Texas Labor Code
§ 409.0091 — REIMBURSEMENT PROCEDURES FOR CERTAIN ENTITIES
LA § 409.0091Title 5. WORKERS' COMPENSATION · Part A. TEXAS WORKERS' COMPENSATION ACT · Ch. 409. COMPENSATION PROCEDURES · Art. A. INJURY REPORTS, CLAIMS, AND RECORDS
Statute text
View on source(a)In this section, "health care insurer" means an insurance carrier and an authorized representative of an insurance carrier, as described by Section 402.084(c-1).
(b)This section applies only to a request for reimbursement by a health care insurer.
(c)Health care paid by a health care insurer may be reimbursable as a medical benefit.
(d)Except as provided by Subsection (e), this section does not prohibit or limit a substantive defense by a workers' compensation insurance carrier that the health care paid for by the health care insurer was not a medical benefit or not a correct payment. A subclaimant may not be reimbursed for payment for any health care that was previously denied by a workers' compensation insurance carrier under:
(1)a preauthorization review of the specific service or medical procedure; or
(2)a medical necessity review that determined the service was not medically necessary for the treatment of a compensable injury.
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Legislative history
Acts 2017, 85th Leg., R.S., Ch. 839 (H.B. 2111), Sec. 2, eff. September 1, 2017.