Texas Labor Code
§ 413.0312 — REVIEW OF MEDICAL FEE DISPUTES; BENEFIT REVIEW CONFERENCE
LA § 413.0312Title 5. WORKERS' COMPENSATION · Part A. TEXAS WORKERS' COMPENSATION ACT · Ch. 413. MEDICAL REVIEW · Art. C. DISPUTE RESOLUTION
Statute text
View on source(a)This section applies only to a medical fee dispute that remains unresolved after any applicable review under Sections 413.031(b) through (i).
(b)Subject to Subsection (e), a party to a medical fee dispute described by Subsection (a) must adjudicate the dispute in the manner required by Subchapter B, Chapter 410.
(c)At a benefit review conference conducted under this section, the parties to the dispute may not resolve the dispute by negotiating fees that are inconsistent with any applicable fee guidelines adopted by the commissioner.
(d)If issues remain unresolved after a benefit review conference, the parties may elect to engage in arbitration as provided by Section 410.104.
(e)If arbitration is not elected as described by Subsection (d), a party to a medical fee dispute described by Subsection (a) is entitled to a contested case hearing. A hearing under this subsection shall be conducted by the State Office of Administrative Hearings in the manner provided for a contested case under Chapter 2001, Government Code.
(f)The commissioner or the division may participate in a contested case hearing conducted under Subsection (e) if the hearing involves the interpretation of fee guidelines adopted by the commissioner. The division and the department are not considered to be parties to the medical fee dispute for purposes of this section.
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Legislative history
Added by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 21, eff. September 1, 2011.