Sec. 415.008. FRAUDULENTLY OBTAINING OR DENYING BENEFITS; ADMINISTRATIVE VIOLATION. (a) A person commits an administrative violation if the person, to obtain or deny a payment of a workers' compensation benefit or the provision of a benefit for the person or another, knowingly or intentionally:
(1) makes a false or misleading statement;
(2) misrepresents or conceals a material fact;
(3) fabricates, alters, conceals, or destroys a document; or
(4) conspires to commit an act described by Subdivision (1), (2), or (3).
(b) Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1162, Sec. 37(5), eff. September 1, 2011.
(c) A person who has obtained an excess payment in violation of this section is liable for full repayment plus interest computed at the rate prescribed by Section 401.023. If the person is an employee or person claiming death benefits, the repayment may be redeemed from future income or death benefits to which the person is otherwise entitled.
(d) An employer who has committed an act described by Subsection (a) that results in denial of payments is liable for the past benefit payments that would otherwise have been payable by the insurance carrier during the period of denial, plus interest computed at the rate prescribed by Section 401.023. The insurance carrier is not liable for benefit payments during the period of denial.
(e) If an administrative violation proceeding is pending under this section against an employee or person claiming death benefits, the division may not take final action on the person's benefits.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.272, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 28, eff. September 1, 2011.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 37(5), 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