Sec. 409.021. INITIATION OF BENEFITS; INSURANCE CARRIER'S REFUSAL; ADMINISTRATIVE VIOLATION. (a) An insurance carrier shall initiate compensation under this subtitle promptly. Not later than the 15th day after the date on which an insurance carrier receives written notice of an injury, the insurance carrier shall:
(1) begin the payment of benefits as required by this subtitle; or
(2) notify the division and the employee in writing of its refusal to pay and advise the employee of:
(A) the right to request a benefit review conference; and
(B) the means to obtain additional information from the division.
(a-1) An insurance carrier that fails to comply with Subsection (a) does not waive the carrier's right to contest the compensability of the injury as provided by Subsection (c) but commits an administrative violation subject to Subsection (e).
(a-2) An insurance carrier is not required to comply with Subsection (a) if the insurance carrier has accepted the claim as a compensable injury and income or death benefits have not yet accrued but will be paid by the insurance carrier when the benefits accrue and are due.
(a-3) An insurance carrier is not required to comply with Subsection (a) if the claim results from an employee's disability or death for which a presumption is claimed to be applicable under Subchapter B, Chapter 607, Government Code, and, not later than the 15th day after the date on which the insurance carrier received written notice of the injury, the insurance carrier has provided the employee and the division with a notice that describes all steps taken by the insurance carrier to investigate the injury before the notice was given and the evidence the carrier reasonably believes is necessary to complete its investigation of the compensability of the injury. The commissioner shall adopt rules as necessary to implement this subsection.
(b) An insurance carrier shall notify the division in writing of the initiation of income or death benefit payments in the manner prescribed by commissioner rules.
(c) If an insurance carrier does not contest the compensability of an injury on or before the 60th day after the date on which the insurance carrier is notified of the injury, the insurance carrier waives its right to contest compensability. The initiation of payments by an insurance carrier does not affect the right of the insurance carrier to continue to investigate or deny the compensability of an injury during the 60-day period.
(d) An insurance carrier may reopen the issue of the compensability of an injury if there is a finding of evidence that could not reasonably have been discovered earlier.
(e) An insurance carrier commits an administrative violation if the insurance carrier does not initiate payments or file a notice of refusal as required by this section.
Text of subsec. (f) as added by Acts 2003, 78th Leg., ch. 939, Sec. 1
(f) For purposes of this section, "written notice" to a certified self-insurer occurs only on written notice to the qualified claims servicing contractor designated by the certified self-insurer under Section 407.061(c).
Text of subsec. (f) as added by Acts 2003, 78th Leg., ch. 1100, Sec. 1
(f) For purposes of this section:
(1) a certified self-insurer receives notice on the date the qualified claims servicing contractor designated by the certified self-insurer under Section 407.061(c) receives notice; and
(2) a political subdivision that self-insures under Section 504.011, either individually or through an interlocal agreement with other political subdivisions, receives notice on the date the intergovernmental risk pool or other entity responsible for administering the claim for the political subdivision receives notice.
(j) Each insurance carrier shall establish a single point of contact in the carrier's office for an injured employee for whom the carrier receives a notice of injury.
Added by Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 2003, 78th Leg., ch. 939, Sec. 1, eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1100, Sec. 1, eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.145, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 13, eff. September 1, 2011.
Acts 2019, 86th Leg., R.S., Ch. 701 (S.B. 2551), Sec. 3, eff. June 10, 2019.
Notes of Decisions
Cited in
78
cases (
5 in the last 5 years), 1994–2025 · leading case:
Cont'l Cas. Co. v. Downs, 81 S.W.3d 803 (Tex. 2002).
Cont'l Cas. Co. v. Downs, 81 S.W.3d 803 (Tex. 2002).
· cites it 14× “See Tex. Lab.Code §§ 409.021, 409.022. The district court granted summary judgment for the carrier on the basis that it had timely contested compensability even though it had not timely notified the claimant that it was refusing to pay benefits.”
S. Ins. Co. v. Brewster, 249 S.W.3d 6 (Tex. App. 2007).
· cites it 8× “The initiation of payments by an insurance carrier does not affect the right of the insurance carrier to continue to investigate or deny the compensability of an injury during the 60-day period.”
Texas Mut. Ins. Co. v. Ruttiger, 381 S.W.3d 430 (Tex. 2012).
· cites it 3× “Tex. Lab.Code § 409.021 (providing that a carrier shall begin paying benefits or file a notice of dispute within fifteen days after receiving written notice of injury).”
Zurich Am. Ins. Co. v. Gill, 173 S.W.3d 878 (Tex. App. 2005).
· cites it 8× “[35] TEX. LAB.CODE ANN. § 409.021 (c). [36] See Williamson, 971 S.”
State Off. of Risk Mgmt. v. Lawton, 295 S.W.3d 646 (Tex. 2009).
· cites it 5× “The administrative rule states: Texas Labor Code, § 409.021 and subsection (a) of this section do not apply to disputes of extent of injury.”
Alexander v. Lockheed Martin Corp., 188 S.W.3d 348 (Tex. App. 2006).
· cites it 6× “Thus, it had sixty days to contest the compensability of the injury pursuant to Texas Labor Code section 409.021(c). 1 Appellee did not file a dispute within the sixty-day period but filed one later, claiming that it should be able to reopen the issue because it had “newly…”
Medina v. Herrera, 927 S.W.2d 597 (Tex. 1996).
· cites it 3× “See TEX.LAB.CODE § 409.021(c) (carrier must contest compensability of injury within sixty days after receiving notice of injury, or else it waives its right to do so).”
Krueger v. Atascosa Cnty., 155 S.W.3d 614 (Tex. App. 2004).
· cites it 2× “Downs, but is based on the same principle that an insurance carrier’s failure to begin paying benefits, or give written notice of refusal to pay, within the seven-day period prescribed by Section 409.”
In Re Texas Mut. Ins. Co., 157 S.W.3d 75 (Tex. App. 2004).
· cites it 2× “” Goetz points out that the legislature has placed on the compensation carrier the burden of notifying the Commission of an injury and thereby establishing administrative jurisdiction over the injury.”
Texas Prop. & Cas. Guar. Ass'n v. Nat'l Am. Ins. Co., 208 S.W.3d 523 (Tex. App. 2006).
· cites it 2× “; see Tex. Lab.Code Ann. § 409.021. Of relevance here, Houston General argued on appeal that the critical issue was not “compensability” for the injury but “coverage” of the claim, and that it had not waived its right to contest coverage.”
— Tex. Lab. Code § 409.021(C) — 1 case
— Tex. Lab. Code § 409.021(a) — 14 cases
Cont'l Cas. Co. v. Downs, 81 S.W.3d 803 (Tex. 2002).
“See Tex. Lab.Code §§ 409.021, 409.022. The district court granted summary judgment for the carrier on the basis that it had timely contested compensability even though it had not timely notified the claimant that it was refusing to pay benefits.”
S. Ins. Co. v. Brewster, 249 S.W.3d 6 (Tex. App. 2007).
“The initiation of payments by an insurance carrier does not affect the right of the insurance carrier to continue to investigate or deny the compensability of an injury during the 60-day period.”
Texas Mut. Ins. Co. v. Ruttiger, 381 S.W.3d 430 (Tex. 2012).
“Tex. Lab.Code § 409.021 (providing that a carrier shall begin paying benefits or file a notice of dispute within fifteen days after receiving written notice of injury).”
Krueger v. Atascosa Cnty., 155 S.W.3d 614 (Tex. App. 2004).
“Downs, but is based on the same principle that an insurance carrier’s failure to begin paying benefits, or give written notice of refusal to pay, within the seven-day period prescribed by Section 409.”
— Tex. Lab. Code § 409.021(a)(1) — 1 case
— Tex. Lab. Code § 409.021(a)(2) — 1 case
— Tex. Lab. Code § 409.021(a)(2)(A) — 1 case
— Tex. Lab. Code § 409.021(c) — 32 cases
Cont'l Cas. Co. v. Downs, 81 S.W.3d 803 (Tex. 2002).
“See Tex. Lab.Code §§ 409.021, 409.022. The district court granted summary judgment for the carrier on the basis that it had timely contested compensability even though it had not timely notified the claimant that it was refusing to pay benefits.”
Alexander v. Lockheed Martin Corp., 188 S.W.3d 348 (Tex. App. 2006).
“Thus, it had sixty days to contest the compensability of the injury pursuant to Texas Labor Code section 409.021(c). 1 Appellee did not file a dispute within the sixty-day period but filed one later, claiming that it should be able to reopen the issue because it had “newly…”
Medina v. Herrera, 927 S.W.2d 597 (Tex. 1996).
“See TEX.LAB.CODE § 409.021(c) (carrier must contest compensability of injury within sixty days after receiving notice of injury, or else it waives its right to do so).”
— Tex. Lab. Code § 409.021(d) — 7 cases
Texas Prop. & Cas. Guar. Ass'n v. Nat'l Am. Ins. Co., 208 S.W.3d 523 (Tex. App. 2006).
“; see Tex. Lab.Code Ann. § 409.021. Of relevance here, Houston General argued on appeal that the critical issue was not “compensability” for the injury but “coverage” of the claim, and that it had not waived its right to contest coverage.”
— Tex. Lab. Code § 409.021(e) — 4 cases
Cont'l Cas. Co. v. Downs, 81 S.W.3d 803 (Tex. 2002).
“See Tex. Lab.Code §§ 409.021, 409.022. The district court granted summary judgment for the carrier on the basis that it had timely contested compensability even though it had not timely notified the claimant that it was refusing to pay benefits.”
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