<<Prev Rule

Texas Administrative Code

Next Rule>>
TITLE 28INSURANCE
PART 2TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
CHAPTER 42MEDICAL BENEFITS
SUBCHAPTER AGENERAL MEDICAL PROVISIONS
RULE §42.75Excess Recovery from Third Party Actions

(a) When an injured worker has received an excess recovery in a third party action, pursuant to Texas Civil Statutes, Article 8307, §6a(c), the carrier shall immediately:

  (1) notify all providers of the date of the judgment or agreed judgment, and the amount of the excess; and

  (2) file a copy of the judgment or agreed judgment with the board.

(b) The provider shall continue to submit reports as required by these sections.

(c) Bills for services and supplies provided after the judgment date shall be sent to the injured worker, or his or her representative. Copies of such bills shall be filed with the carrier.

(d) The claimant shall notify the board, the carrier, and current health care providers when the amount of the excess has been reduced to zero. Upon receipt of such notice, the provider(s) shall resume billing only the carrier, pursuant to §42.30 of this title (relating to Written Communications).


Source Note: The provisions of this §42.75 adopted to be effective October 20, 1988, 13 TexReg 4990.

Link to Texas Secretary of State Home Page | link to Texas Register home page | link to Texas Administrative Code home page | link to Open Meetings home page