By Rhodes, Brimer H.B. No. 3522
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the administration and enforcement of the workers'
1-3 compensation law; providing penalties.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 401.011(30), Labor Code, is amended to
1-6 read as follows:
1-7 (30) "Maximum medical improvement" means the earlier
1-8 of:
1-9 (A) the earliest date after which, based on
1-10 reasonable medical probability, further material recovery from or
1-11 lasting improvement to an injury can no longer reasonably be
1-12 anticipated; [or]
1-13 (B) the expiration of 104 weeks from the date on
1-14 which income benefits begin to accrue; or
1-15 (C) the date determined as provided by Section
1-16 408.104.
1-17 SECTION 2. Section 402.011, Labor Code, is amended by
1-18 amending Subsection (b) and adding Subsections (c) and (d) to read
1-19 as follows:
1-20 (b) A member is entitled to reimbursement for actual lost
1-21 wages, if any, for:
1-22 (1) [due to] attendance at commission meetings, not to
1-23 exceed one day in each calendar quarter;
1-24 (2) preparation for a commission meeting, not to
2-1 exceed two days in each calendar quarter;
2-2 (3) attendance at a subcommittee meeting, not to
2-3 exceed one day each month;
2-4 (4) attendance by the chair or vice chair of the
2-5 commission at a legislative committee meeting if attendance is
2-6 requested by the committee chair; and
2-7 (5) attendance at a meeting by a member appointed to
2-8 the Research and Oversight Council on Workers' Compensation or the
2-9 Texas Certified Self-Insured Guarantee Association.
2-10 (c) Reimbursement under Subsection (b) [this subsection] may
2-11 not exceed $100 a day and $12,000 a year.
2-12 (d) A member of the commission is entitled to reimbursement
2-13 for actual and necessary expenses for attendance at not more than
2-14 five seminars in a calendar year if:
2-15 (1) the member is invited as a representative of the
2-16 commission to participate in a program offered at the seminar; and
2-17 (2) the member's participation is approved by the
2-18 chair of the commission.
2-19 SECTION 3. Sections 403.002(a) and (b), Labor Code, are
2-20 amended to read as follows:
2-21 (a) Each insurance carrier, other than a governmental
2-22 entity, shall pay an annual maintenance tax to pay the costs of
2-23 administering this subtitle and to support the prosecution of
2-24 workers' compensation insurance fraud in this state.
2-25 (b) The assessment may not exceed an amount equal to two
2-26 percent of the correctly reported gross workers' compensation
2-27 insurance premiums. Out of this amount, and in addition to the
3-1 amounts assessed to pay the costs of administration, an amount not
3-2 to exceed one-tenth of one percent of correctly reported gross
3-3 premiums shall be assessed annually to support the prosecution of
3-4 workers' compensation insurance fraud.
3-5 SECTION 4. Section 403.003(a), Labor Code, is amended to
3-6 read as follows:
3-7 (a) The commission shall set and certify to the comptroller
3-8 the rate of maintenance tax assessment not later than October 31 of
3-9 each year, taking into account:
3-10 (1) any expenditure projected as necessary for the
3-11 commission to:
3-12 (A) administer this subtitle during the fiscal
3-13 year for which the rate of assessment is set; and
3-14 (B) reimburse the general revenue fund as
3-15 provided by Article 4.19, Insurance Code;
3-16 (2) projected employee benefits paid from general
3-17 revenues;
3-18 (3) a surplus or deficit produced by the tax in the
3-19 preceding year; [and]
3-20 (4) revenue recovered from other sources, including
3-21 reappropriated receipts, grants, payments, fees, gifts, and
3-22 penalties recovered under this subtitle; and
3-23 (5) expenditures projected as necessary to support the
3-24 prosecution of workers' compensation insurance fraud.
3-25 SECTION 5. Subchapter F, Chapter 408, Labor Code, is amended
3-26 by adding Section 408.104 to read as follows:
3-27 Sec. 408.104. MAXIMUM MEDICAL IMPROVEMENT AFTER SPINAL
4-1 SURGERY. (a) On application by either the employee or the
4-2 insurance carrier, the commission by order may extend the 104-week
4-3 period described by Section 401.011(30)(B) if the employee has had
4-4 spinal surgery, or has been approved for spinal surgery under
4-5 Section 408.026 and commission rules, within 12 weeks before the
4-6 expiration of the 104-week period. If an order is issued under
4-7 this section, the order shall extend the statutory period for
4-8 maximum medical improvement to a date certain, based on medical
4-9 evidence presented to the commission.
4-10 (b) Either the employee or the insurance carrier may dispute
4-11 an application for extension made under this section. A dispute
4-12 under this subsection is subject to Chapter 410.
4-13 (c) The commission shall adopt rules to implement this
4-14 section, including rules establishing procedures for requesting and
4-15 disputing an extension.
4-16 SECTION 6. Section 407.103(a), Labor Code, is amended to
4-17 read as follows:
4-18 (a) Each certified self-insurer shall pay a self-insurer
4-19 maintenance tax for the administration of the commission and to
4-20 support the prosecution of workers' compensation insurance fraud in
4-21 this state. Not more than two percent of the total tax base of all
4-22 certified self-insurers, as computed under Subsection (b), may be
4-23 assessed for a maintenance tax under this section. Out of this
4-24 amount, and in addition to the amounts assessed to pay the costs of
4-25 administration, an amount not to exceed one-tenth of one percent of
4-26 the total tax base of all certified self-insurers shall be assessed
4-27 annually to support the prosecution of workers' compensation
5-1 insurance fraud.
5-2 SECTION 7. Section 409.042(b), Labor Code, is amended to
5-3 read as follows:
5-4 (b) To be eligible for designation as an ombudsman, a person
5-5 must:
5-6 (1) demonstrate satisfactory knowledge of the
5-7 requirements of:
5-8 (A) this subtitle and the provisions of Subtitle
5-9 C that relate to claims management;
5-10 (B) other laws relating to workers'
5-11 compensation; and
5-12 (C) rules adopted under this subtitle and the
5-13 laws described under Subdivision (1)(B);
5-14 (2) have demonstrated experience in handling and
5-15 resolving problems for the general public;
5-16 (3) possess strong interpersonal skills; and
5-17 (4) have at least one year [three years] of
5-18 demonstrated experience in the field of workers' compensation.
5-19 SECTION 8. Subchapter B, Chapter 415, Labor Code, is amended
5-20 by adding Section 415.024 to read as follows:
5-21 Sec. 415.024. BREACH OF SETTLEMENT AGREEMENT; ADMINISTRATIVE
5-22 VIOLATION. A breach of a settlement agreement that establishes a
5-23 compliance plan is an administrative violation punishable by an
5-24 administrative penalty not to exceed $50,000. In determining the
5-25 amount of the penalty, the commission shall consider the total
5-26 volume of claims handled by the insurance carrier.
5-27 SECTION 9. (a) This Act takes effect September 1, 1997.
6-1 (b) The change in law made by Section 415.024, Labor Code,
6-2 as added by this Act, applies only to a violation that occurs on or
6-3 after the effective date of this Act. A violation that occurs
6-4 before the effective date of this Act is governed by the law in
6-5 effect on the date the violation occurred, and the former law is
6-6 continued for that purpose.
6-7 (c) The change in law made by this Act applies only to a
6-8 claim for workers' compensation benefits based on a compensable
6-9 injury that occurs on or after the effective date of this Act. A
6-10 claim based on a compensable injury that occurs before that date is
6-11 governed by the law in effect on the date that the compensable
6-12 injury occurred, and the former law is continued in effect for that
6-13 purpose.
6-14 SECTION 10. The importance of this legislation and the
6-15 crowded condition of the calendars in both houses create an
6-16 emergency and an imperative public necessity that the
6-17 constitutional rule requiring bills to be read on three several
6-18 days in each house be suspended, and this rule is hereby suspended.