Texas Codes

Tex. Lab. Code § 413.002 (2026)

Medical Review

✓ current as of May 2026

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Sec. 413.002. MEDICAL REVIEW. (a) The division shall monitor health care providers, insurance carriers, independent review organizations, and workers' compensation claimants who receive medical services to ensure the compliance of those persons with rules adopted by the commissioner relating to health care, including medical policies and fee guidelines.

(b) In monitoring health care providers who serve as designated doctors under Chapter 408 and independent review organizations who provide services described by this chapter, the division shall evaluate:

(1) compliance with this subtitle and with rules adopted by the commissioner relating to medical policies, fee guidelines, treatment guidelines, return-to-work guidelines, and impairment ratings; and

(2) the quality and timeliness of decisions made under Section 408.0041, 408.122, 408.151, or 413.031.

(c) The division shall report the results of the monitoring of independent review organizations under Subsection (b) to the department on at least a quarterly basis.

(d) If the commissioner determines that an independent review organization is in violation of this chapter, rules adopted by the commissioner under this chapter, applicable provisions of this code or rules adopted under this code, or applicable provisions of the Insurance Code or rules adopted under that code, the commissioner or a designated representative shall notify the independent review organization of the alleged violation and may compel the production of any documents or other information as necessary to determine whether the violation occurred.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.42, eff. Sept. 1, 1995.

Amended by:

Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.227, eff. September 1, 2005.

Notes of Decisions

Cited in 13 cases, 1998–2019 · leading case: Texas Workers' Comp. Comm'n v. Patient Advocates of Texas, 136 S.W.3d 643 (Tex. 2004).

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Texas Workers' Comp. Comm'n v. Patient Advocates of Texas, 136 S.W.3d 643 (Tex. 2004). · cites it 2× “Tex. Lab.Code §§ 413.002, 413.015. In this instance, TWCC retains all the powers delegated to it by the Legislature.”

Patient Advocates v. Texas Workers Comp. Comm'n, 80 S.W.3d 66 (Tex. App. 2002). · cites it 2× “Tex. Lab.Code Ann. § 413.002. The division of medical review must also monitor health care providers, insurance carriers, and workers' compensation claimants.”

All Saints Health Sys. v. Texas Workers' Comp. Comm'n, 125 S.W.3d 96 (Tex. App. 2003). · cites it 2× “Tex. Lab.Code Ann. § 413.002 (West 1996).”

Schade v. Texas Workers' Comp. Comm'n, 150 S.W.3d 542 (Tex. App. 2004). · cites it 2× “See Tex. Lab.Code Ann. §§ 413.002, 414.002, 415.”

Texas Workers' Comp. Comm'n v. East Side Surgical Ctr., 142 S.W.3d 541 (Tex. App. 2004). “See Tex. Lab.Code Ann. §§ 413.002, .011, .031 (giving the Commission adjudicatory power over the resolution of fee disputes).”

John Molyneaux v. Ins. Co. of the State of Pennsylvania (Tex. App. 2001). · cites it 2× “Tex. Lab. Code Ann. § 413.002 (b) (West 1996).”

Chris M. Schade, M.D., Ph.D. v. Texas Workers' Comp. Comm'n & Richard F. Reynolds, Exec. Dir. (Tex. App. 2004). · cites it 2× “See Tex. Lab. Code Ann. §§ 413.002 , 414.002, 415.”

Melanie Steele v. Murphy & Beane, Inc., & Viacom, Inc. (Tex. App. 2019). “3d at 518 (citing TEX. LAB. CODE ANN. § 413.002–.055; Cunningham, 7 291 S.”

Patient Advocates of Texas & Allen J. Meril, M.D. v. Texas Workers Comp. Comm'n Leonard Riley, Exec. Dir. & State of Texas (Tex. App. 2002). “Tex. Lab. Code Ann. § 413.002 . The division of medical review must also monitor health care providers, insurance carriers, and workers' compensation claimants.”

All Saints Health Sys. All Saints Episcopal Hosp./Fort Worth All Saints Episcopal Hosp./Cityview Baptist Health Sys. Baptist Med. Ctr. North Cent. Baptist Hosp. Ne. Baptist St. Luke's Baptist v. Texas Workers' Comp. Comm'n State Off. of Risk Mgmt. Cont'l Cas. Co. Texas Ass'n of Sch. Boards Risk Mgmt. Fund Mid-Century Ins. Co. Truck Ins. Exch. Farmers Ins. Exch. (Tex. App. 2003). “Tex. Lab. Code Ann. § 413.002 (West 1996).”

Texas Workers' Comp. Comm'n Richard Reynolds, in His Off. Capacity as Exec. Dir. of the Texas Workers' Comp. Comm'n/East Side Surgical Ctr. Clinic for Special Surgery & Surgical & Diagnostic Ctr., L.P. v. East Side Surgical Ctr. Clinic for Special Surgery/Texas Workers' Comp. Comm'n Richard Reynolds, in His Off. Capacity as Exec. Dir. of the Texas Workers' Comp. Comm'n (Tex. App. 2004). “See Tex. Lab. Code Ann. §§ 413.002 , .011, .031 (giving the Commission adjudicatory power over the resolution of fee disputes).”

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