Sec. 415.0035. ADDITIONAL VIOLATIONS BY INSURANCE CARRIER OR HEALTH CARE PROVIDER. (a) An insurance carrier or its representative commits an administrative violation if that person:
(1) fails to submit to the division a settlement or agreement of the parties;
(2) fails to timely notify the division of the termination or reduction of benefits and the reason for that action; or
(3) denies preauthorization in a manner that is not in accordance with rules adopted by the commissioner under Section 413.014.
(b) A health care provider commits an administrative violation if that person:
(1) fails or refuses to timely file required reports or records; or
(2) fails to file with the division the annual disclosure statement required by Section 413.041.
(c) Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff. September 1, 2011.
(d) Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff. September 1, 2011.
(e) A person regulated by the division under this title commits an administrative violation if the person violates this subtitle or a rule, order, or decision of the commissioner.
(f) Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(2), eff. September 1, 2011.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.45, eff. Sept. 1, 1995. Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.06, eff. June 17, 2001.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.268, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 27, eff. September 1, 2011.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 37(2), eff. September 1, 2011.
Structure Texas Statutes
Title 5 - Workers' Compensation
Subtitle A - Texas Workers' Compensation Act
Chapter 415 - Administrative Violations
Section 415.001. Administrative Violation by Representative of Employee or Legal Beneficiary
Section 415.002. Administrative Violation by Insurance Carrier
Section 415.003. Administrative Violation by Health Care Provider
Section 415.0035. Additional Violations by Insurance Carrier or Health Care Provider
Section 415.0036. Administrative Violation by Person Performing Certain Claim Services
Section 415.005. Overcharging by Health Care Providers Prohibited; Administrative Violation
Section 415.006. Employer Chargebacks Prohibited; Administrative Violation
Section 415.007. Loans by Attorneys Prohibited
Section 415.008. Fraudulently Obtaining or Denying Benefits; Administrative Violation
Section 415.009. Frivolous Actions; Administrative Violation
Section 415.010. Breach of Agreement; Administrative Violation