Tex. Codes » Labor Code · TITLE 5. WORKERS' COMPENSATION · SUBTITLE A. TEXAS WORKERS' COMPENSATION ACT · CHAPTER 413. MEDICAL REVIEW
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Tex. Lab. Code § 413.013 (2026)

Programs

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Sec. 413.013. PROGRAMS. The commissioner by rule shall establish:

(1) a program for prospective, concurrent, and retrospective review and resolution of a dispute regarding health care treatments and services;

(2) a program for the systematic monitoring of the necessity of treatments administered and fees charged and paid for medical treatments or services, including the authorization of prospective, concurrent, or retrospective review under the medical policies of the division to ensure that the medical policies or guidelines are not exceeded;

(3) a program to detect practices and patterns by insurance carriers in unreasonably denying authorization of payment for medical services requested or performed if authorization is required by the medical policies of the division; and

(4) a program to increase the intensity of review for compliance with the medical policies or fee guidelines for any health care provider that has established a practice or pattern in charges and treatments inconsistent with the medical policies and fee guidelines.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.235, eff. September 1, 2005.

Notes of Decisions
Cited in 10 cases (1 in the last 5 years), 2002–2022 · 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× “See Tex. Lab.Code §§ 413.013(1), 413.031(a); 28 Tex.”
Howell v. Texas Workers' Comp. Comm'n, 143 S.W.3d 416 (Tex. App.—Austin 2004). · cites it 2× “” Tex. Lab.Code Ann. § 413.013(1) (West 1996).”
Patient Advocates v. Texas Workers Comp. Comm'n, 80 S.W.3d 66 (Tex. App.—Austin 2002). · cites it 2× “See Tex. Lab.Code Ann. § 413.013. Advocates contends that the Commission's delegation of auditing powers violates the Act's provisions and case law concerning the delegation of governmental powers to private entities.”
Schade v. Texas Workers' Comp. Comm'n, 150 S.W.3d 542 (Tex. App.—Austin 2004). · cites it 2× “” Tex. Lab.Code Ann. § 413.013 (West 1996).”
Robert S. Howell, D.C. First Rio Valley Med., P.A. Keith Gilbert William Maxwell & Gilbert & Maxwell, P.L.L.C. v. Texas Workers' Comp. Comm'n Envoy Med. Sys., L.L.C., No. 03-03-00381-CV (Tex. App.—Austin Aug. 12, 2004). · cites it 2× “" Tex. Lab. Code Ann. § 413.013 (1) (West 1996).”
Chris M. Schade v. Texas Workers' Comp. Comm'n & Richard F. Reynolds, No. 03-03-00379-CV (Tex. App.—Austin Apr. 8, 2004). · cites it 2× “Compare Tex. Lab. Code Ann. § 413.013 (2) (West 1996),5 and id.”
Chris M. Schade v. Texas Workers' Comp. Comm'n & Richard F. Reynolds, No. 03-03-00379-CV (Tex. App.—Austin Apr. 8, 2004). · cites it 2× “Compare Tex. Lab. Code Ann. § 413.013 (2) (West 1996), (5) and id .”
Vista Med. Ctr. Hosp. v. Texas Mut. Ins. Co., No. 03-21-00242-CV (Tex. App.—Austin Dec. 28, 2022). “See Tex. Lab. Code § 413.013(k-1) (“Judicial review under this subsection shall be conducted in the manner provided for judicial review of a contested case under Subchapter G, Chapter 2001, Government Code[.”
Patient Advocates of Texas & Allen J. Meril v. Texas Workers Comp. Comm'n Leonard Riley, No. 03-01-00215-CV (Tex. App.—Austin Apr. 25, 2002). “See Tex. Lab. Code Ann. § 413.013 . Advocates contends that the Commission's delegation of auditing powers violates the Act's provisions and case law concerning the delegation of governmental powers to private entities.”
Robert S. Howell, D.C. First Rio Valley Med., P.A. Keith Gilbert William Maxwell & Gilbert & Maxwell, P.L.L.C. v. Texas Workers' Comp. Comm'n Envoy Med. Sys., L.L.C., No. 03-03-00381-CV (Tex. App.—Austin Aug. 12, 2004). “” Tex. Lab. Code Ann. § 413.013 (1) (West 1996).”
Tex. Lab. Code § 413.013(1): 2 cases
Texas Workers' Comp. Comm'n v. Patient Advocates of Texas, 136 S.W.3d 643 (Tex. 2004). “See Tex. Lab.Code §§ 413.013(1), 413.031(a); 28 Tex.”
Howell v. Texas Workers' Comp. Comm'n, 143 S.W.3d 416 (Tex. App.—Austin 2004). “” Tex. Lab.Code Ann. § 413.013(1) (West 1996).”
Tex. Lab. Code § 413.013(2): 1 case
Schade v. Texas Workers' Comp. Comm'n, 150 S.W.3d 542 (Tex. App.—Austin 2004). “” Tex. Lab.Code Ann. § 413.013 (West 1996).”
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