Tex. Codes » Labor Code · TITLE 5. WORKERS' COMPENSATION · SUBTITLE A. TEXAS WORKERS' COMPENSATION ACT · CHAPTER 413. MEDICAL REVIEW
Texas Codes

Tex. Lab. Code § 413.015 (2026)

Payment By Insurance Carriers; Audit And Review

✓ laws through the 89th Legislature (2025)
Find cases: SyfertCases citing this section TX-LEGstatutes.capitol.texas.gov Justiaon Justia CornellLII Search CasesGoogle Scholar

Sec. 413.015. PAYMENT BY INSURANCE CARRIERS; AUDIT AND REVIEW. (a) Insurance carriers shall make appropriate payment of charges for medical services provided under this subtitle. An insurance carrier may contract with a separate entity to forward payments for medical services. Any payment due the insurance carrier from the separate entity must be made in accordance with the contract. The separate entity is subject to the direction of the insurance carrier, and the insurance carrier is responsible for the actions of the separate entity under this subsection.

(b) The commissioner shall provide by rule for the review and audit of the payment by insurance carriers of charges for medical services provided under this subtitle to ensure compliance of health care providers and insurance carriers with the medical policies and fee guidelines adopted by the commissioner.

(c) The rules must require the insurance carrier to pay the expenses of the review and audit.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 2001, 77th Leg., ch. 1456, Sec. 6.03, eff. June 17, 2001.

Amended by:

Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.238, eff. September 1, 2005.

Notes of Decisions
Cited in 8 cases (1 in the last 5 years), 2002–2022 · leading case: Patient Advocates v. Texas Workers Comp. Comm'n, 80 S.W.3d 66 (Tex. App.—Austin 2002).
Sort: Relevance Newest Treatment
Patient Advocates v. Texas Workers Comp. Comm'n, 80 S.W.3d 66 (Tex. App.—Austin 2002). · cites it 2× “Tex. Lab.Code Ann. § 413.015(b). Advocates argues that, while the Act provides the authority for the Commission to conduct audits of insurance carriers, the Legislature did not expressly or implicitly grant the Commission the power to delegate any audit powers to insurance…”
Apollo Enter., Inc. v. Scripnet, Inc., 301 S.W.3d 848 (Tex. App.—Austin 2009). “307 (d)(2); see also Tex. Lab.Code Ann. § 413.015(a) (“An insurance carrier may contract with a separate entity to forward payments for medical services.”
Vista Med. Ctr. Hosp. v. Texas Mut. Ins. Co., No. 03-21-00242-CV (Tex. App.—Austin Dec. 28, 2022). “Tex. Lab. Code § 413.015(a).2 In 1989, the legislature required the Division of Workers’ Compensation in the Texas Department of Insurance (Division) to promulgate reimbursement guidelines to ensure the quality of medical care without unnecessary expense to insurance carriers.”
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). “Tex. Lab. Code Ann. § 413.015 (b). Advocates argues that, while the Act provides the authority for the Commission to conduct audits of insurance carriers, the Legislature did not expressly or implicitly grant the Commission the power to delegate any audit powers to insurance…”
Chris M. Schade v. Texas Workers' Comp. Comm'n & Richard F. Reynolds, No. 03-03-00379-CV (Tex. App.—Austin Apr. 8, 2004). “See Tex. Lab. Code Ann. §§ 413.015 , 414.002 (West 1996); 28 Tex.”
Chris M. Schade v. Texas Workers' Comp. Comm'n & Richard F. Reynolds, No. 03-03-00379-CV (Tex. App.—Austin Apr. 8, 2004). “See Tex. Lab. Code Ann. §§ 413.015 , 414.002 (West 1996); 28 Tex.”
Apollo Enter., Inc. v. ScripNet, Inc., No. 03-07-00551-CV (Tex. App.—Austin Dec. 4, 2009). “307 (d)(2); see also Tex. Lab. Code Ann. § 413.015 (a) (“An insurance carrier may contract with a separate entity to forward payments for medical services .”
Apollo Enter., Inc. v. ScripNet, Inc., No. 03-07-00551-CV (Tex. App.—Austin Dec. 4, 2009). “307 (d)(2); see also Tex. Lab. Code Ann. § 413.015 (a) ("An insurance carrier may contract with a separate entity to forward payments for medical services .”
Tex. Lab. Code § 413.015(a): 2 cases
Apollo Enter., Inc. v. Scripnet, Inc., 301 S.W.3d 848 (Tex. App.—Austin 2009). “307 (d)(2); see also Tex. Lab.Code Ann. § 413.015(a) (“An insurance carrier may contract with a separate entity to forward payments for medical services.”
Vista Med. Ctr. Hosp. v. Texas Mut. Ins. Co., No. 03-21-00242-CV (Tex. App.—Austin Dec. 28, 2022). “Tex. Lab. Code § 413.015(a).2 In 1989, the legislature required the Division of Workers’ Compensation in the Texas Department of Insurance (Division) to promulgate reimbursement guidelines to ensure the quality of medical care without unnecessary expense to insurance carriers.”
Tex. Lab. Code § 413.015(b): 1 case
Patient Advocates v. Texas Workers Comp. Comm'n, 80 S.W.3d 66 (Tex. App.—Austin 2002). “Tex. Lab.Code Ann. § 413.015(b). Advocates argues that, while the Act provides the authority for the Commission to conduct audits of insurance carriers, the Legislature did not expressly or implicitly grant the Commission the power to delegate any audit powers to insurance…”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.