1-1 By: Dukes (Senate Sponsor - Shapleigh) H.B. No. 2510
1-2 (In the Senate - Received from the House April 23, 1999;
1-3 April 26, 1999, read first time and referred to Committee on State
1-4 Affairs; May 13, 1999, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 9, Nays 0; May 13, 1999,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR H.B. No. 2510 By: Shapleigh
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the administration and operation of the workers'
1-11 compensation program of this state.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Section 401.013(a), Labor Code, is amended to
1-14 read as follows:
1-15 (a) In this subtitle, "intoxication" means the state of:
1-16 (1) having an alcohol concentration to qualify as
1-17 intoxicated under [defined by] Section 49.01(2), Penal Code[, of
1-18 0.10 or more]; or
1-19 (2) not having the normal use of mental or physical
1-20 faculties resulting from the voluntary introduction into the body
1-21 of:
1-22 (A) an alcoholic beverage, as defined by Section
1-23 1.04, Alcoholic Beverage Code;
1-24 (B) a controlled substance or controlled
1-25 substance analogue, as defined by Section 481.002, Health and
1-26 Safety Code;
1-27 (C) a dangerous drug, as defined by Section
1-28 483.001, Health and Safety Code;
1-29 (D) an abusable glue or aerosol paint, as
1-30 defined by Section 485.001, Health and Safety Code; or
1-31 (E) any similar substance, the use of which is
1-32 regulated under state law.
1-33 SECTION 2. Section 401.023(b), Labor Code, is amended to
1-34 read as follows:
1-35 (b) The commission shall compute and publish the interest
1-36 and discount rate quarterly, using the auction rate quoted on a
1-37 discount basis for the 52-week treasury bills issued by the United
1-38 States government, as published by the Federal Reserve Board on the
1-39 date nearest to the 15th day preceding the first day of the
1-40 calendar quarter for which the rate is to be effective, plus 3.5
1-41 percent. For this purpose, calendar quarters begin January 1,
1-42 April 1, July 1, and October 1.
1-43 SECTION 3. Sections 402.011(b) and (c), Labor Code, are
1-44 amended to read as follows:
1-45 (b) A member is entitled to reimbursement for actual lost
1-46 wages or use of leave benefits, if any, for:
1-47 (1) attendance at commission meetings and hearings[,
1-48 not to exceed one day in each calendar quarter];
1-49 (2) preparation for a commission meeting, not to
1-50 exceed two days in each calendar quarter;
1-51 (3) attendance at a subcommittee meeting, not to
1-52 exceed one day each month;
1-53 (4) attendance by the chair or vice chair of the
1-54 commission at a legislative committee meeting if attendance is
1-55 requested by the committee chair; and
1-56 (5) attendance at a meeting by a member appointed to
1-57 the Research and Oversight Council on Workers' Compensation or the
1-58 Texas Certified Self-Insured Guaranty [Guarantee] Association.
1-59 (c) Reimbursement under Subsection (b) may not exceed $100 a
1-60 day and $5,000 [$12,000] a year.
1-61 SECTION 4. Section 402.062, Labor Code, is amended to read
1-62 as follows:
1-63 Sec. 402.062. Acceptance of Gifts, Grants, and Donations.
1-64 (a) The commission may accept gifts, grants, or donations as
2-1 provided by rules adopted by the commission.
2-2 (b) Notwithstanding Chapter 575, Government Code, the
2-3 commission may accept a grant paid from the Texas Workers'
2-4 Compensation Insurance Fund established under Article 5.76-3,
2-5 Insurance Code, to implement specific steps to control and lower
2-6 medical costs in the workers' compensation system. The commission
2-7 must publish the name of the grantor and the purpose and conditions
2-8 of the grant in the Texas Register and provide for a 20-day public
2-9 comment period before the commission may accept the grant. The
2-10 commission shall acknowledge acceptance of the grant at a public
2-11 meeting. The minutes of the public meeting must include the name
2-12 of the grantor, a description of the grant, and a general statement
2-13 of the purposes for which the grant will be used.
2-14 SECTION 5. Section 402.085(a), Labor Code, is amended to
2-15 read as follows:
2-16 (a) The commission shall release information on a claim to:
2-17 (1) the Texas Department of Insurance for any
2-18 statutory or regulatory purpose;
2-19 (2) a legislative committee for legislative purposes;
2-20 (3) a state or federal elected official requested in
2-21 writing to provide assistance by a constituent who qualifies to
2-22 obtain injury information under Section 402.084(b), if the request
2-23 for assistance is provided to the commission;
2-24 (4) the Research and Oversight Council on Workers'
2-25 Compensation [research center] for research purposes; or
2-26 (5) the attorney general or another entity that
2-27 provides child support services under Part D, Title IV, Social
2-28 Security Act (42 U.S.C. Section 651 et seq.), [or Chapter 76, Human
2-29 Resources Code,] relating to:
2-30 (A) establishing, modifying, or enforcing a
2-31 child support or medical support obligation; or
2-32 (B) locating an absent parent.
2-33 SECTION 6. Section 404.007(a), Labor Code, is amended to
2-34 read as follows:
2-35 (a) The board shall:
2-36 (1) approve the operating budget of the council;
2-37 (2) adopt rules for the operations of the board and
2-38 the council;
2-39 (3) conduct professional studies and research on all
2-40 matters relevant to the cost, quality, and operational
2-41 effectiveness of the workers' compensation system;
2-42 (4) monitor the cost of income benefits under this
2-43 subtitle, with emphasis on the availability and cost of
2-44 supplemental income benefits;
2-45 (5) monitor the performance and operation of the Texas
2-46 Workers' Compensation Insurance Fund, with emphasis on the insurer
2-47 of last resort program;
2-48 (6) hold regular public hearings and receive testimony
2-49 and reports from:
2-50 (A) the commission;
2-51 (B) the Texas Workers' Compensation Insurance
2-52 Fund;
2-53 (C) [the Texas workers' compensation insurance
2-54 facility;]
2-55 [(D)] the Texas Department of Insurance;
2-56 (D) [(E)] the State Office of Risk Management
2-57 [office of the attorney general]; and
2-58 (E) [(F)] any other public or private entity
2-59 that is involved in the workers' compensation system;
2-60 (7) receive information about workers' compensation
2-61 rules and operations of an entity listed in Subdivision (6); and
2-62 (8) review specific recommendations for legislation
2-63 relating to the Texas Workers' Compensation Act formally proposed
2-64 by an entity listed in Subdivision (6).
2-65 SECTION 7. Section 404.010, Labor Code, is amended by
2-66 amending Subsection (a) and adding Subsection (d) to read as
2-67 follows:
2-68 (a) As required to fulfill the objectives of the council,
2-69 the council is entitled to access to the files and records of:
3-1 (1) the commission;
3-2 (2) the Texas Workforce [Employment] Commission;
3-3 (3) the Texas Department of Insurance;
3-4 (4) the Texas Department of Human Services;
3-5 (5) [the Texas workers' compensation insurance
3-6 facility;]
3-7 [(6)] the Texas Workers' Compensation Insurance Fund;
3-8 and
3-9 (6) [(7)] other state agencies.
3-10 (d) The identity of an individual or entity selected to
3-11 participate in a council survey or who participates in such a
3-12 survey is confidential and is not subject to public disclosure
3-13 under Chapter 552, Government Code.
3-14 SECTION 8. Sections 408.004(e) and (f), Labor Code, are
3-15 amended to read as follows:
3-16 (e) An employee who, without good cause as determined by the
3-17 commission, fails or refuses to appear at the time scheduled for an
3-18 examination under Subsection (a) or (b) commits a violation. A
3-19 violation under this subsection is a Class D administrative
3-20 violation. An employee is not entitled to temporary income
3-21 benefits, and an insurance carrier may suspend the payment of
3-22 temporary income benefits, during and for a period in which the
3-23 employee fails to submit to an examination under Subsection (a) or
3-24 (b) unless the commission determines that the employee had good
3-25 cause for the failure to submit to the examination. The commission
3-26 may order temporary income benefits to be paid for the period that
3-27 the commission determines the employee had good cause. The
3-28 commission by rule shall ensure that an employee receives
3-29 reasonable notice of an examination and of the insurance carrier's
3-30 basis for suspension of payment, and that the employee is provided
3-31 a reasonable opportunity to reschedule an examination missed by the
3-32 employee for good cause. [If the report of a doctor selected by an
3-33 insurance carrier indicates that the employee can return to work
3-34 immediately, the commission shall schedule a benefit review
3-35 conference on the next available docket. The insurance carrier may
3-36 not suspend medical or income benefit payments pending the benefit
3-37 review conference.]
3-38 (f) If the report of a doctor selected by an insurance
3-39 carrier indicates that an employee can return to work immediately
3-40 or has reached maximum medical improvement, the insurance carrier
3-41 may suspend or reduce the payment of temporary income benefits on
3-42 the 14th day after the date on which the insurance carrier files a
3-43 notice of suspension with the commission as provided by this
3-44 subsection. The commission shall hold an expedited benefit review
3-45 conference, by personal appearance or by telephone, not later than
3-46 the 10th day after the date on which the commission receives the
3-47 insurance carrier's notice of suspension. The commission is not
3-48 required to automatically schedule a contested case hearing as
3-49 required by Section 410.025(b) if a benefit review conference is
3-50 scheduled under this subsection. The commission may enter an
3-51 interlocutory order for the continuation of benefits, and the
3-52 insurance carrier is eligible for reimbursement for any
3-53 overpayments of benefits as provided by Chapter 410. The
3-54 commission shall adopt rules as necessary to implement this
3-55 subsection under which:
3-56 (1) an insurance carrier is required to notify the
3-57 employee and the treating doctor of the suspension of benefits
3-58 under this subsection by certified mail or another verifiable
3-59 delivery method;
3-60 (2) the commission makes a reasonable attempt to
3-61 obtain the treating doctor's opinion before the commission makes a
3-62 determination regarding the entry of an interlocutory order; and
3-63 (3) the commission may allow abbreviated contested
3-64 case hearings by personal appearance or telephone to consider
3-65 issues relating to overpayment of benefits under this section [An
3-66 employee who, without good cause, fails or refuses to appear at the
3-67 time scheduled for an examination under Subsection (a) or (b)
3-68 commits a violation. A violation under this subsection is a Class
3-69 D administrative violation].
4-1 SECTION 9. Section 408.025(d), Labor Code, is amended to
4-2 read as follows:
4-3 (d) On the request of an injured employee, the employee's
4-4 attorney, or the insurance carrier, a health care provider
4-5 [facility] shall furnish records relating to treatment or
4-6 hospitalization for which compensation is being sought. The
4-7 commission may regulate the charge for furnishing a report or
4-8 record, but the charge may not be less than the fair and reasonable
4-9 charge for furnishing the report or record. A health care provider
4-10 [facility] may disclose to the insurance carrier of an affected
4-11 employer records relating to the diagnosis or treatment of the
4-12 injured employee without the authorization of the injured employee
4-13 to determine the amount of payment or the entitlement to payment.
4-14 SECTION 10. Section 408.027(a), Labor Code, is amended to
4-15 read as follows:
4-16 (a) An insurance carrier shall pay the fee allowed under
4-17 Section 413.011 [charged] for a service rendered by a health care
4-18 provider not later than the 45th day after the date the insurance
4-19 carrier receives the charge unless the amount of the payment or the
4-20 entitlement to payment is disputed.
4-21 SECTION 11. Section 408.081, Labor Code, is amended to read
4-22 as follows:
4-23 Sec. 408.081. Income Benefits. (a) An employee is entitled
4-24 to income benefits as provided in this chapter.
4-25 (b) Except as otherwise provided by this section or this
4-26 subtitle, income benefits and interest on accrued but unpaid income
4-27 benefits shall be paid weekly as and when they accrue without order
4-28 from the commission.
4-29 (c) The commission by rule shall establish requirements for
4-30 agreements under which income benefits may be paid monthly. Income
4-31 benefits may be paid monthly only:
4-32 (1) on the request of the employee and the agreement
4-33 of the employee and the insurance carrier; and
4-34 (2) in compliance with the requirements adopted by the
4-35 commission.
4-36 (d) An employee's entitlement to income benefits under this
4-37 chapter terminates on the death of the employee. An interest in
4-38 future income benefits does not survive after the employee's death.
4-39 SECTION 12. Section 408.124(b), Labor Code, is amended to
4-40 read as follows:
4-41 (b) For [The commission shall use for] determining the
4-42 existence and degree of an employee's impairment, the commission
4-43 shall use "Guides to the Evaluation of Permanent Impairment," third
4-44 edition, second printing, dated February 1989, published by the
4-45 American Medical Association.
4-46 (c) Notwithstanding Subsection (b), the commission by rule
4-47 may adopt the fourth edition of the "Guides to the Evaluation of
4-48 Permanent Impairment" published by the American Medical Association
4-49 for determining the existence and degree of an employee's
4-50 impairment. If the commission adopts the Guides to the Evaluation
4-51 of Permanent Impairment, fourth edition, the commission shall use
4-52 the range of motion model for evaluating impairment resulting from
4-53 a back injury.
4-54 SECTION 13. Section 408.150(b), Labor Code, is amended to
4-55 read as follows:
4-56 (b) An employee who refuses services or refuses to cooperate
4-57 with services provided under this section loses entitlement to
4-58 supplemental [supplementary] income benefits.
4-59 SECTION 14. Section 408.161, Labor Code, is amended by
4-60 adding Subsection (d) to read as follows:
4-61 (d) An insurance carrier may pay lifetime income benefits
4-62 through an annuity if the annuity agreement meets the terms and
4-63 conditions for annuity agreements adopted by the commission by
4-64 rule. The establishment of an annuity under this subsection does
4-65 not relieve the insurance carrier of the liability under this title
4-66 for ensuring that the lifetime income benefits are paid.
4-67 SECTION 15. Section 408.181, Labor Code, is amended by
4-68 adding Subsections (c) and (d) to read as follows:
4-69 (c) The commission by rule shall establish requirements for
5-1 agreements under which death benefits may be paid monthly. Death
5-2 benefits may be paid monthly only:
5-3 (1) on the request of the legal beneficiary and the
5-4 agreement of the legal beneficiary and the insurance carrier; and
5-5 (2) in compliance with the requirements adopted by the
5-6 commission.
5-7 (d) An insurance carrier may pay death benefits through an
5-8 annuity if the annuity agreement meets the terms and conditions for
5-9 annuity agreements adopted by the commission by rule. The
5-10 establishment of an annuity under this subsection does not relieve
5-11 the insurance carrier of the liability under this title for
5-12 ensuring that the death benefits are paid.
5-13 SECTION 16. Section 408.186(a), Labor Code, is amended to
5-14 read as follows:
5-15 (a) If the death of an employee results from a compensable
5-16 injury, the insurance carrier shall pay to the person who incurred
5-17 liability for the costs of burial the lesser of:
5-18 (1) the actual costs incurred for reasonable burial
5-19 expenses; or
5-20 (2) $6,000 [$2,500].
5-21 SECTION 17. Section 413.005(b), Labor Code, is amended to
5-22 read as follows:
5-23 (b) The medical advisory committee is composed of members
5-24 appointed by the commission as follows:
5-25 (1) a representative of a public health care facility;
5-26 (2) a representative of a private health care
5-27 facility;
5-28 (3) a doctor of medicine;
5-29 (4) a doctor of osteopathic medicine;
5-30 (5) a chiropractor;
5-31 (6) a dentist;
5-32 (7) a physical therapist;
5-33 (8) a pharmacist;
5-34 (9) a podiatrist;
5-35 (10) an occupational therapist;
5-36 (11) a medical equipment supplier;
5-37 (12) a registered nurse;
5-38 (13) a representative of employers;
5-39 (14) a representative of employees; [and]
5-40 (15) a representative of an insurance carrier; and
5-41 (16) two representatives of the general public.
5-42 SECTION 18. Section 504.012(a), Labor Code, is amended to
5-43 read as follows:
5-44 (a) A political subdivision may cover volunteer fire
5-45 fighters, police officers, emergency medical personnel, and other
5-46 volunteers that are specifically named. A person covered under
5-47 this subsection is entitled to full medical benefits and the
5-48 minimum compensation payments under the law. Notwithstanding any
5-49 other law, the governing body of the political subdivision may
5-50 elect to provide compensation payments to a person covered under
5-51 this subsection that are greater than the minimum benefits provided
5-52 under this title.
5-53 SECTION 19. Article 5.61, Insurance Code, is amended to read
5-54 as follows:
5-55 Art. 5.61. Adequate Reserves. (a) Each workers'
5-56 compensation insurer transacting business in this state shall
5-57 maintain reserves in an amount estimated in the aggregate to
5-58 provide for the payment of all losses and claims incurred, whether
5-59 reported or unreported, but not in an amount greater than
5-60 reasonably required for those purposes. The reserves shall be
5-61 computed in accordance with any rules adopted [approved] by the
5-62 commissioner [Board] for the purpose of adequately protecting the
5-63 insureds, securing the solvency of the insurer, and preventing
5-64 unreasonably large reserves.
5-65 (b) [Each workers' compensation insurer shall provide a
5-66 separate report to the Board showing its year-end loss, expense,
5-67 and unearned premium reserves for workers' compensation insurance
5-68 results in this state. The report must be filed not later than
5-69 June 30 of each year and must show the reserve development over a
6-1 period of years sufficiently long to allow the Board to determine
6-2 whether the reserves are adequate, inadequate, or unreasonably
6-3 large. The report shall be audited by an independent certified
6-4 public accountant in accordance with generally accepted auditing
6-5 standards and the rules of the Board. The reserve amounts reported
6-6 may be taken from an audited financial report prepared by an
6-7 independent auditor as prescribed by law.]
6-8 [(c)] If the reserves are determined to be inadequate, the
6-9 commissioner [Board] shall notify the insurer and require the
6-10 insurer to establish and maintain reasonable additional reserves.
6-11 If the reserves are determined to be unreasonably large, the
6-12 commissioner [Board] shall notify the insurer and require the
6-13 insurer to reduce its reserves to a reasonable amount.
6-14 (c) [(d)] Not later than the 60th day after the date of the
6-15 notification by the commissioner [Board] that its reserves have
6-16 been determined not to be in compliance with the requirements of
6-17 this article, the insurer shall restore compliance and file a
6-18 statement of restored compliance, together with such documentation
6-19 as the commissioner [Board] may require.
6-20 SECTION 20. Section 13, Article 5.76-3, Insurance Code, is
6-21 amended by adding Subsection (l) to read as follows:
6-22 (l) Notwithstanding any other law, the fund may issue grants
6-23 from available fund surplus to the Texas Workers' Compensation
6-24 Commission as provided by Section 402.062, Labor Code. The amount
6-25 of the grant is not to exceed $2.2 million for the four-year period
6-26 of September 1, 1999 through September 1, 2003. This subsection
6-27 expires September 1, 2003.
6-28 SECTION 21. (a) Except as provided by Subsection (b) of
6-29 this section, this Act takes effect September 1, 1999, and applies
6-30 only to an agreement regarding payment of workers' compensation
6-31 income benefits or death benefits that is entered into on or after
6-32 that date.
6-33 (b) Section 401.023(b), Labor Code, as amended by this Act,
6-34 takes effect October 1, 1999.
6-35 (c) Section 408.124(b), Labor Code, as amended by this Act,
6-36 applies only to determination of an impairment rating for workers'
6-37 compensation benefits under Subchapter G, Chapter 408, Labor Code,
6-38 on or after January 1, 2000. The determination of an impairment
6-39 rating before that date is governed by the law in effect
6-40 immediately before the effective date of this Act, and the former
6-41 law is continued in effect for that purpose.
6-42 (d) Section 408.186(a), Labor Code, as amended by this Act,
6-43 applies only to a claim for workers' compensation burial benefits
6-44 based on a compensable injury that occurs on or after the effective
6-45 date of this Act. A claim based on a compensable injury that
6-46 occurs before that date is governed by the law in effect on the
6-47 date that the compensable injury occurred, and the former law is
6-48 continued in effect for that purpose.
6-49 SECTION 22. The importance of this legislation and the
6-50 crowded condition of the calendars in both houses create an
6-51 emergency and an imperative public necessity that the
6-52 constitutional rule requiring bills to be read on three several
6-53 days in each house be suspended, and this rule is hereby suspended.
6-54 * * * * *