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Title 28 - Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION

Chapter 41 - PRACTICE AND PROCEDURE

Subchapter A - COMMUNICATIONS

41.1 - Name Change
41.5 - Compliance and Suspension of Rules
41.8 - Contents of Rule-making Petitions
41.10 - Definitions
41.15 - Social Security Number
41.20 - Adjuster Identification
41.25 - Attorney Identification
41.27 - Employer's Identification
41.30 - Self-insureds
41.35 - Designation of Insurance Carriers' Austin Representative
41.40 - General Policy Concerning Communications
41.45 - Communication to Claimants
41.55 - Communication to Employers
41.60 - Communication to Insurance Carriers
41.65 - Communication to Health Care Provider
41.70 - Filing of Instruments
41.75 - Timely Filing
41.80 - Filing Subsequent to Final Order or Award
41.85 - Translation of Documents
41.90 - Responsibility of Translators
41.95 - Wage Information

Chapter 42 - MEDICAL BENEFITS

Subchapter A - GENERAL MEDICAL PROVISIONS

42.5 - Applicability and Scope of Rules
42.10 - Acceptance of Rules and Guidelines
42.15 - Definitions
42.20 - Who May Treat
42.25 - Prohibited Practices
42.28 - Confirmation of Coverage
42.30 - Written Communications
42.33 - Health Care Providers' Reporting Requirements
42.35 - Required Reports: First Report
42.40 - Required Reports: Subsequent Reports
42.55 - Required Reports: Change of Status Reports
42.60 - Required Reports: Special Reports
42.65 - Changing Treating Doctors
42.75 - Excess Recovery from Third Party Actions
42.78 - Reports To Be Filed by the Carrier
42.80 - Assignment of Medical Benefits
42.85 - Voluntary Arbitration
42.90 - Demand for Surgical Operation
42.95 - Scars and Deformities

Subchapter B - MEDICAL COST EVALUATION

42.101 - Purpose
42.105 - Medical Fee Guideline
42.115 - Pharmaceutical Fee Guideline
42.135 - Liability for Covered Health Care
42.137 - Utilization Review
42.140 - Amount of Payment
42.145 - Billing
42.155 - Carrier Review of Bills
42.160 - Carrier Desk Audit of Bills
42.165 - Carrier On-Site Audit of Hospital Bills
42.175 - Miscellaneous Covered Services

Subchapter D - DISPUTE RESOLUTION

42.305 - Requesting Dispute Review and Resolution
42.307 - Procedure for Requesting Dispute Review
42.308 - Procedure for Responding to a Request for Dispute Review
42.309 - Payment for the Review
42.310 - Board Review and Resolution
42.315 - Appeal

Chapter 43 - INSURANCE COVERAGE

43.5 - Notice That Employer Has Become Subscriber
43.10 - Termination of Coverage

Chapter 45 - EMPLOYER'S REPORT OF INJURY OR DISEASE

45.5 - Forms
45.10 - Employer's Report of Injury and Disease
45.13 - Wage Statement
45.20 - Board Request for Additional Information
45.25 - Employer's Supplemental Report of Injury
45.30 - Sanctions

Chapter 47 - EMPLOYEE NOTICE OF INJURY OR DEATH AND CLAIM FOR BENEFITS

47.5 - Information Constituting Claim
47.10 - Signature of Claimant
47.15 - Employer Advances Compensation
47.20 - Beneficiaries Filing Claim

Chapter 49 - PROCEDURES FOR FORMAL HEARINGS BY THE BOARD

Subchapter A - FORMAL HEARINGS

49.5 - Schedule of Hearings
49.10 - Timely Acceptance of Evidence
49.15 - Formal Statement of Position
49.20 - Request for Cancellation
49.25 - Delay or Postponement of Hearing
49.30 - Filing of Medical Bills
49.35 - Filing of Medical Reports and Records
49.40 - Carrier Attendance
49.45 - Contents of Formal Statement of Position
49.50 - Sanctions

Subchapter B - SPECIAL FORMAL AND OTHER INVESTIGATIVE HEARINGS

49.105 - Procedures
49.110 - Commencement of Hearings
49.115 - Notice
49.120 - Special Statutory Notice
49.125 - Notice of Special Formal Hearing
49.130 - Personal Appearance Hearings in Austin
49.131 - Withdrawal of Attorney
49.135 - Use of Court Reporters
49.140 - Continuance
49.145 - Recess
49.150 - Complaint Specifications
49.155 - Documentary Evidence
49.160 - Filing of Formal Statement of Position
49.165 - Subpoenas and Subpoenas Duces Tecum

Chapter 51 - AWARD OF THE BOARD

51.10 - Joint Payment of Award
51.15 - Periodic Installments
51.20 - Lump Sum Payment
51.25 - Request for Review
51.30 - Review of Award
51.50 - Payments of Attorney's Fees
51.65 - Attorney Fees

Chapter 53 - CARRIER'S REPORT OF INITIATION AND SUSPENSION OF COMPENSATION PAYMENTS

53.5 - Payment of Benefits Without Prejudice
53.10 - Written Notice of Injury Defined
53.15 - Board Notice to Carrier of Injury
53.20 - Notice of Initiation of Compensation; Mode of Payment of Compensation
53.22 - Application To Change the Benefits Payment Period
53.25 - Contents of Statement of Controversion or Statement of Position
53.30 - Filing of Wage Statement
53.35 - Notice of Suspension of Compensation
53.40 - Transmittal Letters
53.45 - Maximum Payment to Minor
53.48 - Payment of Partial Benefits for General Injuries
53.50 - Resumption of Compensation
53.55 - Payment for Amputation
53.60 - Application for Suspension of Compensation
53.63 - Suspension of Weekly Compensation
53.64 - Nonpayment of Compensation Based on Another Carrier's Liability
53.65 - Certification Procedure

Chapter 55 - LUMP SUM PAYMENTS

55.3 - Request for Advance Payment of Compensation
55.5 - Lump Sum Payments
55.10 - Settlements Final When Approved
55.15 - Compromise Settlement Agreements
55.20 - Execution of Compromise Settlement Agreement
55.25 - Loss of an Eye
55.30 - Hearing Impairment
55.35 - Stipulation of Medical Payments
55.40 - Attorney's Signature
55.45 - Percent of Medical Impairment
55.50 - Attorneys Fees and Expenses
55.55 - Compromise Settlement Agreement To Set Aside Award
55.60 - Consent Withdrawn
55.65 - Withdrawal of Consent by Death
55.75 - Tender Payment Time Period
55.80 - Waiving of Approval Appearance

Chapter 56 - STRUCTURED COMPROMISE SETTLEMENT AGREEMENTS

56.5 - Definitions
56.10 - Form
56.15 - Execution
56.20 - Personal Appearance by Claimant
56.25 - Medical Benefits
56.30 - Consent of Parties--Withdrawal
56.35 - Attorney's Signature
56.40 - Attorney's Fees and Expenses
56.45 - Tender Payment Time Period
56.50 - Final When Approved
56.55 - Annuity Company
56.60 - Payments Guaranteed
56.65 - Cost of the Annuity
56.70 - Structured Settlement Agreement To Set Aside Award

Chapter 59 - NOTICES OF INTENTION TO APPEAL

59.5 - Filing of Notice
59.10 - Receipt of Notice

Chapter 61 - PREHEARING CONFERENCES

61.5 - Request for Prehearing Conference
61.7 - Request of Prehearing Conference
61.15 - Setting under Texas Civil Statutes, Article 8306, §18a
61.20 - Setting on Hardship
61.25 - Setting at Carrier's Request
61.30 - Filing of Medical Information
61.35 - Exchange of Medical Information
61.40 - Additional Medical
61.45 - Charges for Reports
61.50 - Representatives Must Be Qualified
61.55 - Supply of Forms
61.60 - Attendance at Conference
61.65 - Request for Cancellation of Prehearing Conference
61.70 - Maintain Setting
61.75 - Failure To Appear
61.80 - Participation at Conference
61.85 - Carrier Self-Audit of Prehearing Conference
61.90 - Conduct at Prehearing Conference
61.95 - Consular Officers

Chapter 63 - PROMPTNESS OF FIRST PAYMENT

63.5 - Quarterly Report
63.10 - Sanctions for Late Payment

Chapter 64 - REPRESENTING CLAIMANTS BEFORE THE BOARD

64.25 - Discharged Attorney
64.30 - Adverse Representation in Claims for Death Benefits

Chapter 65 - UNETHICAL OR FRAUDULENT CLAIMS PRACTICES

65.5 - Practicing before the Board
65.10 - Actions by Carrier, Claimant's Attorney, and/or Agent
65.15 - Filing of Violation Report

Chapter 67 - ALLEGATIONS OF FRAUD

67.5 - Referral to Attorney General

Chapter 69 - MEDICAL EXAMINATION ORDERS

69.5 - Application of Chapter
69.10 - Definitions
69.15 - Carrier May Apply for Order from Board
69.20 - Application
69.25 - Bases for Denial
69.30 - Appeal
69.33 - Claimant's Medical Records
69.35 - Claimant's Expenses
69.40 - Attendance of Claimant's Health Care Provider
69.45 - Unreasonable Delay
69.50 - Reports of Examinations
69.55 - Failure To Attend Examination

Chapter 102 - PRACTICES AND PROCEDURES--GENERAL PROVISIONS

102.2 - Gifts, Grants, and Donations
102.3 - Computation of Time
102.4 - General Rules for Non-Division Communications
102.5 - General Rules for Written Communications to and from the Division
102.7 - Abbreviations
102.8 - Information Requested on Written Communications to the Division
102.9 - Submission of Information Requested by the Commission
102.10 - Interest, General
102.11 - Electronic Formats for Electronic Claim Data Request and Report

Chapter 104 - GENERAL PROVISIONS--RULE-MAKING

104.1 - Contents of Rulemaking Petitions

Chapter 109 - WORKERS' COMPENSATION COVERAGE FOR STATE EMPLOYEES

109.1 - State Agencies: General Provisions

Chapter 110 - REQUIRED NOTICES OF COVERAGE

Subchapter A - CARRIER NOTICES

110.1 - Insurance Carrier Requirements for Notifying the Division of Insurance Coverage
110.7 - Self-Insured Political Subdivision Requirements for Notifying the Division of Election to Provide Medical Benefits

Subchapter B - EMPLOYER NOTICES

110.101 - Covered and Non-Covered Employer Notices to Employees
110.103 - Employer Requirements for Notifying the Division of Non-Coverage
110.105 - Employer Requirements for Notifying the Division of Termination of Coverage
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

Chapter 112 - SCOPE OF LIABILITY FOR COMPENSATION

112.101 - Agreement Regarding Workers' Compensation Insurance Coverage Between General Contractors and Subcontractors
112.102 - Agreements between Motor Carriers and Owner Operators
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
112.301 - Labor Agent's Notification of Coverage to Certain Farm or Ranch Employees
112.401 - Election of Coverage by Certain Professional Athletes
112.402 - Determination of Equivalent Benefits for Professional Athletes

Chapter 114 - SELF-INSURANCE

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 Division
114.14 - Impaired Employer
114.15 - Revocation or Suspension of Certificate of Authority to Self-Insure
114.16 - Withdrawal from Self-Insurance

Chapter 116 - GENERAL PROVISIONS--SUBSEQUENT INJURY FUND

116.11 - Request for Reimbursement from the Subsequent Injury Fund
116.12 - Subsequent Injury Fund Payment/Reimbursement Schedule

Chapter 120 - COMPENSATION PROCEDURE--EMPLOYERS

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

Chapter 122 - COMPENSATION PROCEDURE--CLAIMANTS

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

Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING

Subchapter A - INSURANCE CARRIERS: REQUIRED NOTICES AND MODES OF PAYMENT

124.1 - Notice of Injury
124.2 - Insurance Carrier Notification Requirements
124.3 - Investigation of an Injury and Notice of Denial or Dispute
124.5 - Mode of Payment Made by Insurance Carriers
124.6 - Electronic Transfer Payments Made Through an Access Card
124.7 - Initial Payment of Temporary Income Benefits
124.8 - Receipt, Records, and Notice of Death or Claim for Death Benefits

Subchapter B - INSURANCE CARRIER CLAIM ELECTRONIC DATA INTERCHANGE REPORTING TO THE DIVISION

124.100 - Applicability
124.101 - Purpose
124.102 - Definitions
124.103 - Reporting Standards
124.104 - Reporting Requirements
124.105 - Records Required to be Reported
124.106 - Records Excluded from Reporting
124.107 - State Specific Requirements
124.108 - Insurance Carrier EDI Compliance Coordinator and Trading Partners

Chapter 126 - GENERAL PROVISIONS APPLICABLE TO ALL BENEFITS

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
126.8 - 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
126.15 - Procedures for Resolution of Underpayments of Income Benefits
126.16 - Procedures for Recouping Overpayments of Income Benefits
126.17 - Guidelines for Examination by a Treating Doctor or Referral Doctor After a Designated Doctor Examination to Address Issues Other Than Certification of Maximum Medical Improvement and the Evaluation of Permanent Impairment

Chapter 127 - DESIGNATED DOCTOR PROCEDURES AND REQUIREMENTS

Subchapter A - DESIGNATED DOCTOR SCHEDULING AND EXAMINATIONS

127.1 - Requesting Designated Doctor Examinations
127.5 - Scheduling Designated Doctor Appointments
127.10 - General Procedures for Designated Doctor Examinations
127.15 - Undue Influence on a Designated Doctor
127.20 - Requesting a Letter of Clarification Regarding Designated Doctor Reports
127.25 - Failure to Attend a Designated Doctor Examination

Subchapter B - DESIGNATED DOCTOR CERTIFICATION, RENEWAL, AND QUALIFICATIONS

127.100 - Designated Doctor Certification
127.120 - Exception to Certification as a Designated Doctor for Out-of-State Doctors
127.130 - Qualification Standards for Designated Doctor Examinations
127.140 - Disqualifying Associations

Subchapter C - DESIGNATED DOCTOR DUTIES AND RESPONSIBILITIES

127.200 - Duties of a Designated Doctor
127.210 - Designated Doctor Administrative Violations
127.220 - Designated Doctor Reports

Chapter 128 - BENEFITS--CALCULATION OF AVERAGE WEEKLY WAGE

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

Chapter 129 - INCOME BENEFITS--TEMPORARY INCOME BENEFITS

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

Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL 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 aDoctor other than the Treating Doctor
130.4 - Presumption that Maximum Medical Improvement (MMI) has been Reached and Resolution when MMI has not been Certified
130.7 - Acceleration of Impairment Income Benefits
130.8 - Initiating Payment of Impairment Income Benefits
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

Chapter 131 - BENEFITS--LIFETIME INCOME BENEFITS

Subchapter A - GENERAL PROVISIONS

131.1 - Initiation of Lifetime Income Benefits; Notice of Denial
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
131.5 - Verification by the Subsequent Injury Fund

Subchapter B - LIFETIME INCOME BENEFITS--CERTAIN FIRST RESPONDERS

131.10 - Definitions
131.11 - Applicability
131.12 - First Responder's Annual Certification to Insurance Carrier
131.13 - Suspension and Reinstatement of Lifetime Income Benefits
131.14 - Dispute of Continuing Entitlement of Lifetime Income Benefits

Chapter 132 - DEATH BENEFITS--DEATH AND BURIAL 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

Chapter 133 - GENERAL MEDICAL PROVISIONS

Subchapter A - GENERAL RULES FOR MEDICAL BILLING AND PROCESSING

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
133.30 - Telemedicine, Telehealth, and Teledentistry Services

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 - Medical Fee Dispute Resolution
133.308 - MDR of Medical Necessity Disputes
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
133.502 - Electronic Medical Billing Supplemental Data Requirements

Chapter 134 - BENEFITS--GUIDELINES FOR MEDICAL SERVICES, CHARGES, AND PAYMENTS

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
134.150 - Reimbursement of Services Provided by a Federal Military Treatment Facility
134.155 - Federal Military Treatment Facility Disputes

Subchapter C - MEDICAL FEE GUIDELINES

134.201 - Medical Fee Guideline for Medical Treatments and Services Provided under the Texas Workers' Compensation Act
134.203 - Medical Fee Guideline for Professional Services
134.204 - Medical Fee Guideline for Workers' Compensation Specific Services
134.209 - Applicability
134.210 - Medical Fee Guideline for Workers' Compensation Specific Services
134.215 - Home Health Services
134.220 - Case Management Services
134.225 - Functional Capacity Evaluations
134.230 - Return to Work Rehabilitation Programs
134.235 - Required Medical Examinations
134.239 - Billing for Work Status Reports
134.240 - Designated Doctor Examinations
134.250 - Maximum Medical Improvement Evaluations and Impairment Rating Examinations by Treating Doctors
134.260 - Maximum Medical Improvement Evaluations and Impairment Rating Examinations by Referred Doctors
134.303 - 2005 Dental Fee Guideline

Subchapter E - HEALTH FACILITY FEES

134.402 - Ambulatory Surgical Center Fee Guideline
134.403 - Hospital Facility Fee Guideline--Outpatient
134.404 - Hospital Facility Fee Guideline--Inpatient

Subchapter F - PHARMACEUTICAL BENEFITS

134.500 - Definitions
134.501 - Initial Pharmaceutical Coverage
134.502 - Pharmaceutical Services
134.503 - Pharmacy Fee Guideline
134.504 - Pharmaceutical Expenses Incurred by the Injured Employee
134.520 - Outpatient Closed Formulary
134.530 - Closed Formulary for Claims Not Subject to Certified Networks
134.540 - Closed Formulary for Claims Subject to Certified Networks
134.550 - Medical Interlocutory Order

Subchapter G - PROSPECTIVE AND CONCURRENT REVIEW OF HEALTH CARE

134.600 - Preauthorization, Concurrent Utilization Review, and Voluntary Certification of Health Care

Subchapter I - MEDICAL BILL REPORTING

134.800 - Applicability
134.801 - Purpose
134.802 - Definitions
134.803 - Reporting Standards
134.804 - Reporting Requirements
134.805 - Records Required to be Reported
134.806 - Records Excluded from Reporting
134.807 - State Specific Requirements
134.808 - Insurance Carrier EDI Compliance Coordinator and Trading Partners

Subchapter J - REVIEWS AND AUDITS

134.900 - Medical Benefit Review and Audit

Chapter 136 - BENEFITS--VOCATIONAL REHABILITATION

136.1 - Review of Employer Report of Injury

Chapter 137 - DISABILITY MANAGEMENT

Subchapter A - GENERAL PROVISIONS

137.1 - Disability Management Concept
137.5 - Case Manager Certification

Subchapter B - RETURN TO WORK

137.10 - Return to Work Guidelines
137.41 - Purpose
137.42 - Definitions
137.43 - Return-to-Work Reimbursement Program Administrator
137.44 - Return-to-Work Reimbursement Program for Employers
137.45 - Employer Eligibility for Disbursements from the Return-to-Work Reimbursement Program
137.46 - Application for Funds from the Return-to-Work Reimbursement Program
137.47 - Criteria for Return-to-Work Reimbursement Program Applications
137.48 - Return-to-Work Reimbursement Program Administrator Determinations
137.49 - Optional Preauthorization Plan
137.50 - Optional Advance of Funds Plan
137.51 - Monitoring and Enforcement

Subchapter C - TREATMENT GUIDELINES

137.100 - Treatment Guidelines

Chapter 140 - DISPUTE RESOLUTION--GENERAL PROVISIONS

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, Rights, 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
140.9 - Requests by Parties

Chapter 141 - DISPUTE RESOLUTION--BENEFIT REVIEW CONFERENCE

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 - Sending and Exchanging Pertinent Information
141.5 - Description of the Benefit Review Conference
141.7 - Division Actions After a Benefit Review Conference

Chapter 142 - DISPUTE RESOLUTION--BENEFIT CONTESTED CASE HEARING

142.1 - Application of the Administrative Procedure Act
142.2 - Authority of the Administrative Law Judge
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
142.20 - Interlocutory Orders

Chapter 143 - DISPUTE RESOLUTION REVIEW BY THE APPEALS PANEL

143.1 - Definitions
143.2 - Description of the Appeal Proceeding
143.3 - Requesting the Appeals Panel to Review the Decision of the Administrative Law Judge
143.4 - Responding to a Request for Review by the Appeals Panel
143.5 - Decision of the Appeals Panel

Chapter 144 - DISPUTE RESOLUTION

Subchapter A - ARBITRATION

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

Chapter 147 - DISPUTE RESOLUTION--AGREEMENTS, SETTLEMENTS, COMMUTATIONS

147.1 - Form and Execution
147.4 - Agreements; Filing and Effective Dates
147.5 - Settlements: Requirements, Effective Dates, and Informal Settlement Conferences
147.7 - Agreements and Settlements: Effect on Previously Entered Decisions and Orders
147.10 - Commutation of Impairment Income Benefits
147.11 - Notification to Division of Proposed Judgments and Settlements

Chapter 148 - HEARINGS CONDUCTED BY THE STATE OFFICE OF ADMINISTRATIVE HEARINGS

148.1 - Definitions
148.2 - Scope and Applicability
148.3 - Requesting a Hearing
148.4 - Correction of Clerical Error
148.5 - Notice of Hearing
148.6 - Venue
148.7 - Representation
148.8 - Withdrawal of Hearing Request
148.10 - Hearings Subpoenas to Compel Attendance and Subpoenas Duces Tecum
148.11 - Commissions to Compel Attendance for Deposition
148.13 - Recording the Hearing
148.14 - Burden of Proof
148.15 - Final Decision by the ALJ
148.16 - Proposal for Decision or Order by the ALJ
148.17 - Special Provisions for Sanctions
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 - Division Enforcement of Orders
148.24 - Confidentiality of Records

Chapter 150 - REPRESENTATION OF PARTIES BEFORE THE AGENCY--QUALIFICATIONS FOR REPRESENTATIVES

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

Chapter 152 - ATTORNEY FEES

152.1 - Attorney Fees: General Provisions
152.2 - Attorney Fees: Representation of Claimants
152.3 - Approval or Denial of Fee by the Division
152.4 - Guidelines for Legal Services Provided to Claimants and Insurance Carriers
152.5 - Allowable Expenses
152.6 - Attorney Withdrawal

Chapter 156 - REPRESENTATION OF PARTIES BEFORE THE AGENCY--CARRIER'S AUSTIN REPRESENTATIVE

156.1 - Carrier's Austin Representative

Chapter 160 - REPORTS OF INJURY AND OCCUPATIONAL DISEASE--GENERAL PROVISIONS

160.1 - Applicability
160.2 - Non-Subscribing Employer's Report of Injury
160.3 - Subscribing Employer's Report of Injury

Chapter 165 - REJECTED RISK: INJURY PREVENTION SERVICES

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

Chapter 166 - ACCIDENT PREVENTION SERVICES

166.1 - Definitions of Terms
166.2 - Adequacy of Accident Prevention Services
166.3 - Annual Information Submitted by Insurance Companies
166.5 - Inspections of Adequacy of Accident Prevention Facilities and Services

Chapter 180 - MONITORING AND ENFORCEMENT

Subchapter A - GENERAL RULES FOR ENFORCEMENT

180.1 - Definitions
180.2 - Filing a Complaint
180.3 - Compliance Audits
180.4 - On-Site Visits
180.5 - Access to Workers' Compensation Related Records and Information
180.8 - Notices of Violation; Notices of Hearing; Default Judgments
180.9 - Proposals for Decision
180.10 - Ex Parte Emergency Cease and Desist Orders
180.19 - Incentives

Subchapter B - MEDICAL BENEFIT REGULATION

180.22 - Health Care Provider Roles and Responsibilities
180.23 - Division-Required Training for Doctors
180.24 - Financial Disclosure
180.25 - Improper Inducements, Influence and Threats
180.26 - Criteria for Imposing, Recommending and Determining Sanctions; Other Remedies
180.27 - Restoration
180.28 - Peer Review Requirements, Reporting, and Sanctions
180.50 - Severability

Subchapter C - MEDICAL QUALITY REVIEW PANEL

180.60 - Definitions
180.62 - Medical Quality Review Panel
180.64 - MQRP Application Process
180.66 - Medical Case Review
180.68 - Medical Quality Review Process
180.70 - MQRP Training
180.72 - Conflict of Interest
180.74 - MQRP Notification of Case Status
180.76 - Rights and Responsibilities of Persons Involved in the Medical Quality Review Process