GQ Corner
Q. I have a Network claim that I have denied, but I received a few bills from the Network provider prior to my denial. Am I required to pay these bills?
A. According to Texas Labor Code Annotated Sec. 1305.153 (e), a carrier may not deny payment for health care services provided by a network provider before that notification on the grounds that the injury was not compensable. If the insurance carrier successfully contests compensability, the carrier is liable for health care provided before issuance of the notification required by this subsection, up to a maximum of $7,000.
Q. I have an injured employee who has not yet been released to return to work, and I am paying her Temporary Income Benefits. Yesterday I learned that she has been incarcerated for an unknown offense. Am I able to suspend benefits, or must I continue to pay TIBs?
A. Appeals Panel Decision number 120412 held that Disability is an economic concept. Thus, if an injured employee becomes incarcerated, the actual loss of wages is attributable to the incarceration and not the injury. As such, you may suspend TIBs.
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