Bill Text: TX HB790 | 2023-2024 | 88th Legislature | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the processes for and the adjudication and payment of certain claims under the workers' compensation system.
Spectrum: Moderate Partisan Bill (Republican 6-1)
Status: (Engrossed - Dead) 2023-04-26 - Referred to Business & Commerce [HB790 Detail]
Download: Texas-2023-HB790-Comm_Sub.html
Bill Title: Relating to the processes for and the adjudication and payment of certain claims under the workers' compensation system.
Spectrum: Moderate Partisan Bill (Republican 6-1)
Status: (Engrossed - Dead) 2023-04-26 - Referred to Business & Commerce [HB790 Detail]
Download: Texas-2023-HB790-Comm_Sub.html
88R20088 KKR-F | |||
By: Patterson, Longoria, Frazier, Thimesch, | H.B. No. 790 | ||
Isaac | |||
Substitute the following for H.B. No. 790: | |||
By: Vasut | C.S.H.B. No. 790 |
|
||
|
||
relating to the processes for and the adjudication and payment of | ||
certain claims under the workers' compensation system. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 408.0042, Labor Code, is amended by | ||
amending Subsections (a), (c), (d), (e), and (f) and adding | ||
Subsection (a-1) to read as follows: | ||
(a) Subject to Subsection (a-1), the [ |
||
require an injured employee to submit to a single medical | ||
examination to define the compensable injury on request by the | ||
insurance carrier. | ||
(a-1) In this subsection, the terms "custodial officer," | ||
"detention officer," "emergency medical technician," | ||
"firefighter," and "peace officer" have the meanings assigned by | ||
Section 607.051, Government Code. On request by an injured | ||
employee who is a custodial officer, a detention officer, an | ||
emergency medical technician, a firefighter, or a peace officer, | ||
the division may authorize the performance of a medical examination | ||
to define the compensable injury, regardless of whether an | ||
examination under Subsection (a) was previously performed. | ||
(c) After a [ |
||
Subsection (a) or (a-1), the treating doctor shall submit to the | ||
insurance carrier a report that details all injuries and diagnoses | ||
related to the compensable injury, on receipt of which the | ||
insurance carrier shall: | ||
(1) accept all injuries and diagnoses as related to | ||
the compensable injury; or | ||
(2) dispute the determination of specific injuries and | ||
diagnoses. | ||
(d) Any treatment for an injury or diagnosis that is not | ||
accepted by the insurance carrier under Subsection (c) as | ||
compensable at the time of the medical examination under Subsection | ||
(a) or (a-1) must be preauthorized before treatment is rendered. If | ||
the insurance carrier denies preauthorization because the | ||
treatment is for an injury or diagnosis unrelated to the | ||
compensable injury, the injured employee or affected health care | ||
provider may file an extent of injury dispute. | ||
(e) Any treatment for an injury or diagnosis that is | ||
accepted by the insurance carrier under Subsection (c) as | ||
compensable at the time of the medical examination under Subsection | ||
(a) or (a-1) may not be reviewed for compensability, but may be | ||
reviewed for medical necessity. | ||
(f) The commissioner may adopt rules relating to | ||
requirements for: | ||
(1) a request for an examination under Subsection (a) | ||
or (a-1); or | ||
(2) a report under this section, including | ||
requirements regarding the contents of a report. | ||
SECTION 2. Section 409.021, Labor Code, is amended by | ||
amending Subsection (a-1) and adding Subsection (a-4) to read as | ||
follows: | ||
(a-1) An insurance carrier that fails to comply with | ||
Subsection (a) or (a-4) does not waive the carrier's right to | ||
contest the compensability of the injury as provided by Subsection | ||
(c) but commits an administrative violation subject to Subsection | ||
(e). | ||
(a-4) In this subsection, the terms "custodial officer," | ||
"detention officer," "emergency medical technician," | ||
"firefighter," and "peace officer" have the meanings assigned by | ||
Section 607.051, Government Code. Notwithstanding any other | ||
provision of this title, if an insurance carrier fails to begin | ||
payment or provide notice as required by Subsection (a) on or before | ||
the 60th day after the date the carrier receives written notice of | ||
an injury of a custodial officer, a detention officer, an emergency | ||
medical technician, a firefighter, or a peace officer, the carrier | ||
waives its right to contest the extent of the injury specifically | ||
claimed by the employee or reasonably reflected in the employee's | ||
medical records available to the carrier for review during that | ||
time period. | ||
SECTION 3. Section 409.022, Labor Code, is amended by | ||
adding Subsections (c-1) and (c-2) and amending Subsection (d) to | ||
read as follows: | ||
(c-1) For purposes of [ |
||
the terms "custodial officer," "detention officer," "emergency | ||
medical technician," "firefighter," and "peace officer" have the | ||
meanings assigned by Section 607.051, Government Code. | ||
(c-2) In addition to the other requirements of this section, | ||
an insurance carrier's notice of refusal to pay benefits under | ||
Section 409.021 sent in response to a claim for compensation by an | ||
injured employee who is a custodial officer, a detention officer, | ||
an emergency medical technician, a firefighter, or a peace officer | ||
must include a statement by the carrier that: | ||
(1) for purposes of Subsection (a), includes the | ||
specific reasons why the carrier is disputing the compensability of | ||
the injury or the extent of injury; and | ||
(2) describes the evidence that the carrier reviewed | ||
in making the determination to dispute the issue under Subdivision | ||
(1). | ||
(d) In addition to the other requirements of this section, | ||
if an insurance carrier's notice of refusal to pay benefits under | ||
Section 409.021 is sent in response to a claim for compensation | ||
resulting from a custodial officer's, a detention officer's, an | ||
emergency medical technician's, a firefighter's, or a peace | ||
officer's disability or death for which a presumption is claimed to | ||
be applicable under Subchapter B, Chapter 607, Government Code, the | ||
notice must include a statement by the carrier that: | ||
(1) explains why the carrier determined a presumption | ||
under that subchapter does not apply to the claim for compensation; | ||
and | ||
(2) describes the evidence that the carrier reviewed | ||
in making the determination described by Subdivision (1). | ||
SECTION 4. Section 410.005(a), Labor Code, is amended to | ||
read as follows: | ||
(a) A [ |
||
hearing may not be conducted at a site more than 75 miles from the | ||
claimant's residence at the time of the injury unless: | ||
(1) the division determines that good cause exists for | ||
the selection of a different location; or | ||
(2) the contested case hearing is conducted by | ||
videoconference as provided by Section 410.0055. | ||
SECTION 5. Subchapter A, Chapter 410, Labor Code, is | ||
amended by adding Section 410.0055 to read as follows: | ||
Sec. 410.0055. CONDUCTING CERTAIN CONTESTED CASE HEARINGS | ||
BY VIDEOCONFERENCE. (a) In this section, the terms "custodial | ||
officer," "detention officer," "emergency medical technician," | ||
"firefighter," and "peace officer" have the meanings assigned by | ||
Section 607.051, Government Code. | ||
(b) The division shall conduct a contested case hearing by | ||
videoconference on request of: | ||
(1) an injured employee who is a custodial officer, a | ||
detention officer, an emergency medical technician, a firefighter, | ||
or a peace officer; or | ||
(2) the attorney of an injured employee described by | ||
Subdivision (1). | ||
SECTION 6. Subchapter D, Chapter 410, Labor Code, is | ||
amended by adding Section 410.170 to read as follows: | ||
Sec. 410.170. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN | ||
MEDICAL EXPENSES. (a) In this section, the terms "custodial | ||
officer," "detention officer," "emergency medical technician," | ||
"firefighter," and "peace officer" have the meanings assigned by | ||
Section 607.051, Government Code. | ||
(b) Notwithstanding the amount of an award of benefits due | ||
in a written decision by an administrative law judge under Section | ||
410.168, an insurance carrier shall reimburse an injured employee | ||
who is a custodial officer, a detention officer, an emergency | ||
medical technician, a firefighter, or a peace officer for all | ||
medical expenses incurred by the employee that are related to the | ||
specific injury claimed by the employee if: | ||
(1) the carrier denied the employee's claim for | ||
medical benefits on or before the 60th day after the carrier had | ||
reasonable notice of the specific injury claimed by the employee; | ||
(2) the decision of the administrative law judge | ||
includes a determination that the injury is compensable; and | ||
(3) the decision of the administrative law judge is | ||
not appealed to the appeals panel and becomes final. | ||
SECTION 7. Subchapter E, Chapter 410, Labor Code, is | ||
amended by adding Section 410.2051 to read as follows: | ||
Sec. 410.2051. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN | ||
MEDICAL EXPENSES. (a) In this section, the terms "custodial | ||
officer," "detention officer," "emergency medical technician," | ||
"firefighter," and "peace officer" have the meanings assigned by | ||
Section 607.051, Government Code. | ||
(b) An insurance carrier shall directly reimburse an | ||
injured employee who is a custodial officer, a detention officer, | ||
an emergency medical technician, a firefighter, or a peace officer | ||
for all medical expenses incurred by the employee that are related | ||
to the specific injury claimed by the employee if: | ||
(1) the carrier denied the employee's claim for | ||
medical benefits on or before the 60th day after the carrier had | ||
reasonable notice of the specific injury claimed by the employee; | ||
and | ||
(2) either: | ||
(A) the administrative law judge's determination | ||
that benefits are owed becomes final without an appeal; or | ||
(B) the appeals panel: | ||
(i) affirms the administrative law judge's | ||
determination that the benefits are owed; or | ||
(ii) reverses the administrative law | ||
judge's determination that the benefits are not owed. | ||
(c) If the appeals panel affirms the administrative law | ||
judge's determination that the benefits are owed, the insurance | ||
carrier shall directly reimburse the employee for all medical | ||
expenses incurred by the employee that are related to the specific | ||
injury claimed by the employee, regardless of the amount of an award | ||
of benefits due in the written decision by the administrative law | ||
judge under Section 410.168. | ||
(d) The insurance carrier must reimburse the injured | ||
employee under Subsection (b), regardless of whether the appeals | ||
panel's decision is appealed for judicial review. | ||
SECTION 8. (a) Except as provided by Subsection (b) of this | ||
section, the changes in law made by this Act apply only to a claim | ||
for workers' compensation benefits based on a compensable injury | ||
that occurs on or after the effective date of this Act. A claim | ||
based on a compensable injury that occurs before that date is | ||
governed by the law as it existed on the date the compensable injury | ||
occurred, and the former law is continued in effect for that | ||
purpose. | ||
(b) Section 410.0055, Labor Code, as added by this Act, | ||
applies to a contested case hearing held on or after the effective | ||
date of this Act. | ||
SECTION 9. This Act takes effect September 1, 2023. |