The purpose of this webpage is to provide information about the "Notice of Network Requirements; Employee Information (Notice) and Acknowledgement Form. You will find excerpts which contain rules and statutes that govern the issuance of the Notice and Acknowledgement Form. You will also find a sample Acknowledgement Form.
When an injury occurs on the job an employee may be able to obtain medical care for that injury if their employer has elected to offer Workers' Compensation (WC) coverage through a certified network. The state of Texas has established rules and statutes that govern WC Networks (WCNet); as a result employers and networks are required to follow specific protocol when handling a new employee or an injured employee. One of these protocols is the issuance of the "Notice of Network Requirements" (Notice). If your employer has WC coverage, your employer is required to give you a copy of the Notice via paper or electronically no later than the 3rd day of hire, or after you have notified the employer of a compensable injury. Your employer must maintain proof that you were notified of it's participation in a WCNet by obtaining a signed Acknowledgement Form (Sample Acknowledgement Form).
The Notice addresses the responsibilities of the network and your rights as an injured employee, for example the Notice should contain information such as:
- The certified Network's toll-free number and address.
- What to do if services are not available in the area that you reside.
- How to obtain emergency care and after hours care.
- A list of medical services that require pre-approval by the network.
- An explanation about medical billing for in-network and out-of-network care.
- Information on filing a complaint with the Texas Department of Insurance about the Network.
- An explanation on how to choose treating doctors and how often their list of doctors is updated.
- An explanation about your right to receive all healthcare services including referrals to specialist no than 21 days from the date of your request.
If you would like additional information on the requirements of the Notice, you may want to read the rule governing the Notice 28 Texas Administrative Code 10.60(g).