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. Section 403.002(a), Labor Code, is amended to
2-20 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.
3-1 SECTION 4. Section 403.003(a), Labor Code, is amended to
3-2 read as follows:
3-3 (a) The commission shall set and certify to the comptroller
3-4 the rate of maintenance tax assessment not later than October 31 of
3-5 each year, taking into account:
3-6 (1) any expenditure projected as necessary for the
3-7 commission to:
3-8 (A) administer this subtitle during the fiscal
3-9 year for which the rate of assessment is set; and
3-10 (B) reimburse the general revenue fund as
3-11 provided by Article 4.19, Insurance Code;
3-12 (2) projected employee benefits paid from general
3-13 revenues;
3-14 (3) a surplus or deficit produced by the tax in the
3-15 preceding year; [and]
3-16 (4) revenue recovered from other sources, including
3-17 reappropriated receipts, grants, payments, fees, gifts, and
3-18 penalties recovered under this subtitle; and
3-19 (5) expenditures projected as necessary to support the
3-20 prosecution of workers' compensation insurance fraud.
3-21 SECTION 5. Subchapter F, Chapter 408, Labor Code, is amended
3-22 by adding Section 408.104 to read as follows:
3-23 Sec. 408.104. MAXIMUM MEDICAL IMPROVEMENT AFTER SPINAL
3-24 SURGERY. (a) On application by either the employee or the
3-25 insurance carrier, the commission by order may extend the 104-week
3-26 period described by Section 401.011(30)(B) if the employee has had
3-27 spinal surgery, or has been approved for spinal surgery under
4-1 Section 408.026 and commission rules, within 12 weeks before the
4-2 expiration of the 104-week period. If an order is issued under
4-3 this section, the order shall extend the statutory period for
4-4 maximum medical improvement to a date certain, based on medical
4-5 evidence presented to the commission.
4-6 (b) Either the employee or the insurance carrier may dispute
4-7 an application for extension made under this section. A dispute
4-8 under this subsection is subject to Chapter 410.
4-9 (c) The commission shall adopt rules to implement this
4-10 section, including rules establishing procedures for requesting and
4-11 disputing an extension.
4-12 SECTION 6. Section 407.103(a), Labor Code, is amended to
4-13 read as follows:
4-14 (a) Each certified self-insurer shall pay a self-insurer
4-15 maintenance tax for the administration of the commission and to
4-16 support the prosecution of workers' compensation insurance fraud in
4-17 this state. Not more than two percent of the total tax base of all
4-18 certified self-insurers, as computed under Subsection (b), may be
4-19 assessed for a maintenance tax under this section.
4-20 SECTION 7. Section 408.161(a), Labor Code, is amended to
4-21 read as follows:
4-22 (a) Lifetime income benefits are paid until the death of the
4-23 employee for:
4-24 (1) total and permanent loss of sight in both eyes;
4-25 (2) loss of both feet at or above the ankle;
4-26 (3) loss of both hands at or above the wrist;
4-27 (4) loss of one foot at or above the ankle and the
5-1 loss of one hand at or above the wrist;
5-2 (5) an injury to the spine that results in permanent
5-3 and complete paralysis of both arms, both legs, or one arm and one
5-4 leg; or
5-5 (6) a physically traumatic injury to the brain [an
5-6 injury to the skull] resulting in incurable insanity or imbecility.
5-7 SECTION 8. Section 409.042(b), Labor Code, is amended to
5-8 read as follows:
5-9 (b) To be eligible for designation as an ombudsman, a person
5-10 must:
5-11 (1) demonstrate satisfactory knowledge of the
5-12 requirements of:
5-13 (A) this subtitle and the provisions of Subtitle
5-14 C that relate to claims management;
5-15 (B) other laws relating to workers'
5-16 compensation; and
5-17 (C) rules adopted under this subtitle and the
5-18 laws described under Subdivision (1)(B);
5-19 (2) have demonstrated experience in handling and
5-20 resolving problems for the general public;
5-21 (3) possess strong interpersonal skills; and
5-22 (4) have at least one year [three years] of
5-23 demonstrated experience in the field of workers' compensation.
5-24 SECTION 9. Subchapter B, Chapter 415, Labor Code, is amended
5-25 by adding Section 415.024 to read as follows:
5-26 Sec. 415.024. BREACH OF SETTLEMENT AGREEMENT; ADMINISTRATIVE
5-27 VIOLATION. A material and substantial breach of a settlement
6-1 agreement that establishes a compliance plan is a Class A
6-2 administrative violation. In determining the amount of the
6-3 penalty, the commission shall consider the total volume of claims
6-4 handled by the insurance carrier.
6-5 SECTION 10. (a) Except as provided in Subsection (b), this
6-6 Act takes effect September 1, 1997.
6-7 (b) Section 408.104, Labor Code, as added by Section 5 of
6-8 this Act, takes effect January 1, 1998.
6-9 (c) The change in law made by Section 415.024, Labor Code,
6-10 as added by this Act, applies only to a violation that occurs on or
6-11 after the effective date of this Act. A violation that occurs
6-12 before the effective date of this Act is governed by the law in
6-13 effect on the date the violation occurred, and the former law is
6-14 continued for that purpose.
6-15 (d) The change in law made by this Act applies only to a
6-16 claim for workers' compensation benefits based on a compensable
6-17 injury that occurs on or after the effective date of this Act. A
6-18 claim based on a compensable injury that occurs before that date is
6-19 governed by the law in effect on the date that the compensable
6-20 injury occurred, and the former law is continued in effect for that
6-21 purpose.
6-22 SECTION 11. The importance of this legislation and the
6-23 crowded condition of the calendars in both houses create an
6-24 emergency and an imperative public necessity that the
6-25 constitutional rule requiring bills to be read on three several
6-26 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 3522 was passed by the House on April
29, 1997, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 3522 on June 1, 1997, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 3522 was passed by the Senate, with
amendments, on May 22, 1997, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor