or Ranch Employees §112.301 Labor Agent's Notification of Coverage
SUBCHAPTER E - Professional Athletes Election Of Coverage §112.401 Election of Coverage by Certain Professional Athletes §112.402 Determination of Equivalent Benefits for Professional Athletes
§114.1 Purpose §114.2 Definitions §114.3 Application Form and Financial Information Requirements §114.4 Security Deposit Requirements §114.5 Excess Insurance Requirements §114.6 Safety Program Requirements §114.7 Certification Process §114.8 Refusal To Certify an Employer §114.9 Required Safety Program Inspections §114.10 Claims Contractor Requirements §114.11 Audit Program §114.12 Required Reporting §114.13 Required Notices to the Director §114.14 Impaired Employer §114.15 Revocation of Certificate of Authority To Self-Insure
§120.1 Employer's Record of Injuries §120.2 Employer's First Report of Injury and Notice of Injured Employee Rights and Responsibilities §120.3 Employer's Supplemental Report of Injury §120.4 Employer's Wage Statement
SUBCHAPTER A - Claims Procedure For Injured Employees §122.1 Notice to Employer of Injury or Occupational Disease §122.2 Injured Employee's Claim for Compensation §122.3 Exposure to Communicable Diseases: Reporting and Testing Requirements for Emergency Responders §122.4 State Employees Exposed to Human Immunodeficiency Virus (HIV): Reporting and Testing Requirements §122.5 Employee's Multiple Employment Wage Statement
SUBCHAPTER B - Claims Procedure For Beneficiaries Of Injured Employees §122.100 Claim for Death Benefits
§124.1 Notice of Injury §124.2 Carrier Reporting and Notification Requirements §124.3 Investigation of an Injury and Notice of Denial/Dispute §124.5 Mode of Payment Made by Carriers §124.7 Initial Payment of Temporary Income Benefit
§126.1 Definitions Applicable to All Benefits §126.2 Payment of Benefits to Minors §126.3 Payment of Benefits to Legally Incompetent Persons §126.4 Advance of Benefits Based on Financial Hardship §126.5 Entitlement and Procedure for Requesting Required Medical Examinations §126.6 Required Medical Examination §126.7 Designated Doctor Examinations: Requests and General Procedures §126.8 Commission Approved Doctor List §126.9 Choice of Treating Doctor and Liability for Payment §126.11 Extension of the Date of Maximum Medical Improvement for Spinal Surgery §126.12 Payment of Interest on Accrued but Unpaid Income Benefits §126.13 Employer Initiation of Benefits and Reimbursement §126.14 Treating Doctor Examination to Define the Compensable Injury
§128.1 Average Weekly Wage: General Provisions §128.2 Carrier Presumption of Employee's Average Weekly Wage §128.3 Average Weekly Wage Calculation for Full-Time Employees, and for Temporary Income Benefits for All Employees §128.4 Average Weekly Wage Calculation for Part-Time Employees §128.5 Average Weekly Wage Calculation for Seasonal Employees §128.6 Average Weekly Wage Adjustment for Certain Employees Who Are Also Minors, Apprentices, Trainees, or Students §128.7 Average Weekly Wage for School District Employees
§129.1 Definitions for Temporary Income Benefits §129.2 Entitlement to Temporary Income Benefits §129.3 Amount of Temporary Income Benefits §129.4 Adjustment of Temporary Income Benefit Amount §129.5 Work Status Reports §129.6 Bona Fide Offers of Employment §129.7 Non-Reimbursable Employer Payments §129.11 Agreement for Monthly Payment of Temporary Income Benefits
SUBCHAPTER A - Impairment Income Benefits §130.1 Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment §130.2 Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by the Treating Doctor §130.3 Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by a Doctor other than the Treating Doctor §130.4 Presumption that Maximum Medical Improvement (MMI) has been Reached and Resolution when MMI has not been Certified §130.6 Designated Doctor Examinations for Maximum Medical Improvement and/or Impairment Ratings §130.7 Acceleration of Impairment Income Benefits §130.8 Initiating Payment of Impairment Income Benefits §130.10 Commission Review of Employment Status during the Impairment Income Benefits Period §130.11 Agreement for Monthly Payment of Impairment Income Benefits §130.12 Finality of the First Certification of Maximum Medical Improvement and/or First Assignment of Impairment Rating
SUBCHAPTER B - Supplemental Income Benefits §130.100 Applicability §130.101 Definitions §130.102 Eligibility for Supplemental Income Benefits; Amount §130.103 Determination of Entitlement or Non-entitlement for the First Quarter §130.104 Determination of Entitlement or Non-entitlement for Subsequent Quarters §130.105 Failure to Timely File Application for Supplemental Income Benefits; Subsequent Quarters §130.106 Loss of Entitlement to Supplemental Income Benefits §130.107 Payment of Supplemental Income Benefits §130.108 Contesting Entitlement or Amount of Supplemental Income Benefits; Attorney Fees §130.109 Reinstatement of Entitlement If Discharged with Intent To Deprive of Supplemental Income Benefits
§131.2 Calculation of Lifetime Income Benefits §131.3 Carrier's Petition for Payment of Benefits by the Subsequent Injury Fund §131.4 Change in Payment Period; Purchase of Annuity for Lifetime Income Benefits
§132.1 Calculation of Death Benefits §132.2 Determination of Facts of Dependent Status §132.3 Eligibility of Spouse To Receive Death Benefits §132.4 Eligibility of a Child To Receive Death Benefits §132.5 Eligibility of a Grandchild To Receive Death Benefits §132.6 Eligibility of Other Surviving Dependents and Eligible Parents To Receive Death Benefits §132.7 Duration of Death Benefits for Eligible Spouse §132.8 Duration of Death Benefits for an Eligible Child §132.9 Duration of Death Benefits for an Eligible Grandchild, Eligible Dependent, and Eligible Parent §132.10 Payment of Death Benefits to the Subsequent Injury Fund §132.11 Distribution of Death Benefits §132.12 Redistribution of Death Benefits §132.13 Burial Benefits §132.14 Autopsy §132.15 Definitions §132.16 Change in Payment Periods; Purchase of Annuity for Death Benefits §132.17 Denial, Dispute, and Payment of Death Benefits
SUBCHAPTER A - General Rules For Required Reports §133.1 Applicability of Medical Billing and Processing §133.2 Definitions §133.3 Communication Between Health Care Providers and Insurance Carriers §133.4 Written Notification to Health Care Providers of Contractual Agreements for Informal and Voluntary Networks §133.5 Informal Network and Voluntary Network Reporting Requirements to the Division
SUBCHAPTER B – Health Care Provider Billing Procedures §133.10 Required Billing Forms/Formats §133.20 Medical Bill Submission by Health Care Provider
SUBCHAPTER C - Medical Bill Processing/Audit by Insurance Carrier §133.200 Insurance Carrier Receipt of Medical Bills from Health Care Providers §133.210 Medical Documentation §133.230 Insurance Carrier Audit of a Medical Bill §133.240 Medical Payments and Denials §133.250 Reconsideration for Payment of Medical Bills §133.260 Refunds §133.270 Injured Employee Reimbursement for Health Care Paid §133.280 Employer Reimbursement for Health Care Paid
SUBCHAPTER D - Dispute of Medical Bills §133.305 MDR - General §133.306 Interlocutory Orders for Medical Benefits §133.307 MDR of Fee Disputes §133.308 MDR by Independent Review Organizations §133.309 Alternate Medical Necessity Dispute Resolution by Case Review Doctor
SUBCHAPTER G - Electronic Medical Billing, Reimbursement, and Documentation §133.500 Electronic Formats for Electronic Medical Bill Processing §133.501 Electronic Medical Bill Processing
SUBCHAPTER A - Medical Reimbursement Policies §134.1 Medical Reimbursement §134.2 Incentive Payments for Workers' Compensation Underserved Areas
SUBCHAPTER B - Miscellaneous Reimbursement §134.100 Reimbursement of Treating Doctor for Attendance at Required Medical Examination §134.110 Reimbursement of Injured Employee for Travel Expenses Incurred §134.120 Reimbursement for Medical Documentation §134.130 Interest for Late Payment on Medical Bills and Refunds
SUBCHAPTER C - Medical Fee Guidelines §134.201 Medical Fee Guideline for Medical Treatments and Services Provided Under the Texas Workers' Compensation Act §134.202 Medical Fee Guideline §134.203 Medical Fee Guideline for Professional Services §134.204 Medical Fee Guideline for Workers' Compensation Specific Services §134.302 Dental Fee Guideline §134.303 2005 Dental Fee Guideline
SUBCHAPTER F - Pharmaceutical Benefits §134.500 Definitions §134.501 Initial Pharmaceutical Coverage §134.502 Pharmaceutical Services §134.503 Reimbursement Methodology §134.504 Pharmaceutical Expenses Incurred by the Injured Employee §134.506 Outpatient Drug Formulary
SUBCHAPTER G - Prospective And Concurrent Review Of Health Care §134.600 Preauthorization, Concurrent Review, and Voluntary Certification of Health Care
SUBCHAPTER I – Medical Bill Reporting §134.802 Insurance Carrier Medical Electronic Data Interchange to the Division
SUBCHAPTER J - Reviews And Audits §134.900 Medical Benefit Review and Audit
SUBCHAPTER B--Return-to-Work §137.10 Return to Work Guidelines §137.41 Purpose §137.42 Definitions §137.43 Return-to-Work Account Administrator §137.44 Return-to-Work Account for Small Employers §137.45 Employer Eligibility for Reimbursement from the Return-to-Work Account §137.46 Application for Reimbursement from the Return-to-Work Account §137.47 Criteria for Evaluation of Application §137.48 Return-to-Work Account Administrator Determinations §137.49 Optional Preauthorization Plan
§140.1 Definitions §140.2 Special Accommodations §140.3 Expedited Proceedings §140.4 Conduct and Decorum §140.5 Correction of Clerical Error §140.6 Subclaimant Status: Establishment, Right, and Procedures §140.7 Health Care Insurer Reimbursement under Labor Code §409.0091 §140.8 Procedures for Health Care Insurers to Pursue Reimbursement of Medical Benefits under Labor Code §409.0091.
§141.1 Requesting and Setting a Benefit Review Conference §141.2 Canceling or Rescheduling a Benefit Review Conference §141.3 Failure to Attend a Benefit Review Conference §141.4 Filing and Exchanging Pertinent Information §141.5 Description of the Benefit Review Conference §141.7 Division Actions After a Benefit Review Conference
§142.1 Application of the Administrative Procedure Act §142.2 Authority of the Hearing Officer §142.3 Ex Parte Communications §142.4 Delivery of Copies to All Parties §142.5 Sequence of Proceedings to Resolve Benefit Disputes §142.6 Setting a Benefit Contested Case Hearing §142.7 Statement of Disputes §142.8 Summary Procedures §142.9 Stipulations, Agreements, and Settlements §142.10 Continuance §142.11 Failure To Attend a Benefit Contested Case Hearing §142.12 Subpoena §142.13 Discovery §142.14 Permission To Use Court Reporter §142.16 Decision §142.17 Transcript or Duplicate of the Hearing Audiotape §142.18 Special Provisions for Cases on Remand from the Appeals Panel §142.19 Form Interrogatories
§143.1 Definitions §143.2 Description of the Appeal Proceeding §143.3 Requesting the Appeals Panel to Review the Decision of the Hearing Officer §143.4 Responding to a Request for Review by the Appeals Panel §143.5 Decision of the Appeals Panel
§144.1 Authority and Duties of Arbitrators §144.2 Ex Parte Communications §144.3 Delivery of Copies of Documents §144.4 Election To Engage in Arbitration §144.5 Statement of Disputes §144.6 Assignment of Arbitrator §144.7 Setting the Arbitration Proceeding §144.8 Expediting Procedures §144.9 Exchange of Evidence and Proposed Resolution §144.10 Stipulations, Agreements, and Settlements §144.11 Continuance §144.12 Failure To Attend Arbitration §144.13 Rights of Parties §144.14 Usual Order of Proceedings §144.15 Award of the Arbitrator §144.16 Requesting a Copy of the Record
§147.1 Definitions §147.2 Form §147.3 Execution §147.4 Filing Agreements with the Commission; Effective Dates §147.5 Filing Settlements with the Commission; Effective Dates §147.6 Settlement Conference §147.7 Effect on Previously Entered Decisions and Orders §147.8 Withdrawal from Settlement §147.9 Requirements for Agreements and Settlements §147.10 Commutation of Impairment Income Benefits §147.11 Notification of Commission of Proposed Judgments and Settlements
§148.1 Definitions §148.2 Scope and Applicability §148.3 Requesting a Hearing §148.4 Correction of Clerical Error in Medical Review Division Decisions or Orders Absent a Request For Hearing §148.5 Notice of Hearing §148.6 Venue §148.7 Representation §148.8 Withdrawal of Hearing Request §148.9 Informal Disposition §148.10 Hearings Subpoenas to Compel Attendance and Subpoenas Duces Tecum §148.11 Commissions to Compel Attendance for Deposition §148.12 Ex Parte Communications §148.13 Recording the Hearing §148.14 Burden of Proof §148.15 Final Decision by the ALJ §148.16 Proposal for Decision by the ALJ §148.17 Special Provisions for Administrative Penalties §148.18 Record of the Hearing §148.19 Transcript or Duplicate of the Hearing Audiotape or Videotape §148.20 Reimbursement, Travel Expenses, and Fees for Witnesses and Deponents §148.21 Expenses to be Paid by Party Seeking Judicial Review §148.22 Failure to Appear or Comply with Order or Decision, Administrative Violation §148.23 Commission Enforcement of Orders
§149.1 Definitions §149.2 General Statement §149.3 Referral of Contested Case to SOAH §149.4 Notice of Hearing §149.5 Hearings §149.6 Confidentiality of Records §149.7 Action Upon Withdrawal of Decision §149.8 Final Orders in Accordance with the Act, §§411.049, 413.031, 413.055 and 415.034 §149.9 Proposals for Decision in Accordance with the Act, §§402.072, 407.046, and 408.0231 §149.10 Custody of the Hearing Record
§150.1 Minimum Standards of Practice for an Attorney §150.2 Qualification and Authorization of Attorney To Practice Before the Commission §150.3 Representatives: Written Authorization Required
§152.1 Attorney Fees: General Provisions §152.2 Attorney Fees: Representation of Claimants §152.3 Approval or Denial of Fee by the Commission §152.4 Guidelines for Legal Services Provided to Claimants and Carriers §152.5 Allowable Expenses
§165.1 Identification and Notification of Certain Policyholders Insured by the Texas Mutual Insurance Company Acting as the Insurer of Last Resort §165.2 Safety Consultation §165.3 Formulation and Components of Accident Prevention Plan §165.4 Request for Safety Consultation From the Division §165.5 Reimbursement of Division for Services Provided to Rejected Risk Employers §165.6 Follow-up Inspection of the Policyholder's Premises by the Division §165.7 Report of Follow-Up Inspection
§166.1 Definitions of Terms §166.2 Initial Writing and Resumption of Writing of Workers' Compensation Insurance §166.3 Annual Report to the Commission §166.4 Required Accident Prevention Services §166.5 Required Periodic Inspections of Accident Prevention Services and Site of Inspection §166.6 Exchange of Information for the Inspection §166.7 Inspection of Accident Prevention Services: Conducting and Reporting §166.8 Qualification of Field Safety Representatives §166.9 Approval of Occupational Health and Safety Education Programs
SUBCHAPTER A - General Rules For Enforcement §180.1 Definitions §180.2 Referrals §180.3 Compliance Audits §180.5 Access to Workers' Compensation Related Records §180.6 Evidence of Patterns of Practice §180.7 Date Violation Deemed to Have Occurred; Establishing Willful Violations §180.8 Notices of Violation, Warning Letters, and Notices of Intent §180.10 Duration and Extent of Noncompliance §180.11 Compliance Categories §180.12 Compliance Standards and Compliance Rates §180.13 Warning Letter Criteria; Relevant Time Period §180.14 General Provisions for Penalty Calculations §180.15 Base Penalties §180.16 Review Modifiers §180.17 Audit Modifiers §180.18 Applicability §180.19 Incentives
SUBCHAPTER B - Medical Benefit Regulation §180.20 Commission Approved Doctor List §180.21 Division Designated Doctor List §180.22 Health Care Provider Roles and Responsibilities §180.23 Commission Required Training for Doctors/Certificate of Registration Levels §180.24 Financial Disclosure §180.25 Improper Inducements, Influence and Threats §180.26 Doctor and Insurance Carrier Sanctions §180.27 Sanctions Process/Appeals/Restoration/Reinstatement §180.28 Peer Review Requirements, Reporting, and Sanction
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