Tex. Ins. Code Section 1305.356
Contested Case Hearing on and Judicial Review of Independent Review

(a)

A party to a medical dispute that remains unresolved after a review under Section 1305.355 (Independent Review of Adverse Determination) is entitled to a contested case hearing. A hearing under this subsection shall be conducted by the department’s division of workers’ compensation in the same manner as a hearing conducted under Section 413.0311 (Review of Medical Necessity Disputes; Contested Case Hearing), Labor Code.

(b)

At a contested case hearing held under Subsection (a), the administrative law judge conducting the hearing shall consider evidence-based treatment guidelines adopted by the network under Section 1305.304 (Guidelines and Protocols).

(c)

A party that has exhausted all administrative remedies under Subsection (a) and is aggrieved by a final decision of the department’s division of workers’ compensation may seek judicial review of the decision.

(d)

Judicial review under Subsection (c) shall be conducted in the manner provided for judicial review of a contested case under Subchapter G (Judicial Review), Chapter 2001 (Administrative Procedure), Government Code, and is governed by the substantial evidence rule.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), Sec. 3, eff. September 1, 2011.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 839 (H.B. 2111), Sec. 1, eff. September 1, 2017.

Source: Section 1305.356 — Contested Case Hearing on and Judicial Review of Independent Review, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1305.­htm#1305.­356 (accessed May 4, 2024).

1305.001
Short Title 1305.002
Purpose 1305.003
Limitations on Applicability 1305.004
Definitions 1305.005
Participation in Network 1305.006
Insurance Carrier Liability for Out-of-network Health Care 1305.007
Rules 1305.008
Administrator Certificate of Authority Required 1305.051
Certification Required 1305.052
Certificate Application 1305.053
Contents of Application 1305.054
Action on Application 1305.055
Use of Certain Insurance Terms by Network Prohibited 1305.056
Restraint of Trade 1305.101
Providing or Arranging for Health Care 1305.102
Management Contracts 1305.103
Treating Doctor 1305.104
Selection of Treating Doctor 1305.106
Payment of Health Care Provider 1305.107
Telephone Access 1305.151
Transfer of Risk 1305.152
Network Contracts with Providers 1305.153
Provider Reimbursement 1305.154
Network-carrier Contracts 1305.155
Compliance Requirements 1305.201
Network Financial Requirements 1305.251
Examination of Network 1305.252
Examination of Provider or Third Party 1305.301
Network Organization 1305.302
Accessibility and Availability Requirements 1305.303
Quality of Care Requirements 1305.304
Guidelines and Protocols 1305.351
Utilization Review in Network 1305.353
Notice of Certain Utilization Review Determinations 1305.354
Reconsideration of Adverse Determination 1305.355
Independent Review of Adverse Determination 1305.356
Contested Case Hearing on and Judicial Review of Independent Review 1305.401
Complaint System Required 1305.402
Complaint Initiation and Initial Response 1305.403
Record of Complaints 1305.404
Retaliatory Action Prohibited 1305.405
Posting of Information on Complaint Process Required 1305.451
Employee Information 1305.502
Consumer Report Cards 1305.503
Confidentiality Requirements 1305.551
Determination of Violation 1305.552
Disciplinary Actions 1305.1545
Restrictions on Payment and Reimbursement
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Accessed:
May 4, 2024

§ 1305.356’s source at texas​.gov