By Holzheauser H.B. No. 1893
74R6079 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the powers and duties of an ombudsman under the Texas
1-3 Workers' Compensation Act.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter C, Chapter 409, Labor Code, is amended
1-6 to read as follows:
1-7 SUBCHAPTER C. OMBUDSMAN PROGRAM
1-8 Sec. 409.041. OMBUDSMAN PROGRAM; DUTIES OF OMBUDSMAN
1-9 <ADMINISTRATIVE VIOLATION>. (a) The commission shall maintain an
1-10 ombudsman program as provided by this subchapter to assist injured
1-11 workers and persons claiming death benefits in obtaining benefits
1-12 under this subtitle.
1-13 (b) An ombudsman shall:
1-14 (1) meet with or otherwise provide information to
1-15 injured workers;
1-16 (2) investigate complaints;
1-17 (3) communicate with employers, insurance carriers,
1-18 and health care providers on behalf of injured workers; and
1-19 (4) assist unrepresented claimants, employers, and
1-20 other parties to enable those persons to protect their rights in
1-21 the workers' compensation system.
1-22 (c) To fulfill the duties imposed under Subsection (b), an
1-23 ombudsman may:
1-24 (1) assist participants in the workers' compensation
2-1 system to properly complete required forms;
2-2 (2) contact unrepresented employees when a benefit
2-3 review conference is requested and explain the process under this
2-4 subtitle as well as the services provided by the ombudsman;
2-5 (3) assist an injured worker by:
2-6 (A) explaining the need to state the worker's
2-7 position in a dispute; and
2-8 (B) helping the worker to prepare a checklist
2-9 specific to the issues in question;
2-10 (4) assist an injured worker who needs additional help
2-11 to:
2-12 (A) prepare and present facts; and
2-13 (B) gather reports and other evidence; and
2-14 (5) attend benefit review conferences, contested case
2-15 hearings, and arbitration proceedings conducted under Chapter 410.
2-16 (d) At a benefit review conference, contested case hearing,
2-17 or arbitration proceeding, an ombudsman may assist an injured
2-18 worker by:
2-19 (1) presenting factual information;
2-20 (2) reviewing information presented by the opposing
2-21 party;
2-22 (3) questioning a witness who presents information or
2-23 testifies;
2-24 (4) raising evidentiary questions;
2-25 (5) raising questions on the propriety of actions
2-26 taken on behalf of the injured worker; and
2-27 (6) if appropriate, making a summary statement.
3-1 (e) After a contested case hearing, an ombudsman may assist
3-2 an unrepresented injured worker who wishes to appeal by explaining
3-3 the time requirements imposed under this subtitle and other appeal
3-4 requirements.
3-5 (f) After an appeals panel decision is issued, an ombudsman
3-6 may assist an unrepresented injured worker who wishes to seek
3-7 judicial review of the decision by explaining the time requirements
3-8 imposed under this subtitle, venue requirements, and the
3-9 requirement to file a copy of the petition with the commission and
3-10 opposing party.
3-11 Sec. 409.042. PROHIBITED ACTIVITIES. An ombudsman may not:
3-12 (1) represent an injured worker who is not represented
3-13 by an attorney or other person at an administrative proceeding;
3-14 (2) discuss a case in an off-the-record conversation
3-15 with the benefit review officer or hearings officer presiding over
3-16 that case;
3-17 (3) sign an agreement for any participant;
3-18 (4) give legal advice to any participant;
3-19 (5) make required decisions for any participant; or
3-20 (6) instruct the benefit review officer or hearings
3-21 officer presiding over a case as to how to decide the case.
3-22 Sec. 409.043. DESIGNATION AS OMBUDSMAN. At least one
3-23 specially qualified employee in each commission office shall be
3-24 designated an ombudsman who shall perform the duties imposed under
3-25 this subchapter <section> as the person's primary responsibility.
3-26 Sec. 409.044. EMPLOYER NOTIFICATION; ADMINISTRATIVE
3-27 VIOLATION. (a) <(d)> Each employer shall notify its employees of
4-1 the ombudsman program in a manner prescribed by the commission.
4-2 (b) An employer commits a violation if the employer fails to
4-3 comply with this section <subsection>. A violation under this
4-4 section <subsection> is a Class C administrative violation.
4-5 Sec. 409.045 <409.042>. PUBLIC INFORMATION. The commission
4-6 shall widely disseminate information about the ombudsman program.
4-7 SECTION 2. Section 410.026(a), Labor Code, is amended to
4-8 read as follows:
4-9 (a) A benefit review officer shall:
4-10 (1) mediate disputes between the parties and assist in
4-11 the adjustment of the claim consistent with this subtitle and the
4-12 policies of the commission;
4-13 (2) thoroughly inform all parties of their rights and
4-14 responsibilities under this subtitle, especially in a case in which
4-15 the employee is not represented by an attorney or other
4-16 representative; <and>
4-17 (3) ensure that all documents and information relating
4-18 to the employee's wages, medical condition, and any other
4-19 information pertinent to the resolution of disputed issues are
4-20 contained in the claim file at the conference, especially in a case
4-21 in which the employee is not represented by an attorney or other
4-22 representative; and
4-23 (4) ensure that an employee who is not represented by
4-24 an attorney is assisted by an ombudsman to the extent authorized
4-25 under Subchapter C, Chapter 409.
4-26 SECTION 3. Section 410.103, Labor Code, is amended to read
4-27 as follows:
5-1 Sec. 410.103. DUTIES OF ARBITRATOR. (a) An arbitrator
5-2 shall:
5-3 (1) protect the interests of all parties;
5-4 (2) ensure that all relevant evidence has been
5-5 disclosed to the arbitrator and to all parties; and
5-6 (3) render an award consistent with this subtitle and
5-7 the policies of the commission.
5-8 (b) An arbitrator shall ensure that an employee who is not
5-9 represented by an attorney is assisted by an ombudsman to the
5-10 extent authorized under Subchapter C, Chapter 409.
5-11 SECTION 4. Section 410.163, Labor Code, is amended by adding
5-12 Subsection (c) to read as follows:
5-13 (c) A hearings officer shall ensure that an employee who is
5-14 not represented by an attorney is assisted by an ombudsman to the
5-15 extent authorized under Subchapter C, Chapter 409.
5-16 SECTION 5. This Act takes effect September 1, 1995.
5-17 SECTION 6. The importance of this legislation and the
5-18 crowded condition of the calendars in both houses create an
5-19 emergency and an imperative public necessity that the
5-20 constitutional rule requiring bills to be read on three several
5-21 days in each house be suspended, and this rule is hereby suspended.