GEC C.S.H.B. 3522 75(R) BILL ANALYSIS
BUSINESS & INDUSTRY
C.S.H.B. 3522
By: Rhodes
4-4-97
Committee Report (Substituted)
BACKGROUND
The authors of Senate Bill 1 knew that some provisions of the law would
have to be fine tuned as time passed, and observations could be made about
how the law was implemented. The Sunset process in 1995 helped alleviate
some of the problems. However, as more time has passed, problems in the
system remain that require changes to the law.
PURPOSE
This proposed legislation amends eight sections of the Texas Labor Code
that relate to the administration and enforcement of the workers'
compensation law by the Texas Workers' Compensation Commission
(commission). The modifications proposed by this bill:
- expand the definition of maximum medical improvement (MMI) to allow for
extension of 104-week period if application for extension based on spinal
surgery is made within 12 weeks prior to expiration of 104-week period;
requires commission to adopt rules to establish procedures for
requesting and disputing extension;
- expand the type of meetings and seminars for which commissioners
may be reimbursed;
- provide funding for the prosecution of workers' compensation insurance
fraud through the maintenance tax paid by insurance carriers and self-
insured; sets the maximum assessment at one-tenth of one percent; and
requires the commission to consider, in setting the maintenance tax,
the projected expenditures for fraud prosecution;
- change the eligibility requirement for ombudsmen to one year of
experience in the workers' compensation field; and
- create an administrative violation and penalty for a carrier's breach
of settlement agreement that establishes a compliance plan.
RULEMAKING AUTHORITY
The bill delegates rulemaking authority to the commission in SECTION
5-Section 408.104.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Section 401.011(30)(B), Texas Labor Code, by expanding
the definition of maximum medical improvement to include that which is
provided in Section 408.104.
SECTION 2. Amends Section 402.011, Texas Labor Code, by:
1. amending subsection (b) to expand the types of meetings for which the
TWCC commissioners may be reimbursed for lost wages, if any;
2. amending subsection (c) to provide for reimbursement of services
provided under subsection (b); and
3. adding a new subsection (d) that entitles a commissioner to
reimbursement for actual and necessary expenses to attend not more than 5
seminars a year if the commissioner is an invited participant at the
seminar or if the commissioner's attendance is approved by the chair of
the commission.
SECTION 3. Section 403.002, Texas Labor Code, is amended by:
1. amending subsection (a) to provide that the annual collected
maintenance tax also be used to support the prosecution of workers'
compensation insurance fraud.
2. amending subsection (b) to allow for an assessment not to exceed
one-tenth of one percent of gross premiums to support the prosecution of
workers' compensation
insurance fraud.
SECTION 4. Section 403.003(a), Texas Labor Code is amended by adding a
new subsection (5) that requires the commission to include in its
maintenance tax assessment the expenditures projected as necessary for the
support of the prosecution of workers' compensation insurance fraud.
SECTION 5. Chapter 408, Texas Labor Code, is amended by adding a new
Section 408.104. MAXIMUM MEDICAL IMPROVEMENT AFTER SPINAL SURGERY that (a)
provides for the extension of 104-weeks for MMI if employee has had or has
been approved to have spinal surgery within 12 weeks prior to the
expiration of the 104-week period; (b) provides for an employee or
insurance carrier to dispute the application for extension of MMI; and (c)
requires the commission to adopt rules to implement section and to
establish procedures for requesting and disputing an extension.
SECTION 6. Section 407.103(a), Texas Labor Code, is amended to require
that the maintenance tax paid by self-insured shall be used to support the
prosecution of workers' compensation insurance fraud at one-tenth of one
percent of the total tax base of all certified self-insurers.
SECTION 7. Section 409.042(b) is amended by changing the eligibility
requirement for designation as an ombudsman from at least three years of
experience in the workers' compensation field to at least one year.
SECTION 8. A new Section 415.024 is added to Chapter 415. Administrative
Violations, Texas Labor Code to establish an administrative violation
punishable by an administrative penalty not to exceed $50,000 against a
carrier that breaches a settlement agreement that establishes a compliance
plan.
SECTION 9. (a) Sets September 1, 1997 as the effective date of the Act.
(b) Makes Section 415.024 effective for violations that occur
on or after the effective date of the Act.
(c) The changes in the law to Section 401.011(30) and to Section
408.104 are effective for dates of injury on or after the effective date
of this Act. The former law is continued in effect for dates of injury
prior to the effective date.
SECTION 10. Suspends three-day rule.
COMPARISON OF ORIGINAL TO SUBSTITUTE
SECTION 1 Added "or as provided by Section 408.104." to the end of (B) and
struck (C).
SECTION 2 Changed the number of seminars commissioners can get reimbursed
for from 10 to 5 in subsection (d).
SECTION 5 Struck all of that section, and added a new one that begins with
"Chapter 408 is amended by adding a new Section 408.104 to read as
follows..."
SECTION 9 (c) Changed Section 408.123 to 408.104.