By Rhodes, Brimer H.B. No. 3522
Substitute the following for H.B. No. 3522:
By Rhodes C.S.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 as provided by Section
1-15 408.104.
1-16 [(C) that date that a condition is medically
1-17 stabilized if the injured employee has had surgery not later than
1-18 six weeks after the date computed under Paragraph (b), subject to
1-19 the commission's discretion.]
1-20 SECTION 2. Section 402.011, Labor Code, is amended by
1-21 amending Subsection (b) and adding Subsections (c) and (d) to read
1-22 as follows:
1-23 (b) A member is entitled to reimbursement for actual lost
1-24 wages, if any, for:
2-1 (1) [due to] attendance at commission meetings, not to
2-2 exceed one day in each calendar quarter;
2-3 (2) preparation for a commission meeting, not to
2-4 extend two days in each calendar quarter;
2-5 (3) attendance at a subcommittee meeting, not to
2-6 exceed one day each month;
2-7 (4) attendance by the chair or vice chair of the
2-8 commission at a legislative committee meeting if attendance is
2-9 requested by the committee chair; and
2-10 (5) attendance at a meeting by a member appointed to
2-11 the Research and Oversight Council on Workers' Compensation or the
2-12 Texas Certified Self-Insured Guarantee Association.
2-13 (c) Reimbursement under Subsection (b) [this subsection] may
2-14 not exceed $100 a day and $12,000 a year.
2-15 (d) A member of the commission is entitled to reimbursement
2-16 for actual and necessary expenses for attendance at not more than
2-17 (]L10 ) 5 seminars in a calendar year if:
2-18 (1) the member is invited as a representative of the
2-19 commission to participate in a program offered at the seminar; and
2-20 (2) the member's participation is approved by the
2-21 chair of the commission.
2-22 SECTION 3. Sections 403.002(a) and (b) Labor Code, are
2-23 amended to read as follows:
2-24 (a) Each insurance carrier, other than a governmental
2-25 entity, shall pay an annual maintenance tax to pay the costs of
2-26 administering this subtitle[.] and to support the prosecution of
2-27 workers' compensation insurance fraud in this state.
3-1 (b) The assessment may not exceed an amount equal to two
3-2 percent of the correctly reported gross workers' compensation
3-3 insurance premiums. Out of this amount, and in addition to the
3-4 amounts assessed to pay the costs of administration, an amount not
3-5 to exceed one-tenth of one percent of correctly reported gross
3-6 premiums shall be assessed annually to support the prosecution of
3-7 workers' compensation insurance fraud.
3-8 SECTION 4. Section 403.003(a), Texas Labor Code, is amended
3-9 to read as follows:
3-10 (a) (3) a surplus or deficit produced by the tax in the
3-11 preceding year; [and]
3-12 (a) (4) revenue recovered from other sources, including
3-13 reappropriated receipts, grants, payments, fees, gifts, and
3-14 penalties recovered under this subtitle; and
3-15 (a) (5) expenditures projected as necessary to support the
3-16 prosecution of workers' compensation insurance fraud.
3-17 SECTION 5. Chapter 408 is amended by adding a new Section
3-18 408.104 to read as follows: [Section 408.123, Labor Code, is
3-19 amended by adding Subsection (d) to read as follows:]
3-20 [(d) The commission shall adopt rules that prescribe the
3-21 method of determining maximum medical improvement under Section
3-22 401.011(30)(C) and the criteria for determining whether a specific
3-23 injured employee is subject to that provision.]
3-24 Sec. 408.104. MAXIMUM MEDICAL IMPROVEMENT AFTER SPINAL
3-25 SURGERY. (a) Upon application by either the employee or the
3-26 insurance carrier, the commission may by order extend the 104-week
3-27 period described in Section 401.011(B) if the employee has had
4-1 spinal surgery, or has been approved for spinal surgery pursuant to
4-2 the provisions of Section 408.026 and commission rules, within 12
4-3 weeks prior to the expiration of the 104-week period. If an order
4-4 is issued under this section, the order shall extend the statutory
4-5 period for maximum medical improvement to a date certain, based on
4-6 medical evidence presented to the commission.
4-7 (b) Either the employee or the insurance carrier may dispute
4-8 an application for extension. Such disputes shall be subject to
4-9 the provisions contained in Chapter 410.
4-10 (c) The commission shall adopt rules to implement this
4-11 section, including rules which establish procedures for requesting
4-12 and disputing an extension.
4-13 SECTION 6. Section 407.103(a), Labor Code, is amended to
4-14 read as follows:
4-15 (a) Each certified self-insurer shall pay a self insurer
4-16 maintenance tax for the administration of the commission and to
4-17 support the prosecution of workers' compensation insurance fraud in
4-18 this state. Not more than two-percent of the total tax base of all
4-19 certified self insurers, as computed under Subsection (b), may be
4-20 assessed for a maintenance tax under this section. Out of this
4-21 amount, and in addition to the amounts assessed to pay the costs of
4-22 administration, an amount not to exceed one-tenth of one percent of
4-23 the total tax base of all certified self-insurers shall be assessed
4-24 annually to support the prosecution of workers' compensation
4-25 insurance fraud.
4-26 SECTION 7. [8] Section 409.042(b), Labor Code, is amended
4-27 to read as follows:
5-1 (b) To be eligible for designation as an ombudsman, a person
5-2 must:
5-3 (1) demonstrate satisfactory knowledge of the
5-4 requirements of:
5-5 (A) this subtitle and the provisions of Subtitle
5-6 C that relate to claims management;
5-7 (B) other laws relating to workers'
5-8 compensation; and
5-9 (C) rules adopted under this subtitle and the
5-10 laws described under Subdivision (1)(B);
5-11 (2) have demonstrated experience in handling and
5-12 resolving problems for the general public;
5-13 (3) possesses strong interpersonal skills; and
5-14 (4) have at least [three years] one year of
5-15 demonstrated experience in the field of workers' compensation.
5-16 SECTION 8 [9]. Section 415.024, Labor Code, is added to read
5-17 as follows:
5-18 Sec. 415.024. A breach of a settlement agreement that
5-19 establishes a compliance plan is an administrative violation
5-20 punishable by an administrative penalty not to exceed $50,000. In
5-21 determining the amount of the penalty, the commission shall
5-22 consider the total volume of claims handled by the insurance
5-23 carrier.
5-24 SECTION 9 [10]. (a) This Act takes effect September 1,
5-25 1997.
5-26 (b) The change in law made by this Act to Section 415.024,
5-27 Labor Code, applies only to a violation that occurs on or after the
6-1 effective date of this Act. A violation that occurs before the
6-2 effective date of this Act is governed by the law in effect on the
6-3 date the violation occurred, and the former law is continued for
6-4 that purpose.
6-5 (c) The change in law made by this Act to Sections
6-6 401.011(30) and 408.104, Labor Code, applies only to dates of
6-7 injury on or after the effective date of this Act. For dates of
6-8 injury prior to the effective date of this Act, the former law is
6-9 continued in effect.
6-10 SECTION 10 [11]. The importance of this legislation and the
6-11 crowded condition of the calendars in both houses create an
6-12 emergency and an imperative public necessity that the
6-13 constitutional rule requiring bills to be read on three several
6-14 days in each house is suspended, and this rule is hereby suspended.