§ 140.009.Construction of Chapter

Two clarifications in one sentence, doing different work.

First: this chapter does not create a cause of action. The chapter regulates a right that arises from contract, and supplies no claim of its own.

So a covered individual who believes a payor has taken too much does not sue under this chapter. They resist the payor’s claim, or seek a declaration — which is why the declaratory judgment fee prohibition sits where it does.

Second: nothing prevents a payor from waiving, negotiating, or not pursuing any claim or recovery the chapter addresses.

That preserves the negotiation by which these cases are mostly resolved. Subrogation claims are compromised routinely — a plan takes less than its cap to settle quickly, or waives entirely where the recovery is small and the injured person’s needs are large.

The clarification forecloses an argument the cap might otherwise invite: that a statutory entitlement is a floor as well as a ceiling, or that a plan owes some duty to its other members to collect the maximum.

The cap is a limit on what a payor may take, not an instruction to take it.

The same no-cause-of-action formula appears through this part of the code — in the pandemic liability, food consumption, negligent hiring and wellness program chapters — and means the same thing in each: the chapter shapes claims arising elsewhere.