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What are my responsibilities as an employer under Workers' Compensation Networks?

The insurance carrier must provide the employer with Notice of Network Requirements (Notice) which must be provided to employees in the manner and at the times prescribed under TIC §1305.005 and 28 TAC §10.60. The employer or carrier is required to deliver the Notice and Acknowledgment to current employees, new hires no later than the third day of hire, or upon notification of an injury. The Notice addresses the responsibilities of the network, explains their processes and notifies an employee of their rights; for example the Notice should contain information such as:

  • The certified WC Network's toll-free number and address.
  • How an injured employee should obtain emergency care and after hours care.
  • Information on filing a complaint with the Texas Department of Insurance about any aspect of dissatisfaction involving the network.
  • An explanation on how to choose treating doctors and how often the network's list of doctors is updated.
  • An explanation regarding the receipt of all healthcare services including referrals to specialist no later than 21 days from the date of request as required by 28 TAC §10.60(g)(15). For a complete listing of language that must be included in the Notice, see 28 TAC §10.60(g).

The employee acknowledges receipt of the Notice by signing the Acknowledgment Form. The employer or carrier is required to keep record of acknowledgement forms containing the signature(s) of notified employees. The acknowledgment is required to include language such as:

  • A statement that the employee has received information explaining the employee's responsibilities in relation to obtaining health care under workers' compensation coverage.
  • A statement explaining with the exception of emergency care all health care and specialist referrals must be obtained through the treating doctor.
  • A statement explaining the employee must select a treating doctor from the network's list of contracted doctors. For a complete listing of language that must be included in the Acknowledgment, see 28 TAC §10.60(c)-(h).

An injured employee is not required to use the WC network if the employer or carrier fails to deliver the Notice and Acknowledgement form. If an employee receives the Notice and refuses to sign the Acknowledgment they are still required to use the network, the employer or carrier must maintain proof that the Notice was delivered. The employer or carrier is also required to document the date and method in which the Notice and Acknowledgment were delivered, for additional information see 28 TAC §10.60(h).

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Last updated: 03/03/2015

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