Texas Workers’ Compensation Rules for Pre-1991 Injuries

Communication to Health Care Providers

Apply the rule governing communications to health care providers under §41.65. The available source identifies this section but does not provide its operative text or communication deadline.

• Follow §41.65 for communications directed to health care providers.

Filing, Translation, and Translator Responsibilities

File required instruments under §41.70 and meet the timely-filing requirements in §41.75. Filings made after a final order or award are governed by §41.80; translation and translator responsibilities are addressed in §§41.85 and 41.90.

• File instruments as required by §41.70.
• Meet the timely-filing requirements of §41.75.
• Follow §41.80 for filings after a final order or award.
• Apply §41.85 to document translation and §41.90 to translator responsibilities.

Health Care Provider Reporting

Health care providers must comply with the reporting framework in §42.33 and the required-report provisions that follow. The source identifies first, subsequent, change-of-status, and special reports as separate reporting categories.

• Follow §42.33 for health care provider reporting requirements.
• Submit the first report under §42.35.
• Submit subsequent reports under §42.40.
• Submit change-of-status reports under §42.55.
• Submit special reports under §42.60.

Treating Provider Selection and Changes

Treatment must be provided by a person permitted under §42.20. Changes to the treating doctor must follow the procedure in §42.65.

• Confirm that the selected provider is authorized to treat under §42.20.
• Use §42.65 when changing treating doctors.

Coverage Confirmation and Written Communications

Obtain or address confirmation of coverage under §42.28 and use the written-communications requirements in §42.30. The source identifies both provisions as part of the general medical requirements.

• Follow §42.28 for confirmation of coverage.
• Follow §42.30 for written communications.

Prohibited Practices

Avoid practices prohibited by §42.25 in connection with workers' compensation medical services. The source identifies §42.25 as the governing prohibited-practices provision.

• Review §42.25 before furnishing or arranging covered medical services.
• Do not engage in practices prohibited by §42.25.

Treatment and Communications Requirements

Apply the treatment, provider-selection, coverage-confirmation, written-communication, and reporting provisions in Subchapter A. These requirements include §§42.20, 42.25, 42.28, 42.30, 42.33, 42.35, 42.40, 42.55, 42.60, and 42.65.

• Use an authorized treating provider.
• Comply with prohibited-practice restrictions.
• Confirm coverage and communicate in writing as required.
• Complete required provider reports and follow treating-doctor change procedures.

Treating-Doctor Changes and Carrier Reports

Treating-doctor changes are governed by §42.65, while carrier reporting is governed by §42.78. Coordinate provider and carrier submissions so each report is filed under the applicable rule.

• Follow §42.65 for a change of treating doctor.
• Follow §42.78 for reports to be filed by the carrier.

Employer Injury and Disease Reporting Documentation

Use the forms and reporting documents identified in Chapter 45 for employer injury-or-disease reporting. The chapter covers the Employer's Report of Injury and Disease, wage statement, Board requests for additional information, and the Employer's Supplemental Report of Injury.

• Use the forms identified in §45.5.
• Prepare the Employer's Report of Injury and Disease under §45.10.
• Prepare the wage statement under §45.13.
• Respond to Board requests for additional information under §45.20.
• Submit the Employer's Supplemental Report of Injury under §45.25.

Employee Claim Documentation and Filing

Document an employee's claim under Chapter 47 and comply with the applicable claimant-signature and filing requirements. The source identifies claim information, claimant signature, employer advances of compensation, and beneficiary claims as distinct procedures.

• Provide the information constituting a claim under §47.5.
• Obtain the claimant signature required by §47.10.
• Apply §47.15 when an employer advances compensation.
• Follow §47.20 for a beneficiary filing a claim.

Employer Injury Reporting and Sanctions

Employers must submit supplemental injury reports and comply with the sanctions provision in Chapter 45. The source identifies §45.25 for supplemental reporting and §45.30 for sanctions.

• Submit an Employer's Supplemental Report of Injury under §45.25.
• Review §45.30 for sanctions associated with noncompliance.

Employee and Beneficiary Claim Procedures

Follow Chapter 47 for employee and beneficiary notice and claim procedures. The chapter addresses the information constituting a claim, claimant signature, employer advances of compensation, and beneficiary filings.

• Follow §47.5 for claim information.
• Follow §47.10 for claimant signatures.
• Follow §47.15 for employer advances of compensation.
• Follow §47.20 for beneficiary claims.

Formal Board Hearing Procedures

For formal Board hearings, comply with the hearing schedule, timely evidence-acceptance, formal-position, and cancellation provisions in §§49.5–49.20. Parties must meet the applicable hearing and evidence procedures.

• Follow §49.5 for the hearing schedule.
• Meet §49.10 requirements for timely acceptance of evidence.
• Prepare a formal statement of position under §49.15.
• Use §49.20 for a request for cancellation.

Formal Hearing Documentation and Participation

File and present evidence according to Chapter 49, including medical bills, medical reports and records, and carrier attendance requirements. Formal statements of position and sanctions are addressed in §§49.45 and 49.50.

• File medical bills under §49.30.
• File medical reports and records under §49.35.
• Comply with carrier-attendance requirements in §49.40.
• Address the contents of a formal statement of position under §49.45.
• Review §49.50 for sanctions.

Formal Hearing Participation and Filings

Manage formal-hearing participation through the scheduling, evidence, position-statement, cancellation, postponement, and filing provisions in Chapter 49. Required medical evidence and formal statements must be filed under the applicable sections.

• Follow §§49.5 and 49.25 for hearing scheduling and postponement matters.
• Submit evidence timely under §49.10.
• File medical bills and medical records under §§49.30 and 49.35.
• Prepare and file formal statements under §§49.15, 49.45, and 49.160.
• Use §49.20 for cancellation requests.

Hearing Notices and Appearances

Formal proceedings begin under §49.110 and require the notices specified in §§49.115–49.125. Personal-appearance hearings in Austin and related participation procedures are addressed in §49.130.

• Follow §49.110 for commencement of hearings.
• Provide ordinary notice under §49.115.
• Address special statutory notice under §49.120.
• Provide notice of a special formal hearing under §49.125.
• Follow §49.130 for personal-appearance hearings in Austin.

Hearing and Formal Proceeding Procedures

Comply with the formal-proceeding rules governing appearances, attorney withdrawal, court reporters, documentary evidence, formal statements of position, and subpoenas. The source identifies §§49.131, 49.135, 49.155, 49.160, and 49.165 for these procedures.

• Follow §49.131 for withdrawal of an attorney.
• Use §49.135 for court reporters.
• Submit documentary evidence under §49.155.
• File formal statements of position under §49.160.
• Use §49.165 for subpoenas and subpoenas duces tecum.

Administration of Legacy Awards

Chapter 51 governs Board awards for injuries occurring before January 1, 1991. The identified provisions address joint payment, installments, lump-sum payments, requests, and attorney fees.

• Apply Chapter 51 to awards for injuries before January 1, 1991.
• Follow §51.10 for joint payment of an award.
• Follow the applicable Chapter 51 provisions for installment and lump-sum payments and requests.
• Review §51.65 for attorney fees.

Carrier Reporting of Compensation Payments

For injuries before January 1, 1991, carriers must follow Chapter 53 for reporting initiation and suspension of compensation payments. The chapter establishes the carrier reporting process for these payment events.

• Apply Chapter 53 to pre-January 1, 1991 injuries.
• Report initiation and suspension of compensation payments under the applicable Chapter 53 procedures.

Injury Notice and Payment Initiation

Follow Chapter 53 for payment without prejudice, written injury notice, Board notice to the carrier, and notice of initiation and mode of payment of compensation. These provisions govern starting compensation payments for covered pre-1991 injuries.

• Review §53.5 for payment of benefits without prejudice.
• Use §53.10 for written notice of injury.
• Follow §53.15 for Board notice to the carrier.
• Follow §53.20 for notice of initiation and mode of payment of compensation.

Change to Benefits Payment Period

An application to change the benefits payment period is governed by §53.22. Submit the application and any supporting material required by the applicable Chapter 53 procedure.

• Use §53.22 to apply for a change to the benefits payment period.
• Follow the applicable filing and notice procedures for the application.

Compensation Administration Notices and Filings

Chapter 53 prescribes the contents and filing of controversion or position statements and wage statements, together with related compensation-administration notices. Follow the applicable provisions for payment initiation, suspension, and transmittal communications.

• Include required information in a statement of controversion or statement of position under §53.25.
• File wage statements under §53.30.
• Follow applicable transmittal-letter procedures under §53.40.

Benefit Payment and Suspension Procedures

Administer benefit payments and suspensions under §§53.35–53.60. The identified rules address suspension notices, transmittal letters, maximum payments to minors, partial benefits, resumption, amputation payments, and applications for suspension.

• Provide notice of suspension under §53.35.
• Use transmittal letters under §53.40.
• Apply §53.45 to maximum payments to minors.
• Apply §53.48 to partial benefits for general injuries.
• Apply §53.50 to resumption of compensation.
• Apply §53.55 to payment for amputation.
• Use §53.60 for an application for suspension of compensation.

Weekly Compensation Suspension and Carrier-Liability Issues

Follow the Chapter 53 procedures for suspension of weekly compensation and for nonpayment based on another carrier's liability. Certification requirements are addressed separately in the certification procedure.

• Follow §53.63 for suspension of weekly compensation.
• Apply the rule governing nonpayment based on another carrier's liability.
• Complete the applicable certification procedure.