Texas Workers' Compensation

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§ 42.309. Payment for the Review

(a) The board shall set reasonable fees for reviewing fee and utilization disputes. The board may adjust these fees periodically, as necessary.

(b) The review fee shall be paid by check or money order, payable to Industrial Accident Board.

(c) The carrier, whether requester or respondent, shall be responsible to pay for the review, unless the board has found that the provider has overutilized the board’s review system.

(d) A provider shall be found to have overutilized the board’s review system after three separate disputes involving the provider have been presented to the board for review, and have been resolved by the board against the provider within a 12-month period. The board will notify a provider when such finding is made, and shall maintain a record of such findings. In all subsequent reviews of that provider’s bills, the provider, whether requester or respondent, shall be responsible to pay for the review.

The provisions of this § 42.309 adopted to be effective February 17, 1989, 14 TexReg 694.

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At a Glance:

Title:

§ 42.309. Payment for the Review

Title:

Title 28. Insurance

Status:

Current

Usage:

Old Law Rule

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