28 TAC § 12.6. Independent Review of Adverse Determinations of Health Care Provided Under Labor Code Title 5 or Insurance Code Chapter 1305

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Texas Administrative Code › Title 28 INSURANCE › Part 1 TEXAS DEPARTMENT OF INSURANCE › Chapter 12 INDEPENDENT REVIEW ORGANIZATIONS › 28 TAC § 12.6

This text was captured on Aug 14, 2026. It is a snapshot, not a live feed, so check the official code before relying on it.

Text

(a) Review of the medical necessity or appropriateness of a health care service provided under Labor Code Chapter 408 or Chapter 413 must be conducted under this chapter in the same manner as reviews of utilization review decisions by health maintenance organizations.

(b) Notwithstanding subsection (a) of this section, for independent review of adverse determinations of health care provided under Labor Code Title 5 or Insurance Code Chapter 1305:

(1) IROs and personnel conducting independent review must comply with Labor Code Title 5 and applicable TDI-DWC rules;

(2) in the event of a conflict between this chapter and the Labor Code, the Labor Code controls; and

(3) in the event of a conflict between this chapter and TDI-DWC rules, TDI-DWC rules control.

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.