Tex. Lab. Code § 408.0272 · Subchapter B. MEDICAL BENEFITS
CERTAIN EXCEPTIONS FOR UNTIMELY SUBMISSION OF CLAIM.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) In this section:
(1) "Group accident and health insurance" has the meaning assigned by Chapter 1251, Insurance Code.
(2) "Health maintenance organization" has the meaning assigned by Chapter 843, Insurance Code.
(b) Notwithstanding Section 408.027, a health care provider who fails to timely submit a claim for payment to the insurance carrier under Section 408.027(a) does not forfeit the provider's right to reimbursement for that claim for payment solely for failure to submit a timely claim if:
(1) the provider submits proof satisfactory to the commissioner that the provider, within the period prescribed by Section 408.027(a), erroneously filed for reimbursement with:
(A) an insurer that issues a policy of group accident and health insurance under which the injured employee is a covered insured;
(B) a health maintenance organization that issues an evidence of coverage under which the injured employee is a covered enrollee; or
(C) a workers' compensation insurance carrier other than the insurance carrier liable for the payment of benefits under this title; or
(2) the commissioner determines that the failure resulted from a catastrophic event that substantially interfered with the normal business operations of the provider.
(c) Notwithstanding Subsection (b), a health care provider who erroneously submits a claim for payment to an entity described by Subdivision (1) of that subsection forfeits the provider's right to reimbursement for that claim if the provider fails to submit the claim to the correct workers' compensation insurance carrier within 95 days after the date the provider is notified of the provider's erroneous submission of the claim.
(d) Notwithstanding any other provision of this section or Section 408.027, the period for submitting a claim for payment may be extended by agreement of the parties.
Notes and commentary — not statutory text
History
Added by Acts 2007, 80th Leg., R.S., Ch. 459 (H.B. 1005), Sec. 1, eff. September 1, 2007.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/LA/htm/LA.408.htm
- Text hash
- sha256 271d6fc89029353fd35d5ff468cd24891ccdc949c8a4c963fbd667962fa3ae94
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
This section cites
Provisions in this library that the text above cites, as it prints each citation. A range cited as “ss. 61.13-61.16” links its first and last provisions.
Insurance Code
Cited by 1 provision
Provisions in this library whose text cites Tex. Lab. Code § 408.0272. Each shows the citation as that text prints it.
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.