1-1 By: Rhodes, Brimer (Senate Sponsor - Ratliff) H.B. No. 3522
1-2 (In the Senate - Received from the House April 30, 1997;
1-3 May 1, 1997, read first time and referred to Committee on Economic
1-4 Development; May 18, 1997, reported favorably by the following
1-5 vote: Yeas 11, Nays 0; May 18, 1997, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to the administration and enforcement of the workers'
1-9 compensation law; providing penalties.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Section 401.011(30), Labor Code, is amended to
1-12 read as follows:
1-13 (30) "Maximum medical improvement" means the earlier
1-14 of:
1-15 (A) the earliest date after which, based on
1-16 reasonable medical probability, further material recovery from or
1-17 lasting improvement to an injury can no longer reasonably be
1-18 anticipated; [or]
1-19 (B) the expiration of 104 weeks from the date on
1-20 which income benefits begin to accrue; or
1-21 (C) the date determined as provided by Section
1-22 408.104.
1-23 SECTION 2. Section 402.011, Labor Code, is amended by
1-24 amending Subsection (b) and adding Subsections (c) and (d) to read
1-25 as follows:
1-26 (b) A member is entitled to reimbursement for actual lost
1-27 wages, if any, for:
1-28 (1) [due to] attendance at commission meetings, not to
1-29 exceed one day in each calendar quarter;
1-30 (2) preparation for a commission meeting, not to
1-31 exceed two days in each calendar quarter;
1-32 (3) attendance at a subcommittee meeting, not to
1-33 exceed one day each month;
1-34 (4) attendance by the chair or vice chair of the
1-35 commission at a legislative committee meeting if attendance is
1-36 requested by the committee chair; and
1-37 (5) attendance at a meeting by a member appointed to
1-38 the Research and Oversight Council on Workers' Compensation or the
1-39 Texas Certified Self-Insured Guarantee Association.
1-40 (c) Reimbursement under Subsection (b) [this subsection] may
1-41 not exceed $100 a day and $12,000 a year.
1-42 (d) A member of the commission is entitled to reimbursement
1-43 for actual and necessary expenses for attendance at not more than
1-44 five seminars in a calendar year if:
1-45 (1) the member is invited as a representative of the
1-46 commission to participate in a program offered at the seminar; and
1-47 (2) the member's participation is approved by the
1-48 chair of the commission.
1-49 SECTION 3. Sections 403.002(a) and (b), Labor Code, are
1-50 amended to read as follows:
1-51 (a) Each insurance carrier, other than a governmental
1-52 entity, shall pay an annual maintenance tax to pay the costs of
1-53 administering this subtitle and to support the prosecution of
1-54 workers' compensation insurance fraud in this state.
1-55 (b) The assessment may not exceed an amount equal to two
1-56 percent of the correctly reported gross workers' compensation
1-57 insurance premiums. Out of this amount, and in addition to the
1-58 amounts assessed to pay the costs of administration, an amount not
1-59 to exceed one-tenth of one percent of correctly reported gross
1-60 premiums shall be assessed annually to support the prosecution of
1-61 workers' compensation insurance fraud.
1-62 SECTION 4. Section 403.003(a), Labor Code, is amended to
1-63 read as follows:
1-64 (a) The commission shall set and certify to the comptroller
2-1 the rate of maintenance tax assessment not later than October 31 of
2-2 each year, taking into account:
2-3 (1) any expenditure projected as necessary for the
2-4 commission to:
2-5 (A) administer this subtitle during the fiscal
2-6 year for which the rate of assessment is set; and
2-7 (B) reimburse the general revenue fund as
2-8 provided by Article 4.19, Insurance Code;
2-9 (2) projected employee benefits paid from general
2-10 revenues;
2-11 (3) a surplus or deficit produced by the tax in the
2-12 preceding year; [and]
2-13 (4) revenue recovered from other sources, including
2-14 reappropriated receipts, grants, payments, fees, gifts, and
2-15 penalties recovered under this subtitle; and
2-16 (5) expenditures projected as necessary to support the
2-17 prosecution of workers' compensation insurance fraud.
2-18 SECTION 5. Subchapter F, Chapter 408, Labor Code, is amended
2-19 by adding Section 408.104 to read as follows:
2-20 Sec. 408.104. MAXIMUM MEDICAL IMPROVEMENT AFTER SPINAL
2-21 SURGERY. (a) On application by either the employee or the
2-22 insurance carrier, the commission by order may extend the 104-week
2-23 period described by Section 401.011(30)(B) if the employee has had
2-24 spinal surgery, or has been approved for spinal surgery under
2-25 Section 408.026 and commission rules, within 12 weeks before the
2-26 expiration of the 104-week period. If an order is issued under
2-27 this section, the order shall extend the statutory period for
2-28 maximum medical improvement to a date certain, based on medical
2-29 evidence presented to the commission.
2-30 (b) Either the employee or the insurance carrier may dispute
2-31 an application for extension made under this section. A dispute
2-32 under this subsection is subject to Chapter 410.
2-33 (c) The commission shall adopt rules to implement this
2-34 section, including rules establishing procedures for requesting and
2-35 disputing an extension.
2-36 SECTION 6. Section 407.103(a), Labor Code, is amended to
2-37 read as follows:
2-38 (a) Each certified self-insurer shall pay a self-insurer
2-39 maintenance tax for the administration of the commission and to
2-40 support the prosecution of workers' compensation insurance fraud in
2-41 this state. Not more than two percent of the total tax base of all
2-42 certified self-insurers, as computed under Subsection (b), may be
2-43 assessed for a maintenance tax under this section. Out of this
2-44 amount, and in addition to the amounts assessed to pay the costs of
2-45 administration, an amount not to exceed one-tenth of one percent of
2-46 the total tax base of all certified self-insurers shall be assessed
2-47 annually to support the prosecution of workers' compensation
2-48 insurance fraud.
2-49 SECTION 7. Section 409.042(b), Labor Code, is amended to
2-50 read as follows:
2-51 (b) To be eligible for designation as an ombudsman, a person
2-52 must:
2-53 (1) demonstrate satisfactory knowledge of the
2-54 requirements of:
2-55 (A) this subtitle and the provisions of Subtitle
2-56 C that relate to claims management;
2-57 (B) other laws relating to workers'
2-58 compensation; and
2-59 (C) rules adopted under this subtitle and the
2-60 laws described under Subdivision (1)(B);
2-61 (2) have demonstrated experience in handling and
2-62 resolving problems for the general public;
2-63 (3) possess strong interpersonal skills; and
2-64 (4) have at least one year [three years] of
2-65 demonstrated experience in the field of workers' compensation.
2-66 SECTION 8. Subchapter B, Chapter 415, Labor Code, is amended
2-67 by adding Section 415.024 to read as follows:
2-68 Sec. 415.024. BREACH OF SETTLEMENT AGREEMENT; ADMINISTRATIVE
2-69 VIOLATION. A breach of a settlement agreement that establishes a
3-1 compliance plan is an administrative violation punishable by an
3-2 administrative penalty not to exceed $50,000. In determining the
3-3 amount of the penalty, the commission shall consider the total
3-4 volume of claims handled by the insurance carrier.
3-5 SECTION 9. (a) This Act takes effect September 1, 1997.
3-6 (b) The change in law made by Section 415.024, Labor Code,
3-7 as added by this Act, applies only to a violation that occurs on or
3-8 after the effective date of this Act. A violation that occurs
3-9 before the effective date of this Act is governed by the law in
3-10 effect on the date the violation occurred, and the former law is
3-11 continued for that purpose.
3-12 (c) The change in law made by this Act applies only to a
3-13 claim for workers' compensation benefits based on a compensable
3-14 injury that occurs on or after the effective date of this Act. A
3-15 claim based on a compensable injury that occurs before that date is
3-16 governed by the law in effect on the date that the compensable
3-17 injury occurred, and the former law is continued in effect for that
3-18 purpose.
3-19 SECTION 10. The importance of this legislation and the
3-20 crowded condition of the calendars in both houses create an
3-21 emergency and an imperative public necessity that the
3-22 constitutional rule requiring bills to be read on three several
3-23 days in each house be suspended, and this rule is hereby suspended.
3-24 * * * * *