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

Tex. Lab. Code § 413.042 (2026)

Private Claims; Administrative Violation

✓ current as of May 2026
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Sec. 413.042. PRIVATE CLAIMS; ADMINISTRATIVE VIOLATION. (a) A health care provider may not pursue a private claim against a workers' compensation claimant for all or part of the cost of a health care service provided to the claimant by the provider unless:

(1) the injury is finally adjudicated not compensable under this subtitle; or

(2) the employee violates Section 408.022 relating to the selection of a doctor and the doctor did not know of the violation at the time the services were rendered.

(b) A health care provider commits an administrative violation if the provider violates Subsection (a).

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

Amended by:

Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.248, eff. September 1, 2005.

Notes of Decisions
Cited in 8 cases, 2006–2020 · leading case: Daughters of Charity Health Servs. of Waco v. Linnstaedter, 226 S.W.3d 409 (Tex. 2007).
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Daughters of Charity Health Servs. of Waco v. Linnstaedter, 226 S.W.3d 409 (Tex. 2007). “Tex. Lab.Code § 413.042(a). The Code makes an exception for noncompensable injuries or treatment by nonapproved physicians, circumstances not involved here.”
Air Evac EMS, Inc. v. Sullivan, 331 F. Supp. 3d 650 (W.D. Tex. 2018). · cites it 2× “" TEX. LAB. CODE § 413.042. If a workers' compensation insurer pays less than a service provider's billed charges, the service provider may file a medical fee dispute with the DWC.”
Hays & Martin, L.L.P. v. Ubinas-Brache, 192 S.W.3d 631 (Tex. App. 2006). “See Tex. Lab.Code Ann. § 413.042 (Vernon 2006).”
PHI Air Med., LLC v. Tex. Mut. Ins. Co., 549 S.W.3d 804 (Tex. App. 2018). “Tex. Lab. Code § 413.042(a). However, in its reply brief, it states that it only attacks the balance-billing provision in the alternative and that it would prefer to see that provision left intact while the provisions related to the reimbursement schedule are struck.”
Larry Dean Speegle v. Harris Methodist Health Sys. & Harris Methodist Fort Worth, 303 S.W.3d 32 (Tex. App. 2009). “(citing Tex. Lab.Code Ann. § 413.042(a) (Vernon 2006) (providing that hospitals "may not pursue a private claim against a workers’ compensation claimant” for all or part of the costs of treatment)).”
In Re Texas Mut. Ins. Co., 329 S.W.3d 1 (Tex. App. 2009). “See Tex Lab. Code Ann. § 413.042(a)(1). 3 . In addition, Hernandez's claim is made no more viable simply by restating it under the other legal theories he has asserted in the trial court.”
Texas Mut. Ins. Co., Hartford Underwriters Ins. Co., Tasb Risk Mgmt. Fund, Transp. Ins. Co., Truck Ins. Exch., Twin City Fire Ins. Co., Valley Forge Ins. Co. v. Phi Air Med., LLC (Tex. 2020). “And notably, but for the balance-billing prohibition that prevents a health care provider from recouping the remainder of the unpaid bill from the injured employee, see TEX. LAB. CODE § 413.042, any additional payment would be sought from the injured employee and not the…”
Larry Dean Speegle v. Harris Methodist Health Sys. & Harris Methodist Fort Worth (Tex. App. 2009). “(citing Tex. Lab. Code Ann. § 413.042 (a) (Vernon 2006) (providing that hospitals “may not pursue a private claim against a workers’ compensation claimant” for all or part of the costs of treatment)).”
— Tex. Lab. Code § 413.042(a) — 4 cases
Daughters of Charity Health Servs. of Waco v. Linnstaedter, 226 S.W.3d 409 (Tex. 2007). “Tex. Lab.Code § 413.042(a). The Code makes an exception for noncompensable injuries or treatment by nonapproved physicians, circumstances not involved here.”
PHI Air Med., LLC v. Tex. Mut. Ins. Co., 549 S.W.3d 804 (Tex. App. 2018). “Tex. Lab. Code § 413.042(a). However, in its reply brief, it states that it only attacks the balance-billing provision in the alternative and that it would prefer to see that provision left intact while the provisions related to the reimbursement schedule are struck.”
Air Evac EMS, Inc. v. Sullivan, 331 F. Supp. 3d 650 (W.D. Tex. 2018). “" TEX. LAB. CODE § 413.042. If a workers' compensation insurer pays less than a service provider's billed charges, the service provider may file a medical fee dispute with the DWC.”
Larry Dean Speegle v. Harris Methodist Health Sys. & Harris Methodist Fort Worth, 303 S.W.3d 32 (Tex. App. 2009). “(citing Tex. Lab.Code Ann. § 413.042(a) (Vernon 2006) (providing that hospitals "may not pursue a private claim against a workers’ compensation claimant” for all or part of the costs of treatment)).”
— Tex. Lab. Code § 413.042(a)(1) — 1 case
In Re Texas Mut. Ins. Co., 329 S.W.3d 1 (Tex. App. 2009). “See Tex Lab. Code Ann. § 413.042(a)(1). 3 . In addition, Hernandez's claim is made no more viable simply by restating it under the other legal theories he has asserted in the trial court.”
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