1-1 AN ACT
1-2 relating to the administration and operation of the workers'
1-3 compensation program of this state.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 401.013(a), Labor Code, is amended to
1-6 read as follows:
1-7 (a) In this subtitle, "intoxication" means the state of:
1-8 (1) having an alcohol concentration to qualify as
1-9 intoxicated under [defined by] Section 49.01(2), Penal Code[, of
1-10 0.10 or more]; or
1-11 (2) not having the normal use of mental or physical
1-12 faculties resulting from the voluntary introduction into the body
1-13 of:
1-14 (A) an alcoholic beverage, as defined by Section
1-15 1.04, Alcoholic Beverage Code;
1-16 (B) a controlled substance or controlled
1-17 substance analogue, as defined by Section 481.002, Health and
1-18 Safety Code;
1-19 (C) a dangerous drug, as defined by Section
1-20 483.001, Health and Safety Code;
1-21 (D) an abusable glue or aerosol paint, as
1-22 defined by Section 485.001, Health and Safety Code; or
1-23 (E) any similar substance, the use of which is
1-24 regulated under state law.
2-1 SECTION 2. Section 401.023(b), Labor Code, is amended to
2-2 read as follows:
2-3 (b) The commission shall compute and publish the interest
2-4 and discount rate quarterly, using the auction rate quoted on a
2-5 discount basis for the 52-week treasury bills issued by the United
2-6 States government, as published by the Federal Reserve Board on the
2-7 date nearest to the 15th day preceding the first day of the
2-8 calendar quarter for which the rate is to be effective, plus 3.5
2-9 percent. For this purpose, calendar quarters begin January 1, April
2-10 1, July 1, and October 1.
2-11 SECTION 3. Sections 402.011(b) and (c), Labor Code, are
2-12 amended to read as follows:
2-13 (b) A member is entitled to reimbursement for actual lost
2-14 wages or use of leave benefits, if any, for:
2-15 (1) attendance at commission meetings and hearings[,
2-16 not to exceed one day in each calendar quarter];
2-17 (2) preparation for a commission meeting, not to
2-18 exceed two days in each calendar quarter;
2-19 (3) attendance at a subcommittee meeting, not to
2-20 exceed one day each month;
2-21 (4) attendance by the chair or vice chair of the
2-22 commission at a legislative committee meeting if attendance is
2-23 requested by the committee chair; and
2-24 (5) attendance at a meeting by a member appointed to
2-25 the Research and Oversight Council on Workers' Compensation or the
2-26 Texas Certified Self-Insured Guaranty [Guarantee] Association.
2-27 (c) Reimbursement under Subsection (b) may not exceed $100 a
3-1 day and $5,000 [$12,000] a year.
3-2 SECTION 4. Section 402.062, Labor Code, is amended to read
3-3 as follows:
3-4 Sec. 402.062. ACCEPTANCE OF GIFTS, GRANTS, AND DONATIONS.
3-5 (a) The commission may accept gifts, grants, or donations as
3-6 provided by rules adopted by the commission.
3-7 (b) Notwithstanding Chapter 575, Government Code, the
3-8 commission may accept a grant paid from the Texas Workers'
3-9 Compensation Insurance Fund established under Article 5.76-3,
3-10 Insurance Code, to implement specific steps to control and lower
3-11 medical costs in the workers' compensation system and to ensure the
3-12 delivery of quality medical care. The commission must publish the
3-13 name of the grantor and the purpose and conditions of the grant in
3-14 the Texas Register and provide for a 20-day public comment period
3-15 before the commission may accept the grant. The commission shall
3-16 acknowledge acceptance of the grant at a public meeting. The
3-17 minutes of the public meeting must include the name of the grantor,
3-18 a description of the grant, and a general statement of the purposes
3-19 for which the grant will be used.
3-20 SECTION 5. Section 402.085(a), Labor Code, is amended to
3-21 read as follows:
3-22 (a) The commission shall release information on a claim to:
3-23 (1) the Texas Department of Insurance for any
3-24 statutory or regulatory purpose;
3-25 (2) a legislative committee for legislative purposes;
3-26 (3) a state or federal elected official requested in
3-27 writing to provide assistance by a constituent who qualifies to
4-1 obtain injury information under Section 402.084(b), if the request
4-2 for assistance is provided to the commission;
4-3 (4) the Research and Oversight Council on Workers'
4-4 Compensation [research center] for research purposes; or
4-5 (5) the attorney general or another entity that
4-6 provides child support services under Part D, Title IV, Social
4-7 Security Act (42 U.S.C. Section 651 et seq.), [or Chapter 76, Human
4-8 Resources Code,] relating to:
4-9 (A) establishing, modifying, or enforcing a
4-10 child support or medical support obligation; or
4-11 (B) locating an absent parent.
4-12 SECTION 6. Section 404.007(a), Labor Code, is amended to
4-13 read as follows:
4-14 (a) The board shall:
4-15 (1) approve the operating budget of the council;
4-16 (2) adopt rules for the operations of the board and
4-17 the council;
4-18 (3) conduct professional studies and research on all
4-19 matters relevant to the cost, quality, and operational
4-20 effectiveness of the workers' compensation system;
4-21 (4) monitor the cost of income benefits under this
4-22 subtitle, with emphasis on the availability and cost of
4-23 supplemental income benefits;
4-24 (5) monitor the performance and operation of the Texas
4-25 Workers' Compensation Insurance Fund, with emphasis on the insurer
4-26 of last resort program;
4-27 (6) hold regular public hearings and receive testimony
5-1 and reports from:
5-2 (A) the commission;
5-3 (B) the Texas Workers' Compensation Insurance
5-4 Fund;
5-5 (C) [the Texas workers' compensation insurance
5-6 facility;]
5-7 [(D)] the Texas Department of Insurance;
5-8 (D) [(E)] the State Office of Risk Management
5-9 [office of the attorney general]; and
5-10 (E) [(F)] any other public or private entity
5-11 that is involved in the workers' compensation system;
5-12 (7) receive information about workers' compensation
5-13 rules and operations of an entity listed in Subdivision (6); and
5-14 (8) review specific recommendations for legislation
5-15 relating to the Texas Workers' Compensation Act formally proposed
5-16 by an entity listed in Subdivision (6).
5-17 SECTION 7. Section 404.010, Labor Code, is amended by
5-18 amending Subsection (a) and adding Subsection (d) to read as
5-19 follows:
5-20 (a) As required to fulfill the objectives of the council,
5-21 the council is entitled to access to the files and records of:
5-22 (1) the commission;
5-23 (2) the Texas Workforce [Employment] Commission;
5-24 (3) the Texas Department of Insurance;
5-25 (4) the Texas Department of Human Services;
5-26 (5) [the Texas workers' compensation insurance
5-27 facility;]
6-1 [(6)] the Texas Workers' Compensation Insurance Fund;
6-2 and
6-3 (6) [(7)] other state agencies.
6-4 (d) The identity of an individual or entity selected to
6-5 participate in a council survey or who participates in such a
6-6 survey is confidential and is not subject to public disclosure
6-7 under Chapter 552, Government Code.
6-8 SECTION 8. Sections 408.004(e) and (f), Labor Code, are
6-9 amended to read as follows:
6-10 (e) An employee who, without good cause as determined by the
6-11 commission, fails or refuses to appear at the time scheduled for an
6-12 examination under Subsection (a) or (b) commits a violation. A
6-13 violation under this subsection is a Class D administrative
6-14 violation. An employee is not entitled to temporary income
6-15 benefits, and an insurance carrier may suspend the payment of
6-16 temporary income benefits, during and for a period in which the
6-17 employee fails to submit to an examination under Subsection (a) or
6-18 (b) unless the commission determines that the employee had good
6-19 cause for the failure to submit to the examination. The commission
6-20 may order temporary income benefits to be paid for the period that
6-21 the commission determines the employee had good cause. The
6-22 commission by rule shall ensure that an employee receives
6-23 reasonable notice of an examination and of the insurance carrier's
6-24 basis for suspension of payment, and that the employee is provided
6-25 a reasonable opportunity to reschedule an examination missed by the
6-26 employee for good cause. [If the report of a doctor selected by an
6-27 insurance carrier indicates that the employee can return to work
7-1 immediately, the commission shall schedule a benefit review
7-2 conference on the next available docket. The insurance carrier may
7-3 not suspend medical or income benefit payments pending the benefit
7-4 review conference.]
7-5 (f) If the report of a doctor selected by an insurance
7-6 carrier indicates that an employee can return to work immediately
7-7 or has reached maximum medical improvement, the insurance carrier
7-8 may suspend or reduce the payment of temporary income benefits on
7-9 the 14th day after the date on which the insurance carrier files a
7-10 notice of suspension with the commission as provided by this
7-11 subsection. The commission shall hold an expedited benefit review
7-12 conference, by personal appearance or by telephone, not later than
7-13 the 10th day after the date on which the commission receives the
7-14 insurance carrier's notice of suspension. If a benefit review
7-15 conference is not held by the 14th day after the date on which the
7-16 commission receives the insurance carrier's notice of suspension,
7-17 an interlocutory order, effective from the date of the report
7-18 certifying maximum medical improvement, is automatically entered
7-19 for the continuation of temporary income benefits until a benefit
7-20 review conference is held, and the insurance carrier is eligible
7-21 for reimbursement for any overpayment of benefits as provided by
7-22 Chapter 410. The commission is not required to automatically
7-23 schedule a contested case hearing as required by Section 410.025(b)
7-24 if a benefit review conference is scheduled under this subsection.
7-25 If a benefit review conference is held not later than the 14th day,
7-26 the commission may enter an interlocutory order for the
7-27 continuation of benefits, and the insurance carrier is eligible for
8-1 reimbursement for any overpayments of benefits as provided by
8-2 Chapter 410. The commission shall adopt rules as necessary to
8-3 implement this subsection under which:
8-4 (1) an insurance carrier is required to notify the
8-5 employee and the treating doctor of the suspension of benefits
8-6 under this subsection by certified mail or another verifiable
8-7 delivery method;
8-8 (2) the commission makes a reasonable attempt to
8-9 obtain the treating doctor's opinion before the commission makes a
8-10 determination regarding the entry of an interlocutory order; and
8-11 (3) the commission may allow abbreviated contested
8-12 case hearings by personal appearance or telephone to consider
8-13 issues relating to overpayment of benefits under this section [An
8-14 employee who, without good cause, fails or refuses to appear at the
8-15 time scheduled for an examination under Subsection (a) or (b)
8-16 commits a violation. A violation under this subsection is a Class
8-17 D administrative violation].
8-18 SECTION 9. Section 408.025(d), Labor Code, is amended to
8-19 read as follows:
8-20 (d) On the request of an injured employee, the employee's
8-21 attorney, or the insurance carrier, a health care provider
8-22 [facility] shall furnish records relating to treatment or
8-23 hospitalization for which compensation is being sought. The
8-24 commission may regulate the charge for furnishing a report or
8-25 record, but the charge may not be less than the fair and reasonable
8-26 charge for furnishing the report or record. A health care provider
8-27 [facility] may disclose to the insurance carrier of an affected
9-1 employer records relating to the diagnosis or treatment of the
9-2 injured employee without the authorization of the injured employee
9-3 to determine the amount of payment or the entitlement to payment.
9-4 SECTION 10. Section 408.027(a), Labor Code, is amended to
9-5 read as follows:
9-6 (a) An insurance carrier shall pay the fee allowed under
9-7 Section 413.011 [charged] for a service rendered by a health care
9-8 provider not later than the 45th day after the date the insurance
9-9 carrier receives the charge unless the amount of the payment or the
9-10 entitlement to payment is disputed.
9-11 SECTION 11. Section 408.081, Labor Code, is amended to read
9-12 as follows:
9-13 Sec. 408.081. INCOME BENEFITS. (a) An employee is entitled
9-14 to income benefits as provided in this chapter.
9-15 (b) Except as otherwise provided by this section or this
9-16 subtitle, income benefits shall be paid weekly as and when they
9-17 accrue without order from the commission. Interest on accrued but
9-18 unpaid benefits shall be paid, without order of the commission, at
9-19 the time the accrued benefits are paid.
9-20 (c) The commission by rule shall establish requirements for
9-21 agreements under which income benefits may be paid monthly. Income
9-22 benefits may be paid monthly only:
9-23 (1) on the request of the employee and the agreement
9-24 of the employee and the insurance carrier; and
9-25 (2) in compliance with the requirements adopted by the
9-26 commission.
9-27 (d) An employee's entitlement to income benefits under this
10-1 chapter terminates on the death of the employee. An interest in
10-2 future income benefits does not survive after the employee's death.
10-3 SECTION 12. Section 408.124, Labor Code, is amended by
10-4 amending Subsection (b) and by adding Subsection (c) to read as
10-5 follows:
10-6 (b) For [The commission shall use for] determining the
10-7 existence and degree of an employee's impairment, the commission
10-8 shall use "Guides to the Evaluation of Permanent Impairment," third
10-9 edition, second printing, dated February 1989, published by the
10-10 American Medical Association.
10-11 (c) Notwithstanding Subsection (b), the commission by rule
10-12 may adopt the fourth edition of the "Guides to the Evaluation of
10-13 Permanent Impairment," published by the American Medical
10-14 Association, for determining the existence and degree of an
10-15 employee's impairment.
10-16 SECTION 13. Section 408.150(b), Labor Code, is amended to
10-17 read as follows:
10-18 (b) An employee who refuses services or refuses to cooperate
10-19 with services provided under this section loses entitlement to
10-20 supplemental [supplementary] income benefits.
10-21 SECTION 14. Section 408.161, Labor Code, is amended by
10-22 adding Subsection (d) to read as follows:
10-23 (d) An insurance carrier may pay lifetime income benefits
10-24 through an annuity if the annuity agreement meets the terms and
10-25 conditions for annuity agreements adopted by the commission by
10-26 rule. The establishment of an annuity under this subsection does
10-27 not relieve the insurance carrier of the liability under this title
11-1 for ensuring that the lifetime income benefits are paid.
11-2 SECTION 15. Section 408.181, Labor Code, is amended by
11-3 adding Subsections (c) and (d) to read as follows:
11-4 (c) The commission by rule shall establish requirements for
11-5 agreements under which death benefits may be paid monthly. Death
11-6 benefits may be paid monthly only:
11-7 (1) on the request of the legal beneficiary and the
11-8 agreement of the legal beneficiary and the insurance carrier; and
11-9 (2) in compliance with the requirements adopted by the
11-10 commission.
11-11 (d) An insurance carrier may pay death benefits through an
11-12 annuity if the annuity agreement meets the terms and conditions for
11-13 annuity agreements adopted by the commission by rule. The
11-14 establishment of an annuity under this subsection does not relieve
11-15 the insurance carrier of the liability under this title for
11-16 ensuring that the death benefits are paid.
11-17 SECTION 16. Section 408.186(a), Labor Code, is amended to
11-18 read as follows:
11-19 (a) If the death of an employee results from a compensable
11-20 injury, the insurance carrier shall pay to the person who incurred
11-21 liability for the costs of burial the lesser of:
11-22 (1) the actual costs incurred for reasonable burial
11-23 expenses; or
11-24 (2) $6,000 [$2,500].
11-25 SECTION 17. Section 413.005(b), Labor Code, is amended to
11-26 read as follows:
11-27 (b) The medical advisory committee is composed of members
12-1 appointed by the commission as follows:
12-2 (1) a representative of a public health care facility;
12-3 (2) a representative of a private health care
12-4 facility;
12-5 (3) a doctor of medicine;
12-6 (4) a doctor of osteopathic medicine;
12-7 (5) a chiropractor;
12-8 (6) a dentist;
12-9 (7) a physical therapist;
12-10 (8) a pharmacist;
12-11 (9) a podiatrist;
12-12 (10) an occupational therapist;
12-13 (11) a medical equipment supplier;
12-14 (12) a registered nurse;
12-15 (13) a representative of employers;
12-16 (14) a representative of employees; [and]
12-17 (15) a representative of an insurance carrier; and
12-18 (16) two representatives of the general public.
12-19 SECTION 18. Section 504.012(a), Labor Code, is amended to
12-20 read as follows:
12-21 (a) A political subdivision may cover volunteer fire
12-22 fighters, police officers, emergency medical personnel, and other
12-23 volunteers that are specifically named. A person covered under
12-24 this subsection is entitled to full medical benefits and the
12-25 minimum compensation payments under the law. Notwithstanding any
12-26 other law, the governing body of the political subdivision may
12-27 elect to provide compensation payments to a person covered under
13-1 this subsection that are greater than the minimum benefits provided
13-2 under this title.
13-3 SECTION 19. Article 5.61, Insurance Code, is amended to read
13-4 as follows:
13-5 Art. 5.61. ADEQUATE RESERVES. (a) Each workers'
13-6 compensation insurer transacting business in this state shall
13-7 maintain reserves in an amount estimated in the aggregate to
13-8 provide for the payment of all losses and claims incurred, whether
13-9 reported or unreported, but not in an amount greater than
13-10 reasonably required for those purposes. The reserves shall be
13-11 computed in accordance with any rules adopted [approved] by the
13-12 commissioner [Board] for the purpose of adequately protecting the
13-13 insureds, securing the solvency of the insurer, and preventing
13-14 unreasonably large reserves.
13-15 (b) [Each workers' compensation insurer shall provide a
13-16 separate report to the Board showing its year-end loss, expense,
13-17 and unearned premium reserves for workers' compensation insurance
13-18 results in this state. The report must be filed not later than
13-19 June 30 of each year and must show the reserve development over a
13-20 period of years sufficiently long to allow the Board to determine
13-21 whether the reserves are adequate, inadequate, or unreasonably
13-22 large. The report shall be audited by an independent certified
13-23 public accountant in accordance with generally accepted auditing
13-24 standards and the rules of the Board. The reserve amounts reported
13-25 may be taken from an audited financial report prepared by an
13-26 independent auditor as prescribed by law.]
13-27 [(c)] If the reserves are determined to be inadequate, the
14-1 commissioner [Board] shall notify the insurer and require the
14-2 insurer to establish and maintain reasonable additional reserves.
14-3 If the reserves are determined to be unreasonably large, the
14-4 commissioner [Board] shall notify the insurer and require the
14-5 insurer to reduce its reserves to a reasonable amount.
14-6 (c) [(d)] Not later than the 60th day after the date of the
14-7 notification by the commissioner [Board] that its reserves have
14-8 been determined not to be in compliance with the requirements of
14-9 this article, the insurer shall restore compliance and file a
14-10 statement of restored compliance, together with such documentation
14-11 as the commissioner [Board] may require.
14-12 SECTION 20. Section 13, Article 5.76-3, Insurance Code, is
14-13 amended by adding Subsection (l) to read as follows:
14-14 (l) Notwithstanding any other law, the fund may issue grants
14-15 to the Texas Workers' Compensation Commission as provided by
14-16 Section 402.062, Labor Code. The amount of the grant is not to
14-17 exceed $2.2 million for the four-year period of September 1, 1999,
14-18 through September 1, 2003. This subsection expires September 1,
14-19 2003.
14-20 SECTION 21. (a) Except as otherwise provided by this
14-21 section, this Act takes effect September 1, 1999.
14-22 (b) Section 401.013(a), Labor Code, as amended by this Act,
14-23 applies only to a claim for workers' compensation benefits based on
14-24 a compensable injury that occurs on or after the effective date of
14-25 this Act. A claim based on a compensable injury that occurs before
14-26 that date is governed by the law in effect on the date that the
14-27 compensable injury occurred, and the former law is continued in
15-1 effect for that purpose.
15-2 (c) Section 401.023(b), Labor Code, as amended by this Act,
15-3 takes effect October 1, 1999.
15-4 (d) Section 408.004, Labor Code, as amended by this Act,
15-5 takes effect January 1, 2000, and applies only to required medical
15-6 examinations scheduled to occur on or after that date.
15-7 (e) Sections 408.081, 408.161, and 408.181, Labor Code, as
15-8 amended by this Act, take effect September 1, 1999, and apply only
15-9 to an agreement regarding payment of workers' compensation income
15-10 benefits or death benefits that is entered into on or after that
15-11 date.
15-12 (f) Section 408.186(a), Labor Code, as amended by this Act,
15-13 applies only to a claim for workers' compensation burial benefits
15-14 based on a compensable injury that occurs on or after the effective
15-15 date of this Act. A claim based on a compensable injury that
15-16 occurs before that date is governed by the law in effect on the
15-17 date that the compensable injury occurred, and the former law is
15-18 continued in effect for that purpose.
15-19 SECTION 22. The importance of this legislation and the
15-20 crowded condition of the calendars in both houses create an
15-21 emergency and an imperative public necessity that the
15-22 constitutional rule requiring bills to be read on three several
15-23 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. 2510 was passed by the House on April
22, 1999, by a non-record vote; that the House refused to concur in
Senate amendments to H.B. No. 2510 on May 26, 1999, and requested
the appointment of a conference committee to consider the
differences between the two houses; and that the House adopted the
conference committee report on H.B. No. 2510 on May 30, 1999, by a
non-record vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 2510 was passed by the Senate, with
amendments, on May 24, 1999, by a viva-voce vote; at the request of
the House, the Senate appointed a conference committee to consider
the differences between the two houses; and that the Senate adopted
the conference committee report on H.B. No. 2510 on May 30, 1999,
by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor