77R8976 KSD-D
By Brimer H.B. No. 1205
Substitute the following for H.B. No. 1205:
By Brimer C.S.H.B. No. 1205
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to changing the name of the Texas Workers' Compensation
1-3 Commission to the Texas Department of Workers' Compensation and to
1-4 the powers and duties of the governing authority of that
1-5 department.
1-6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-7 ARTICLE 1. ORGANIZATION OF DEPARTMENT
1-8 SECTION 1.001. Subchapter A, Chapter 402, Labor Code, is
1-9 amended to read as follows:
1-10 SUBCHAPTER A. ORGANIZATION
1-11 Sec. 402.001. DUTIES OF DEPARTMENT. In addition to the other
1-12 duties required of the Texas Department of Workers' Compensation,
1-13 the department shall:
1-14 (1) regulate the business of workers' compensation in
1-15 this state; and
1-16 (2) ensure that this subtitle and other laws granting
1-17 jurisdiction to or applicable to the department or the commissioner
1-18 are executed.
1-19 Sec. 402.002. COMPOSITION OF DEPARTMENT. The department is
1-20 composed of the commissioner and other officers and employees
1-21 required to efficiently implement:
1-22 (1) this subtitle; and
1-23 (2) other laws granting jurisdiction to or applicable
1-24 to the department or the commissioner.
2-1 Sec. 402.003. CHIEF EXECUTIVE. (a) The commissioner is the
2-2 department's chief executive and administrative officer. The
2-3 commissioner shall administer and enforce this subtitle and other
2-4 laws granting jurisdiction to or applicable to the department or
2-5 the commissioner.
2-6 (b) The commissioner has the powers and duties vested in the
2-7 department by this subtitle and other laws granting jurisdiction to
2-8 or applicable to the department or the commissioner.
2-9 (c) The commissioner may:
2-10 (1) investigate misconduct;
2-11 (2) hold hearings;
2-12 (3) issue subpoenas to compel the attendance of
2-13 witnesses and the production of documents;
2-14 (4) administer oaths;
2-15 (5) take testimony directly or by deposition or
2-16 interrogatory;
2-17 (6) assess and enforce penalties established under
2-18 this subtitle;
2-19 (7) enter appropriate orders as authorized by this
2-20 subtitle;
2-21 (8) correct clerical errors in the entry of orders;
2-22 (9) institute an action in the department's name to
2-23 enjoin the violation of this subtitle;
2-24 (10) initiate an action under Section 410.254 to
2-25 intervene in a judicial proceeding;
2-26 (11) prescribe the form, manner, and procedure for
2-27 transmission of information to the department; and
3-1 (12) delegate all powers and duties as necessary.
3-2 (d) The commissioner is the agent for service of process on
3-3 out-of-state employers.
3-4 Sec. 402.004. APPOINTMENT; TERM. (a) The governor, with the
3-5 advice and consent of the senate, shall appoint the commissioner.
3-6 The commissioner serves a two-year term that expires on February 1
3-7 of each odd-numbered year.
3-8 (b) The governor shall appoint the commissioner without
3-9 regard to the race, color, disability, sex, religion, age, or
3-10 national origin of the appointee.
3-11 Sec. 402.005. QUALIFICATIONS. (a) The commissioner must:
3-12 (1) be a competent and experienced administrator;
3-13 (2) be well informed and qualified in the field of
3-14 workers' compensation; and
3-15 (3) have at least 10 years of experience as an
3-16 executive in the administration of business or government or as a
3-17 practicing attorney or certified public accountant, with at least
3-18 five years of that experience in the field of insurance, with
3-19 preference for experience in the field of workers' compensation
3-20 insurance.
3-21 (b) A person who is a former member or former executive
3-22 director of the Texas Workers' Compensation Commission is not
3-23 eligible for appointment as commissioner under Section 402.004.
3-24 Sec. 402.006. INELIGIBILITY FOR PUBLIC OFFICE. The
3-25 commissioner is ineligible to be a candidate for a public elective
3-26 office in this state unless the commissioner has resigned and the
3-27 governor has accepted the resignation.
4-1 Sec. 402.007. BOND. Before taking office, the commissioner
4-2 must execute with a surety company licensed to do business in this
4-3 state a bond for $50,000 payable to this state and conditioned on
4-4 the faithful discharge of the commissioner's duties.
4-5 Sec. 402.008. COMPENSATION. The commissioner is entitled to
4-6 compensation as provided by the General Appropriations Act.
4-7 [MEMBERSHIP REQUIREMENTS. (a) The Texas Workers' Compensation
4-8 Commission is composed of six members appointed by the governor
4-9 with the advice and consent of the senate.]
4-10 [(b) Appointments to the commission shall be made without
4-11 regard to the race, color, disability, sex, religion, age, or
4-12 national origin of the appointee. Section 401.011(16) does not
4-13 apply to the use of the term "disability" in this subsection.]
4-14 [(c) Three members of the commission must be employers of
4-15 labor and three members of the commission must be wage earners. A
4-16 person is not eligible for appointment as a member of the
4-17 commission if the person provides services subject to regulation by
4-18 the commission or charges fees that are subject to regulation by
4-19 the commission.]
4-20 [(d) In making appointments to the commission, the governor
4-21 shall attempt to reflect the social, geographic, and economic
4-22 diversity of the state. To ensure balanced representation, the
4-23 governor may consider:]
4-24 [(1) the geographic location of a prospective
4-25 appointee's domicile;]
4-26 [(2) the prospective appointee's experience as an
4-27 employer or wage earner;]
5-1 [(3) the number of employees employed by a prospective
5-2 member who would represent employers; and]
5-3 [(4) the type of work performed by a prospective
5-4 member who would represent wage earners.]
5-5 [(e) The governor shall consider the factors listed in
5-6 Subsection (d) in appointing a member to fill a vacancy on the
5-7 commission.]
5-8 [(f) In making an appointment to the commission, the
5-9 governor shall consider recommendations made by groups that
5-10 represent employers or wage earners.]
5-11 [Sec. 402.0015. TRAINING PROGRAM FOR COMMISSION MEMBERS. (a)
5-12 Before a member of the commission may assume the member's duties,
5-13 the member must complete the training program established under
5-14 this section.]
5-15 [(b) A training program established under this section must
5-16 provide information to the member regarding:]
5-17 [(1) the enabling legislation that created the
5-18 commission;]
5-19 [(2) the programs operated by the commission;]
5-20 [(3) the role and functions of the commission;]
5-21 [(4) the rules of the commission, with an emphasis on
5-22 the rules that relate to disciplinary and investigatory authority;]
5-23 [(5) the current budget for the commission;]
5-24 [(6) the results of the most recent formal audit of
5-25 the commission;]
5-26 [(7) the requirements of:]
5-27 [(A) the open meetings law, Chapter 551,
6-1 Government Code;]
6-2 [(B) the open records law, Chapter 552,
6-3 Government Code; and]
6-4 [(C) the administrative procedure law, Chapter
6-5 2001, Government Code;]
6-6 [(8) the requirements of the conflict of interest laws
6-7 and other laws relating to public officials; and]
6-8 [(9) any applicable ethics policies adopted by the
6-9 commission or the Texas Ethics Commission.]
6-10 [Sec. 402.002. TERMS; VACANCY. (a) Members of the
6-11 commission hold office for staggered six-year terms, with the terms
6-12 of one member representing employers and one member representing
6-13 wage earners expiring on February 1 of each odd-numbered year.]
6-14 [(b) If a vacancy occurs during a term, the governor shall
6-15 fill the vacancy for the unexpired term. The replacement must be
6-16 from the group represented by the member being replaced.]
6-17 Sec. 402.009 [402.003]. EFFECT OF LOBBYING ACTIVITY. A
6-18 person may not serve as commissioner [a member of the commission]
6-19 or act as the general counsel to the department [commission] if the
6-20 person is required to register as a lobbyist under Chapter 305,
6-21 Government Code, because of the person's activities for
6-22 compensation on behalf of a profession that is regulated by or that
6-23 has fees regulated by the department [commission].
6-24 [Sec. 402.004. VOTING REQUIREMENTS. (a) The commission may
6-25 take action only by a majority vote of its membership.]
6-26 [(b) Decisions regarding the employment of an executive
6-27 director require the affirmative vote of at least two commissioners
7-1 representing employers and two commissioners representing wage
7-2 earners.]
7-3 Sec. 402.010. GROUNDS FOR REMOVAL. [402.005. REMOVAL OF
7-4 COMMISSION MEMBERS.] (a) It is a ground for removal from office if
7-5 the commissioner [the commission if a member]:
7-6 (1) does not have at the time of appointment the
7-7 qualifications required by Section 402.005 [for appointment to the
7-8 commission];
7-9 (2) does not maintain during service as commissioner
7-10 [on the commission] the qualifications required by Section 402.005
7-11 [for appointment to the commission];
7-12 (3) violates a prohibition established by Section
7-13 402.009 or 402.013 [402.003 or 402.012]; or
7-14 (4) cannot because of illness or incapacity discharge
7-15 the commissioner's [member's] duties for a substantial part of the
7-16 commissioner's term [for which the member is appointed; or]
7-17 [(5) is absent from more than half of the regularly
7-18 scheduled commission meetings that the member is eligible to attend
7-19 during a calendar year].
7-20 (b) The validity of an action of the commissioner or the
7-21 department [commission] is not affected by the fact that it is
7-22 taken when a ground for removal of the commissioner [a commission
7-23 member] exists.
7-24 [(c) If the executive director of the commission knows that
7-25 a potential ground for removal exists, the executive director shall
7-26 notify the chairman of the commission of the potential ground. The
7-27 chairman shall then notify the governor and the attorney general
8-1 that a potential ground for removal exists. If the potential
8-2 ground for removal involves the chairman, the executive director
8-3 shall notify the next highest officer of the commission, who shall
8-4 notify the governor and the attorney general that a potential
8-5 ground for removal exists.]
8-6 Sec. 402.011 [402.006]. PROHIBITED GIFTS; ADMINISTRATIVE
8-7 VIOLATION. (a) The commissioner [A member] or an employee of the
8-8 department [commission] may not accept a gift, gratuity, or
8-9 entertainment from a person having an interest in a matter or
8-10 proceeding pending before the department [commission].
8-11 (b) A violation of Subsection (a) is a Class A
8-12 administrative violation and constitutes a ground for removal from
8-13 office or termination of employment.
8-14 [Sec. 402.007. MEETINGS. The commission shall meet at least
8-15 once in each calendar quarter and may meet at other times at the
8-16 call of the chairman or as provided by the rules of the commission.]
8-17 [Sec. 402.008. CHAIRMAN. (a) The governor shall designate a
8-18 member of the commission as the chairman of the commission to serve
8-19 in that capacity for a two-year term expiring February 1 of each
8-20 odd-numbered year. The governor shall alternate the chairmanship
8-21 between the members who are employers and the members who are wage
8-22 earners.]
8-23 [(b) The chairman may vote on all matters before the
8-24 commission.]
8-25 [Sec. 402.009. LEAVE OF ABSENCE. (a) An employer may not
8-26 terminate the employment of an employee who is appointed as a
8-27 member of the commission because of the exercise by the employee of
9-1 duties required as a commission member.]
9-2 [(b) A member of the commission is entitled to a leave of
9-3 absence from employment for the time required to perform commission
9-4 duties. During the leave of absence, the member may not be
9-5 subjected to loss of time, vacation time, or other benefits of
9-6 employment, other than salary.]
9-7 Sec. 402.012 [402.010]. CIVIL LIABILITY OF COMMISSIONER
9-8 [MEMBER]. The commissioner [A member of the commission] is not
9-9 liable in a civil action for an act performed in good faith in the
9-10 execution of duties as commissioner [a commission member].
9-11 [Sec. 402.011. REIMBURSEMENT. (a) A member of the
9-12 commission is entitled to reimbursement for actual and necessary
9-13 expenses incurred in performing functions as a member of the
9-14 commission. Reimbursement under this subsection may not exceed a
9-15 limit established in the General Appropriations Act.]
9-16 [(b) A member is entitled to reimbursement for actual lost
9-17 wages or use of leave benefits, if any, for:]
9-18 [(1) attendance at commission meetings and hearings;]
9-19 [(2) preparation for a commission meeting, not to
9-20 exceed two days in each calendar quarter;]
9-21 [(3) attendance at a subcommittee meeting, not to
9-22 exceed one day each month;]
9-23 [(4) attendance by the chair or vice chair of the
9-24 commission at a legislative committee meeting if attendance is
9-25 requested by the committee chair; and]
9-26 [(5) attendance at a meeting by a member appointed to
9-27 the Research and Oversight Council on Workers' Compensation or the
10-1 Texas Certified Self-Insured Guaranty Association.]
10-2 [(c) Reimbursement under Subsection (b) may not exceed $100
10-3 a day and $5,000 a year.]
10-4 [(d) A member of the commission is entitled to reimbursement
10-5 for actual and necessary expenses for attendance at not more than
10-6 five seminars in a calendar year if:]
10-7 [(1) the member is invited as a representative of the
10-8 commission to participate in a program offered at the seminar; and]
10-9 [(2) the member's participation is approved by the
10-10 chair of the commission.]
10-11 Sec. 402.013 [402.012]. CONFLICT OF INTEREST. (a) An
10-12 officer, employee, or paid consultant of a Texas trade association
10-13 whose members provide services subject to regulation by the
10-14 department [commission] or provide services whose fees are subject
10-15 to regulation by the department [commission] may not be the
10-16 commissioner [a member of the commission] or an employee of the
10-17 department [commission] who is exempt from the state's position
10-18 classification plan or is compensated at or above the amount
10-19 prescribed by the General Appropriations Act for step 1, salary
10-20 group A17 [17], of the position classification salary schedule.
10-21 (b) On acceptance of appointment as commissioner [to the
10-22 commission], a commissioner [an appointee] who is an officer,
10-23 employee, or paid consultant of a Texas trade association described
10-24 by Subsection (a) must resign the position or terminate the
10-25 contract with the trade association.
10-26 (c) For the purposes of this section, "Texas trade
10-27 association" means a nonprofit, cooperative, and voluntarily joined
11-1 association of business or professional competitors in this state
11-2 designed to assist its members and its industry or profession in
11-3 dealing with mutual business or professional problems and in
11-4 promoting their common interest. The term does not include a labor
11-5 union or an employees' association.
11-6 SECTION 1.002. Subchapter C, Chapter 402, Labor Code, is
11-7 amended to read as follows:
11-8 SUBCHAPTER C. DEPARTMENT [EXECUTIVE DIRECTOR AND] PERSONNEL
11-9 Sec. 402.041. APPOINTMENTS. (a) Subject to the General
11-10 Appropriations Act or other law, the commissioner shall appoint
11-11 deputies, assistants, and other personnel as necessary to carry out
11-12 the powers and duties of the commissioner and the department under
11-13 this subtitle and other laws granting jurisdiction to or applicable
11-14 to the department or the commissioner.
11-15 (b) A person appointed under this section must have the
11-16 professional, administrative, and workers' compensation experience
11-17 necessary to qualify the person for the position to which the
11-18 person is appointed.
11-19 (c) A person appointed as an associate or deputy
11-20 commissioner or to hold an equivalent position must have at least
11-21 five years of the experience required for appointment as
11-22 commissioner under Section 402.005. At least two years of that
11-23 experience must be in work related to the position to be held.
11-24 Sec. 402.042. DIVISION OF RESPONSIBILITIES. The commissioner
11-25 shall develop and implement policies that clearly define the
11-26 respective responsibilities of the commissioner and the staff of
11-27 the department. [EXECUTIVE DIRECTOR. (a) The executive director
12-1 is the executive officer and administrative head of the commission.
12-2 The executive director exercises all rights, powers, and duties
12-3 imposed or conferred by law on the commission, except for
12-4 rulemaking and other rights, powers, and duties specifically
12-5 reserved under this subtitle to members of the commission.]
12-6 [(b) The executive director shall hire personnel as
12-7 necessary to administer this subtitle.]
12-8 [(c) The executive director serves at the pleasure of the
12-9 commission.]
12-10 [(d) The commission shall develop and implement policies
12-11 that clearly separate the policymaking responsibilities of the
12-12 commission and the management responsibilities of the executive
12-13 director and the staff of the commission.]
12-14 [Sec. 402.042. GENERAL POWERS AND DUTIES OF EXECUTIVE
12-15 DIRECTOR. (a) The executive director shall conduct the day-to-day
12-16 operations of the commission in accordance with policies
12-17 established by the commission and otherwise implement commission
12-18 policy.]
12-19 [(b) The executive director may:]
12-20 [(1) investigate misconduct;]
12-21 [(2) hold hearings;]
12-22 [(3) issue subpoenas to compel the attendance of
12-23 witnesses and the production of documents;]
12-24 [(4) administer oaths;]
12-25 [(5) take testimony directly or by deposition or
12-26 interrogatory;]
12-27 [(6) assess and enforce penalties established under
13-1 this subtitle;]
13-2 [(7) enter appropriate orders as authorized by this
13-3 subtitle;]
13-4 [(8) correct clerical errors in the entry of orders;]
13-5 [(9) institute an action in the commission's name to
13-6 enjoin the violation of this subtitle;]
13-7 [(10) initiate an action under Section 410.254 to
13-8 intervene in a judicial proceeding;]
13-9 [(11) prescribe the form, manner, and procedure for
13-10 transmission of information to the commission; and]
13-11 [(12) delegate all powers and duties as necessary.]
13-12 [(c) The executive director is the agent for service of
13-13 process on out-of-state employers.]
13-14 [Sec. 402.043. ADMINISTRATIVE ASSISTANTS. The executive
13-15 director shall employ and supervise:]
13-16 [(1) one person representing wage earners permanently
13-17 assigned to act as administrative assistant to the members of the
13-18 commission who represent wage earners; and]
13-19 [(2) one person representing employers permanently
13-20 assigned to act as administrative assistant to the members of the
13-21 commission who represent employers.]
13-22 Sec. 402.043 [402.044]. CAREER LADDER; ANNUAL PERFORMANCE
13-23 EVALUATIONS. (a) The commissioner [executive director] shall
13-24 develop an intra-agency career ladder program that addresses
13-25 opportunities for mobility and advancement for employees within the
13-26 department [commission]. The program shall require intra-agency
13-27 postings of all positions concurrently with any public posting.
14-1 (b) The commissioner [executive director] shall develop a
14-2 system of annual performance evaluations that are based on
14-3 documented employee performance. All merit pay for department
14-4 [commission] employees must be based on the system established
14-5 under this subsection.
14-6 Sec. 402.044 [402.045]. EQUAL EMPLOYMENT OPPORTUNITY POLICY
14-7 STATEMENT. (a) The commissioner [executive director] shall prepare
14-8 and maintain a written policy statement to ensure implementation of
14-9 a program of equal employment opportunity under which all personnel
14-10 transactions are made without regard to race, color, disability,
14-11 sex, religion, age, or national origin. The policy statement must
14-12 include:
14-13 (1) personnel policies, including policies related to
14-14 recruitment, evaluation, selection, appointment, training, and
14-15 promotion of personnel that are in compliance with the requirements
14-16 of Chapter 21;
14-17 (2) a comprehensive analysis of the department
14-18 [commission] work force that meets federal and state guidelines;
14-19 (3) procedures by which a determination can be made of
14-20 significant underuse in the department [commission] work force of
14-21 all persons for whom federal or state guidelines encourage a more
14-22 equitable balance; and
14-23 (4) reasonable methods to appropriately address those
14-24 areas of underuse.
14-25 (b) A policy statement prepared under this section must:
14-26 (1) cover an annual period;
14-27 (2) be updated annually;
15-1 (3) be reviewed by the Commission on Human Rights for
15-2 compliance with Subsection (a)(1); and
15-3 (4) be filed with the governor's office.
15-4 (c) The governor's office shall deliver a biennial report to
15-5 the legislature based on the information received under Subsection
15-6 (b). The report may be made separately or as part of other
15-7 biennial reports made to the legislature.
15-8 ARTICLE 2. CONFORMING AMENDMENTS WITHIN CHAPTER 402, LABOR CODE
15-9 SECTION 2.001. The heading to Chapter 402, Labor Code, is
15-10 amended to read as follows:
15-11 CHAPTER 402. TEXAS DEPARTMENT OF WORKERS' COMPENSATION
15-12 [COMMISSION]
15-13 SECTION 2.002. Section 402.021, Labor Code, is amended to
15-14 read as follows:
15-15 Sec. 402.021. DEPARTMENT [COMMISSION] DIVISIONS. (a) The
15-16 department [commission] shall have:
15-17 (1) a division of workers' health and safety;
15-18 (2) a division of medical review;
15-19 (3) a division of compliance and practices; and
15-20 (4) a division of hearings.
15-21 (b) In addition to the divisions listed by Subsection (a),
15-22 the commissioner [executive director, with the approval of the
15-23 commission,] may establish divisions within the department
15-24 [commission] for effective administration and performance of
15-25 department [commission] functions. The commissioner [executive
15-26 director] may allocate and reallocate functions among those [the]
15-27 divisions and those established under Subsection (a).
16-1 (c) The commissioner [executive director] shall appoint the
16-2 directors of the divisions of the department [commission]. The
16-3 directors serve at the pleasure of the commissioner [executive
16-4 director].
16-5 SECTION 2.003. Section 402.022, Labor Code, is amended to
16-6 read as follows:
16-7 Sec. 402.022. PUBLIC INTEREST INFORMATION. (a) The
16-8 department [executive director] shall prepare information of public
16-9 interest describing the functions of the department [commission]
16-10 and the procedures by which complaints are filed with and resolved
16-11 by the department [commission].
16-12 (b) The department [executive director] shall make the
16-13 information available to the public and appropriate state agencies.
16-14 SECTION 2.004. Section 402.023, Labor Code, is amended to
16-15 read as follows:
16-16 Sec. 402.023. COMPLAINT INFORMATION. (a) The department
16-17 [executive director] shall keep an information file about each
16-18 written complaint filed with the department [commission] that is
16-19 unrelated to a specific workers' compensation claim. The
16-20 information must include:
16-21 (1) the date the complaint is received;
16-22 (2) the name of the complainant;
16-23 (3) the subject matter of the complaint;
16-24 (4) a record of all persons contacted in relation to
16-25 the complaint;
16-26 (5) a summary of the results of the review or
16-27 investigation of the complaint; and
17-1 (6) for complaints for which the department
17-2 [commission] took no action, an explanation of the reason the
17-3 complaint was closed without action.
17-4 (b) For each written complaint that is unrelated to a
17-5 specific workers' compensation claim that the department
17-6 [commission] has authority to resolve, the department [executive
17-7 director] shall provide to the person filing the complaint and the
17-8 person about whom the complaint is made information about the
17-9 department's [commission's] policies and procedures relating to
17-10 complaint investigation and resolution. The department
17-11 [commission], at least quarterly and until final disposition of the
17-12 complaint, shall notify those persons about the status of the
17-13 complaint unless the notice would jeopardize an undercover
17-14 investigation.
17-15 SECTION 2.005. Section 402.024, Labor Code, is amended to
17-16 read as follows:
17-17 Sec. 402.024. PUBLIC PARTICIPATION. (a) The department
17-18 [commission] shall develop and implement policies that provide the
17-19 public with a reasonable opportunity to appear before the
17-20 department [commission] and to speak on issues under the general
17-21 jurisdiction of the department [commission].
17-22 (b) The department [commission] shall comply with federal
17-23 and state laws related to program and facility accessibility.
17-24 (c) In addition to compliance with Subsection (a), the
17-25 department [executive director] shall prepare and maintain a
17-26 written plan that describes how a person who does not speak English
17-27 may be provided reasonable access to the department's
18-1 [commission's] programs and services.
18-2 SECTION 2.006. Section 402.025, Labor Code, is amended to
18-3 read as follows:
18-4 Sec. 402.025. AUDIT. The financial transactions of the
18-5 department [commission] are subject to audit by the state auditor
18-6 in accordance with Chapter 321, Government Code.
18-7 SECTION 2.007. The heading to Subchapter D, Chapter 402,
18-8 Labor Code, is amended to read as follows:
18-9 SUBCHAPTER D. GENERAL POWERS AND DUTIES OF DEPARTMENT
18-10 [COMMISSION]
18-11 SECTION 2.008. Section 402.061, Labor Code, is amended to
18-12 read as follows:
18-13 Sec. 402.061. ADOPTION OF RULES. The commissioner
18-14 [commission] shall adopt rules as necessary for the implementation
18-15 and enforcement of this subtitle.
18-16 SECTION 2.009. Section 402.062, Labor Code, is amended to
18-17 read as follows:
18-18 Sec. 402.062. ACCEPTANCE OF GIFTS, GRANTS, AND DONATIONS.
18-19 (a) The commissioner [commission] may accept gifts, grants, or
18-20 donations as provided by rules adopted by the commissioner
18-21 [commission].
18-22 (b) Notwithstanding Chapter 575, Government Code, the
18-23 commissioner [commission] may accept a grant paid from the Texas
18-24 Workers' Compensation Insurance Fund established under Article
18-25 5.76-3, Insurance Code, to implement specific steps to control and
18-26 lower medical costs in the workers' compensation system and to
18-27 ensure the delivery of quality medical care. The department
19-1 [commission] must publish the name of the grantor and the purpose
19-2 and conditions of the grant in the Texas Register and provide for a
19-3 20-day public comment period before the department [commission] may
19-4 accept the grant. The commissioner [commission] shall acknowledge
19-5 acceptance of the grant at a public meeting. The minutes of the
19-6 public meeting must include the name of the grantor, a description
19-7 of the grant, and a general statement of the purposes for which the
19-8 grant will be used.
19-9 SECTION 2.010. Section 402.064, Labor Code, is amended to
19-10 read as follows:
19-11 Sec. 402.064. FEES. In addition to fees established by this
19-12 subtitle, the commissioner [commission] shall set reasonable fees
19-13 for services provided to persons requesting services from the
19-14 department [commission], including services provided under
19-15 Subchapter E.
19-16 SECTION 2.011. Section 402.065, Labor Code, is amended to
19-17 read as follows:
19-18 Sec. 402.065. EMPLOYMENT OF COUNSEL. The commissioner
19-19 [commission] may employ counsel to represent the department
19-20 [commission] in any legal action the department [commission] is
19-21 authorized to initiate.
19-22 SECTION 2.012. Section 402.066, Labor Code, is amended to
19-23 read as follows:
19-24 Sec. 402.066. RECOMMENDATIONS TO LEGISLATURE. (a) The
19-25 commissioner [commission] shall consider and recommend to the
19-26 legislature changes to this subtitle.
19-27 (b) The commissioner [commission] shall forward the
20-1 recommended changes to the legislature not later than December 1 of
20-2 each even-numbered year.
20-3 SECTION 2.013. Section 402.0665, Labor Code, is amended to
20-4 read as follows:
20-5 Sec. 402.0665. LEGISLATIVE OVERSIGHT. The legislature may
20-6 adopt requirements relating to legislative oversight of the
20-7 department [commission] and the workers' compensation system of
20-8 this state. The department [commission] shall comply with any
20-9 requirements adopted by the legislature under this section.
20-10 SECTION 2.014. Section 402.067, Labor Code, is amended to
20-11 read as follows:
20-12 Sec. 402.067. ADVISORY COMMITTEES. The commissioner
20-13 [commission] may appoint advisory committees as the commissioner
20-14 [it] considers necessary.
20-15 SECTION 2.015. Section 402.068, Labor Code, is amended to
20-16 read as follows:
20-17 Sec. 402.068. DELEGATION OF RIGHTS AND DUTIES. Except as
20-18 expressly provided by this subchapter, the commissioner
20-19 [commission] may not delegate rights and duties imposed on the
20-20 commissioner [it] by this subchapter.
20-21 SECTION 2.016. Section 402.069, Labor Code, is amended to
20-22 read as follows:
20-23 Sec. 402.069. QUALIFICATIONS AND STANDARDS OF CONDUCT
20-24 INFORMATION. The commissioner or the commissioner's designee
20-25 [executive director] shall provide to department [members of the
20-26 commission and commission] employees, as often as necessary,
20-27 information regarding their:
21-1 (1) qualifications for office or employment under this
21-2 subtitle; and
21-3 (2) responsibilities under applicable law relating to
21-4 standards of conduct for state [officers or] employees.
21-5 SECTION 2.017. Section 402.070(a), Labor Code, is amended to
21-6 read as follows:
21-7 (a) The department [commission] shall prepare annually a
21-8 complete and detailed written report accounting for all funds
21-9 received and disbursed by the department [commission] during the
21-10 preceding fiscal year.
21-11 SECTION 2.018. Section 402.071(a), Labor Code, is amended to
21-12 read as follows:
21-13 (a) The commissioner [commission] shall establish
21-14 qualifications for a representative and shall adopt rules
21-15 establishing procedures for authorization of representatives.
21-16 SECTION 2.019. Section 402.072, Labor Code, is amended to
21-17 read as follows:
21-18 Sec. 402.072. SANCTIONS. Only the commissioner [commission]
21-19 may impose:
21-20 (1) a sanction that deprives a person of the right to
21-21 practice before the department [commission] or of the right to
21-22 receive remuneration under this subtitle for a period exceeding 30
21-23 days; or
21-24 (2) another sanction suspending for more than 30 days
21-25 or revoking a license, certification, or permit required for
21-26 practice in the field of workers' compensation.
21-27 SECTION 2.020. Sections 402.073(a) and (c), Labor Code, are
22-1 amended to read as follows:
22-2 (a) The commissioner [commission] and the chief
22-3 administrative law judge of the State Office of Administrative
22-4 Hearings by rule shall adopt a memorandum of understanding
22-5 governing administrative procedure law hearings under this subtitle
22-6 conducted by the State Office of Administrative Hearings in the
22-7 manner provided for a contested case hearing under Chapter 2001,
22-8 Government Code (the administrative procedure law).
22-9 (c) In a case in which a hearing is conducted in conjunction
22-10 with Section 402.072, 407.046, or 408.023, and in other cases under
22-11 this subtitle that are not subject to Subsection (b), the
22-12 administrative law judge who conducts the hearing for the State
22-13 Office of Administrative Hearings shall propose a decision to the
22-14 commissioner [commission] for final consideration and decision by
22-15 the commissioner [commission].
22-16 SECTION 2.021. Section 402.081, Labor Code, is amended to
22-17 read as follows:
22-18 Sec. 402.081. DEPARTMENT [COMMISSION] RECORDS. (a) The
22-19 commissioner [executive director] is the custodian of the
22-20 department's [commission's] records and shall perform the duties of
22-21 a custodian required by law, including providing copies and the
22-22 certification of records.
22-23 (b) The department [executive director] may destroy a record
22-24 maintained by the department [commission] pertaining to an injury
22-25 after the 50th anniversary of the date of the injury to which the
22-26 record refers unless benefits are being paid on the claim on that
22-27 date.
23-1 (c) A record maintained by the department [commission] may
23-2 be preserved in any format permitted by Chapter 441, Government
23-3 Code, and rules adopted by the Texas State Library and Archives
23-4 Commission under that chapter.
23-5 (d) The department [commission] may charge a reasonable fee
23-6 for making available for inspection any of its information that
23-7 contains confidential information that must be redacted before the
23-8 information is made available. However, when a request for
23-9 information is for the inspection of 10 or fewer pages, and a copy
23-10 of the information is not requested, the department [commission]
23-11 may charge only the cost of making a copy of the page from which
23-12 confidential information must be redacted. The fee for access to
23-13 information under Chapter 552, Government Code, shall be in accord
23-14 with the rules of the General Services Commission that prescribe
23-15 the method for computing the charge for copies under that chapter.
23-16 SECTION 2.022. Section 402.082, Labor Code, is amended to
23-17 read as follows:
23-18 Sec. 402.082. INJURY INFORMATION MAINTAINED BY DEPARTMENT
23-19 [COMMISSION]. The department [commission] shall maintain
23-20 information on every compensable injury as to the:
23-21 (1) race, ethnicity, and sex of the claimant;
23-22 (2) classification of the injury;
23-23 (3) amount of wages earned by the claimant before the
23-24 injury; and
23-25 (4) amount of compensation received by the claimant.
23-26 SECTION 2.023. Section 402.083(a), Labor Code, is amended to
23-27 read as follows:
24-1 (a) Information in or derived from a claim file regarding an
24-2 employee is confidential and may not be disclosed by the department
24-3 [commission] except as provided by this subtitle.
24-4 SECTION 2.024. Section 402.084(a), Labor Code, is amended to
24-5 read as follows:
24-6 (a) The department [commission] shall perform and release a
24-7 record check on an employee, including current or prior injury
24-8 information, to the parties listed in Subsection (b) if:
24-9 (1) the claim is:
24-10 (A) open or pending before the department
24-11 [commission];
24-12 (B) on appeal to a court of competent
24-13 jurisdiction; or
24-14 (C) the subject of a subsequent suit in which
24-15 the insurance carrier or the subsequent injury fund is subrogated
24-16 to the rights of the named claimant; and
24-17 (2) the requesting party requests the release on a
24-18 form prescribed by the department [commission] for this purpose and
24-19 provides all required information.
24-20 SECTION 2.025. Section 402.085, Labor Code, is amended to
24-21 read as follows:
24-22 Sec. 402.085. EXCEPTIONS TO CONFIDENTIALITY. (a) The
24-23 department [commission] shall release information on a claim to:
24-24 (1) the Texas Department of Insurance for any
24-25 statutory or regulatory purpose;
24-26 (2) a legislative committee for legislative purposes;
24-27 (3) a state or federal elected official requested in
25-1 writing to provide assistance by a constituent who qualifies to
25-2 obtain injury information under Section 402.084(b), if the request
25-3 for assistance is provided to the department [commission];
25-4 (4) the Research and Oversight Council on Workers'
25-5 Compensation for research purposes; or
25-6 (5) the attorney general or another entity that
25-7 provides child support services under Part D, Title IV, Social
25-8 Security Act (42 U.S.C. Section 651 et seq.), relating to:
25-9 (A) establishing, modifying, or enforcing a
25-10 child support or medical support obligation; or
25-11 (B) locating an absent parent.
25-12 (b) The department [commission] may release information on a
25-13 claim to a governmental agency, political subdivision, or
25-14 regulatory body to use to:
25-15 (1) investigate an allegation of a criminal offense or
25-16 licensing or regulatory violation;
25-17 (2) provide:
25-18 (A) unemployment compensation benefits;
25-19 (B) crime victims compensation benefits;
25-20 (C) vocational rehabilitation services; or
25-21 (D) health care benefits;
25-22 (3) investigate occupational safety or health
25-23 violations;
25-24 (4) verify income on an application for benefits under
25-25 an income-based state or federal assistance program; or
25-26 (5) assess financial resources in an action, including
25-27 an administrative action, to:
26-1 (A) establish, modify, or enforce a child
26-2 support or medical support obligation;
26-3 (B) establish paternity;
26-4 (C) locate an absent parent; or
26-5 (D) cooperate with another state in an action
26-6 authorized under Part D, Title IV, Social Security Act (42 U.S.C.
26-7 Section 651 et seq.), or Chapter 231, Family [76, Human Resources]
26-8 Code.
26-9 SECTION 2.026. Sections 402.088(a), (b), and (d), Labor
26-10 Code, are amended to read as follows:
26-11 (a) On receipt of a valid request made under and complying
26-12 with Section 402.087, the department [commission] shall review its
26-13 records.
26-14 (b) If the department [commission] finds that the applicant
26-15 has made two or more general injury claims in the preceding five
26-16 years, the department [commission] shall release the date and
26-17 description of each injury to the employer.
26-18 (d) If the employer requests information on three or more
26-19 applicants at the same time, the department [commission] may refuse
26-20 to release information until it receives the written authorization
26-21 from each applicant.
26-22 SECTION 2.027. Section 402.089(a), Labor Code, is amended to
26-23 read as follows:
26-24 (a) An employer who receives information by telephone from
26-25 the department [commission] under Section 402.088 and who fails to
26-26 file the necessary authorization in accordance with Section 402.087
26-27 commits a Class C administrative violation.
27-1 SECTION 2.028. Section 402.090, Labor Code, is amended to
27-2 read as follows:
27-3 Sec. 402.090. STATISTICAL INFORMATION. The department
27-4 [commission], the research center, or any other governmental agency
27-5 may prepare and release statistical information if the identity of
27-6 an employee is not explicitly or implicitly disclosed.
27-7 SECTION 2.029. Section 402.091(a), Labor Code, is amended to
27-8 read as follows:
27-9 (a) A person commits an offense if the person knowingly,
27-10 intentionally, or recklessly publishes, discloses, or distributes
27-11 information that is confidential under this subchapter to a person
27-12 not authorized to receive the information directly from the
27-13 department [commission].
27-14 SECTION 2.030. Sections 402.092(a), (b), (d), (e), and (f),
27-15 Labor Code, are amended to read as follows:
27-16 (a) Information maintained in the investigation files of the
27-17 department [commission] is confidential and may not be disclosed
27-18 except:
27-19 (1) in a criminal proceeding;
27-20 (2) in a hearing conducted by the department, or by
27-21 the State Office of Administrative Hearings under this subtitle
27-22 [commission];
27-23 (3) on a judicial determination of good cause; or
27-24 (4) to a governmental agency, political subdivision,
27-25 or regulatory body if the disclosure is necessary or proper for the
27-26 enforcement of the laws of this or another state or of the United
27-27 States.
28-1 (b) Department [Commission] investigation files are not open
28-2 records for purposes of Chapter 552, Government Code.
28-3 (d) For purposes of this section, "investigation file" means
28-4 any information compiled or maintained by the department
28-5 [commission] with respect to a department [commission]
28-6 investigation authorized by law.
28-7 (e) The department [commission], upon request, shall
28-8 disclose the identity of a complainant under this section if the
28-9 department [commission] finds:
28-10 (1) the complaint was groundless or made in bad faith;
28-11 or
28-12 (2) the complaint lacks any basis in fact or evidence;
28-13 or
28-14 (3) the complaint is frivolous; or
28-15 (4) the complaint is done specifically for competitive
28-16 or economic advantage.
28-17 (f) Upon completion of an investigation where the department
28-18 [commission] determines a complaint is groundless, frivolous, made
28-19 in bad faith, or is not supported by evidence or is done
28-20 specifically for competitive or economic advantage the department
28-21 [commission] shall notify the person who was the subject of the
28-22 complaint of its finding and the identity of the complainant.
28-23 ARTICLE 3. GENERAL CONFORMING AMENDMENTS
28-24 SECTION 3.001. Section 91.003(b), Labor Code, is amended to
28-25 read as follows:
28-26 (b) In particular, the Texas Workforce Commission, the Texas
28-27 Department of Insurance, the Texas Department of Workers'
29-1 Compensation [Commission], and the attorney general's office shall
29-2 assist in the implementation of this chapter and shall provide
29-3 information to the department on request.
29-4 SECTION 3.002. Section 401.002, Labor Code, is amended to
29-5 read as follows:
29-6 Sec. 401.002. APPLICATION OF SUNSET ACT. The Texas
29-7 Department of Workers' Compensation [Commission] is subject to
29-8 Chapter 325, Government Code (Texas Sunset Act). Unless continued
29-9 in existence as provided by that chapter, the department
29-10 [commission] is abolished September 1, 2007.
29-11 SECTION 3.003. Section 401.011, Labor Code, is amended by
29-12 amending Subdivisions (8), (15), (37), and (39) and adding
29-13 Subdivision (45) to read as follows:
29-14 (8) "Commissioner" means the commissioner of workers'
29-15 compensation ["Commission" means the Texas Workers' Compensation
29-16 Commission].
29-17 (15) "Designated doctor" means a doctor appointed by
29-18 mutual agreement of the parties or by the department [commission]
29-19 to recommend a resolution of a dispute as to the medical condition
29-20 of an injured employee.
29-21 (37) "Representative" means a person, including an
29-22 attorney, authorized by the department [commission] to assist or
29-23 represent an employee, a person claiming a death benefit, or an
29-24 insurance carrier in a matter arising under this subtitle that
29-25 relates to the payment of compensation.
29-26 (39) "Sanction" means a penalty or other punitive
29-27 action or remedy imposed by the department [commission] on an
30-1 insurance carrier, representative, employee, employer, or health
30-2 care provider for an act or omission in violation of this subtitle
30-3 or a rule or order of the department [commission].
30-4 (45) "Department" means the Texas Department of
30-5 Workers' Compensation.
30-6 SECTION 3.004. Section 401.021, Labor Code, is amended to
30-7 read as follows:
30-8 Sec. 401.021. APPLICATION OF OTHER ACTS. Except as otherwise
30-9 provided by this subtitle:
30-10 (1) a proceeding, hearing, judicial review, or
30-11 enforcement of a department [commission] order, decision, or rule
30-12 is governed by the following subchapters and sections of Chapter
30-13 2001, Government Code:
30-14 (A) Subchapters A, B, D, E, G, and H, excluding
30-15 Sections 2001.004(3) and 2001.005;
30-16 (B) Sections 2001.051, 2001.052, and 2001.053;
30-17 (C) Sections 2001.056 through 2001.062; and
30-18 (D) Section 2001.141(c);
30-19 (2) a proceeding, hearing, judicial review, or
30-20 enforcement of a department [commission] order, decision, or rule
30-21 is governed by Subchapters A and B, Chapter 2002, Government Code,
30-22 excluding Sections 2002.001(3) [2002.001(2)] and 2002.023;
30-23 (3) Chapter 551, Government Code, applies to a
30-24 proceeding under this subtitle, other than:
30-25 (A) a benefit review conference;
30-26 (B) a contested case hearing;
30-27 (C) an appeals panel proceeding;
31-1 (D) arbitration; or
31-2 (E) another proceeding involving a determination
31-3 on a workers' compensation claim; and
31-4 (4) Chapter 552, Government Code, applies to a record
31-5 of the department [commission] or the research center.
31-6 SECTION 3.005. Section 401.023(b), Labor Code, is amended to
31-7 read as follows:
31-8 (b) The department [commission] shall compute and publish
31-9 the interest and discount rate quarterly, using the auction rate
31-10 quoted on a discount basis for the 52-week treasury bills issued by
31-11 the United States government, as published by the Federal Reserve
31-12 Board on the date nearest to the 15th day preceding the first day
31-13 of the calendar quarter for which the rate is to be effective, plus
31-14 3.5 percent. For this purpose, calendar quarters begin January 1,
31-15 April 1, July 1, and October 1.
31-16 SECTION 3.006. Sections 401.024(b), (c), and (d), Labor Code,
31-17 are amended to read as follows:
31-18 (b) Notwithstanding another provision of this subtitle that
31-19 specifies the form, manner, or procedure for the transmission of
31-20 specified information, the commissioner [commission] by rule may
31-21 permit or require the use of an electronic transmission instead of
31-22 the specified form, manner, or procedure. If the electronic
31-23 transmission of information is not authorized or permitted by
31-24 [commission] rule, the transmission of that information is governed
31-25 by any applicable statute or rule that prescribes the form, manner,
31-26 or procedure for the transmission, including standards adopted by
31-27 the Department of Information Resources.
32-1 (c) The department [commission] may designate and contract
32-2 with a data collection agent to fulfill the data collection
32-3 requirements of this subtitle.
32-4 (d) The department [executive director] may prescribe the
32-5 form, manner, and procedure for transmitting any authorized or
32-6 required electronic transmission, including requirements related to
32-7 security, confidentiality, accuracy, and accountability.
32-8 SECTION 3.007. Subchapter C, Chapter 401, Labor Code, is
32-9 amended by adding Section 401.025 to read as follows:
32-10 Sec. 401.025. REFERENCES TO COMMISSION AND EXECUTIVE
32-11 DIRECTOR. A reference in this code or other law to the Texas
32-12 Workers' Compensation Commission or the executive director of that
32-13 commission means the department or the commissioner as consistent
32-14 with the respective duties of the commissioner and the department
32-15 under this subtitle and other workers' compensation laws of this
32-16 state.
32-17 SECTION 3.008. The heading to Section 403.001, Labor Code, is
32-18 amended to read as follows:
32-19 Sec. 403.001. DEPARTMENT [COMMISSION] FUNDS.
32-20 SECTION 3.009. Sections 403.001(a) and (b), Labor Code, are
32-21 amended to read as follows:
32-22 (a) Except as provided by Sections 403.006 and 403.007 or as
32-23 otherwise provided by law, money collected under this subtitle,
32-24 including administrative penalties and advance deposits for
32-25 purchase of services, shall be deposited in the general revenue
32-26 fund of the state treasury to the credit of the department
32-27 [commission].
33-1 (b) The money may be spent as authorized by legislative
33-2 appropriation on warrants issued by the comptroller under
33-3 requisitions made by the department [commission].
33-4 SECTION 3.010. Section 403.003, Labor Code, is amended to
33-5 read as follows:
33-6 Sec. 403.003. RATE OF ASSESSMENT. (a) The department
33-7 [commission] shall set and certify to the comptroller the rate of
33-8 maintenance tax assessment not later than October 31 of each year,
33-9 taking into account:
33-10 (1) any expenditure projected as necessary for the
33-11 department [commission] to:
33-12 (A) administer this subtitle during the fiscal
33-13 year for which the rate of assessment is set; and
33-14 (B) reimburse the general revenue fund as
33-15 provided by Article 4.19, Insurance Code;
33-16 (2) projected employee benefits paid from general
33-17 revenues;
33-18 (3) a surplus or deficit produced by the tax in the
33-19 preceding year;
33-20 (4) revenue recovered from other sources, including
33-21 reappropriated receipts, grants, payments, fees, gifts, and
33-22 penalties recovered under this subtitle; and
33-23 (5) expenditures projected as necessary to support the
33-24 prosecution of workers' compensation insurance fraud.
33-25 (b) In setting the rate of assessment, the department
33-26 [commission] may not consider revenue or expenditures related to:
33-27 (1) the State Office of Risk Management;
34-1 (2) the research and oversight council on workers'
34-2 compensation; or
34-3 (3) any other revenue or expenditure excluded from
34-4 consideration by law.
34-5 SECTION 3.011. Section 403.004, Labor Code, is amended to
34-6 read as follows:
34-7 Sec. 403.004. COLLECTION OF TAX AFTER WITHDRAWAL FROM
34-8 BUSINESS. The insurance commissioner or the department [executive
34-9 director of the commission] immediately shall proceed to collect
34-10 taxes due under this chapter from an insurance carrier that
34-11 withdraws from business in this state, using legal process as
34-12 necessary.
34-13 SECTION 3.012. Section 403.005, Labor Code, is amended to
34-14 read as follows:
34-15 Sec. 403.005. TAX RATE SURPLUS OR DEFICIT. (a) If the tax
34-16 rate set by the department [commission] for a year does not produce
34-17 sufficient revenue to make all expenditures authorized by
34-18 legislative appropriation, the deficit shall be paid from the
34-19 general revenue fund.
34-20 (b) If the tax rate set by the commissioner [commission] for
34-21 a year produces revenue that exceeds the amount required to make
34-22 all expenditures authorized by the legislature, the excess shall be
34-23 deposited in the general revenue fund to the credit of the
34-24 department [commission].
34-25 SECTION 3.013. Section 403.006(c), Labor Code, is amended to
34-26 read as follows:
34-27 (c) The commissioner [executive director] shall appoint an
35-1 administrator for the subsequent injury fund.
35-2 SECTION 3.014. Section 403.007, Labor Code, is amended to
35-3 read as follows:
35-4 Sec. 403.007. FUNDING OF SUBSEQUENT INJURY FUND. (a) If a
35-5 compensable death occurs and no legal beneficiary survives or a
35-6 claim for death benefits is not timely made, the insurance carrier
35-7 shall pay to the department [commission] for deposit to the credit
35-8 of the subsequent injury fund an amount equal to 364 weeks of the
35-9 death benefits otherwise payable.
35-10 (b) The insurance carrier may elect or the department
35-11 [commission] may order that death benefits payable to the fund be
35-12 commuted on written approval of the department [executive
35-13 director]. The commutation may be discounted for present payment
35-14 at the rate established in Section 401.023, compounded annually.
35-15 (c) If a claim for death benefits is not filed with the
35-16 department [commission] by a legal beneficiary on or before the
35-17 first anniversary of the date of the death of the employee, it is
35-18 presumed, for purposes of this section only, that no legal
35-19 beneficiary survived the deceased employee. The presumption does
35-20 not apply against a minor beneficiary or an incompetent beneficiary
35-21 for whom a guardian has not been appointed.
35-22 (d) If the insurance carrier makes payment to the subsequent
35-23 injury fund and it is later determined by a final award of the
35-24 department [commission] or the final judgment of a court of
35-25 competent jurisdiction that a legal beneficiary is entitled to the
35-26 death benefits, the department [commission] shall order the fund to
35-27 reimburse the insurance carrier for the amount overpaid to the
36-1 fund.
36-2 SECTION 3.015. Section 404.002(a), Labor Code, is amended to
36-3 read as follows:
36-4 (a) The Research and Oversight Council on Workers'
36-5 Compensation is an advisory body to the commissioner [commission].
36-6 The council shall be operated in a manner that ensures that its
36-7 research, findings, and conclusions are factual, fair, and
36-8 unbiased.
36-9 SECTION 3.016. Section 404.003(b), Labor Code, is amended to
36-10 read as follows:
36-11 (b) The department [commission] shall set the rate of the
36-12 maintenance tax based on the expenditures authorized and the
36-13 receipts anticipated in legislative appropriations. The tax rate
36-14 for insurance companies may not exceed one-tenth of one percent of
36-15 the correctly reported gross workers' compensation insurance
36-16 premiums. The tax rate for certified self-insurers may not exceed
36-17 one-tenth of one percent of the total tax base of all certified
36-18 self-insurers, as computed under Section 407.103(b).
36-19 SECTION 3.017. Sections 404.004(a) and (d), Labor Code, are
36-20 amended to read as follows:
36-21 (a) The council is governed by a board of directors,
36-22 composed of:
36-23 (1) three senators, appointed by the lieutenant
36-24 governor;
36-25 (2) three members of the house of representatives,
36-26 appointed by the speaker of the house of representatives;
36-27 (3) the commissioner or a person designated by the
37-1 commissioner [a member of the commission, appointed by the
37-2 commission, from the members who are wage earners;]
37-3 [(4) a member of the commission, appointed by the
37-4 commission, from the members who are employers of labor]; and
37-5 (4) [(5)] the commissioner of insurance or a person
37-6 designated by that commissioner.
37-7 (d) An officer, employee, or paid consultant of a Texas
37-8 trade association whose members provide services subject to
37-9 regulation by the department [commission] or provide services whose
37-10 fees are subject to regulation by the department [commission] may
37-11 not be an employee of the council who is exempt from the state's
37-12 position classification plan or is compensated at or above the
37-13 amount prescribed by the General Appropriations Act for step 1,
37-14 salary group A17 [17], of the position classification salary
37-15 schedule.
37-16 SECTION 3.018. Section 404.0041, Labor Code, is amended to
37-17 read as follows:
37-18 Sec. 404.0041. EFFECT OF LOBBYING ACTIVITY. A person may
37-19 not act as the general counsel to the board or the council if the
37-20 person is required to register as a lobbyist under Chapter 305,
37-21 Government Code, because of the person's activities for
37-22 compensation on behalf of a profession that is regulated or has
37-23 fees regulated by the department [commission].
37-24 SECTION 3.019. Sections 404.007(a) and (d), Labor Code, are
37-25 amended to read as follows:
37-26 (a) The board shall:
37-27 (1) approve the operating budget of the council;
38-1 (2) adopt rules for the operations of the board and
38-2 the council;
38-3 (3) conduct professional studies and research on all
38-4 matters relevant to the cost, quality, and operational
38-5 effectiveness of the workers' compensation system;
38-6 (4) monitor the cost of income benefits under this
38-7 subtitle, with emphasis on the availability and cost of
38-8 supplemental income benefits;
38-9 (5) monitor the performance and operation of the Texas
38-10 Workers' Compensation Insurance Fund, with emphasis on the insurer
38-11 of last resort program;
38-12 (6) hold regular public hearings and receive testimony
38-13 and reports from:
38-14 (A) the department [commission];
38-15 (B) the Texas Workers' Compensation Insurance
38-16 Fund;
38-17 (C) the Texas Department of Insurance;
38-18 (D) the State Office of Risk Management; and
38-19 (E) any other public or private entity that is
38-20 involved in the workers' compensation system;
38-21 (7) receive information about workers' compensation
38-22 rules and operations of an entity listed in Subdivision (6); and
38-23 (8) review specific recommendations for legislation
38-24 relating to this subtitle [the Texas Workers' Compensation Act]
38-25 formally proposed by an entity listed in Subdivision (6).
38-26 (d) The board may:
38-27 (1) delegate powers to the executive director as it
39-1 considers appropriate, including general guidance on the
39-2 identification of information needs and the conduct of research;
39-3 (2) contract with other persons, including
39-4 institutions of higher education, for conducting economical studies
39-5 of high quality for the council;
39-6 (3) contract with the department [commission] for a
39-7 fiscal, personnel, or other support function;
39-8 (4) appoint expert advisory committees to provide
39-9 technical assistance in conducting research; and
39-10 (5) request reports and other information on workers'
39-11 compensation from an entity listed in Subsection (a)(6). Requests
39-12 made under this subsection shall be reasonable in scope and shall
39-13 take into account the availability of the information requested,
39-14 the preparation time required, and other relevant circumstances.
39-15 SECTION 3.020. Section 404.008(c), Labor Code, is amended to
39-16 read as follows:
39-17 (c) The executive director shall prepare a request for
39-18 legislative appropriations for the operations of the council. If
39-19 the request is approved by the board, the board shall submit the
39-20 request to the department [commission]. The department
39-21 [commission] shall include the request in the department's
39-22 [commission's] legislative appropriations request.
39-23 SECTION 3.021. Section 404.010(a), Labor Code, is amended to
39-24 read as follows:
39-25 (a) As required to fulfill the objectives of the council,
39-26 the council is entitled to access to the files and records of:
39-27 (1) the department [commission];
40-1 (2) the Texas Workforce Commission;
40-2 (3) the Texas Department of Insurance;
40-3 (4) the Texas Department of Human Services;
40-4 (5) the Texas Workers' Compensation Insurance Fund;
40-5 and
40-6 (6) other state agencies.
40-7 SECTION 3.022. The heading to Section 406.004, Labor Code,
40-8 is amended to read as follows:
40-9 Sec. 406.004. EMPLOYER NOTICE TO DEPARTMENT [COMMISSION];
40-10 ADMINISTRATIVE VIOLATION.
40-11 SECTION 3.023. Sections 406.004(a), (b), (c), and (d), Labor
40-12 Code, are amended to read as follows:
40-13 (a) An employer who does not obtain workers' compensation
40-14 insurance coverage shall notify the department [commission] in
40-15 writing, in the time and as prescribed by department [commission]
40-16 rule, that the employer elects not to obtain coverage.
40-17 (b) The department [commission] shall prescribe forms to be
40-18 used for the employer notification and shall require the employer
40-19 to provide reasonable information to the department [commission]
40-20 about the employer's business.
40-21 (c) The department [commission] may contract with the Texas
40-22 Employment Commission or the comptroller for assistance in
40-23 collecting the notification required under this section. Those
40-24 agencies shall cooperate with the department [commission] in
40-25 enforcing this section.
40-26 (d) The employer notification filing required under this
40-27 section shall be filed with the department [commission] in
41-1 accordance with Section 406.009.
41-2 SECTION 3.024. Section 406.005(c), Labor Code, is amended to
41-3 read as follows:
41-4 (c) Each employer shall post a notice of whether the
41-5 employer has workers' compensation insurance coverage at
41-6 conspicuous locations at the employer's place of business as
41-7 necessary to provide reasonable notice to the employees. The
41-8 commissioner [commission] may adopt rules relating to the form and
41-9 content of the notice. The employer shall revise the notice when
41-10 the information contained in the notice is changed.
41-11 SECTION 3.025. Sections 406.006(a), (b), and (c), Labor
41-12 Code, are amended to read as follows:
41-13 (a) An insurance company from which an employer has obtained
41-14 workers' compensation insurance coverage, a certified self-insurer,
41-15 and a political subdivision shall file notice of the coverage and
41-16 claim administration contact information with the department
41-17 [commission] not later than the 10th day after the date on which
41-18 the coverage or claim administration agreement takes effect, unless
41-19 the commissioner [commission] adopts a rule establishing a later
41-20 date for filing. Coverage takes effect on the date on which a
41-21 binder is issued, a later date and time agreed to by the parties,
41-22 on the date provided by the certificate of self-insurance, or on
41-23 the date provided in an interlocal agreement that provides for
41-24 self-insurance. The commissioner [commission] may adopt rules that
41-25 establish the coverage and claim administration contact information
41-26 required under this subsection.
41-27 (b) The notice required under this section shall be filed
42-1 with the department [commission] in accordance with Section
42-2 406.009.
42-3 (c) An insurance company, certified self-insurer, or
42-4 political subdivision commits a violation if the person fails to
42-5 file notice with the department [commission] as provided by this
42-6 section. A violation under this subsection is a Class C
42-7 administrative violation. Each day of noncompliance constitutes a
42-8 separate violation.
42-9 SECTION 3.026. Sections 406.007(a), (b), and (c), Labor
42-10 Code, are amended to read as follows:
42-11 (a) An employer who terminates workers' compensation
42-12 insurance coverage obtained under this subtitle shall file a
42-13 written notice with the department [commission] by certified mail
42-14 not later than the 10th day after the date on which the employer
42-15 notified the insurance carrier to terminate the coverage. The
42-16 notice must include a statement certifying the date that notice was
42-17 provided or will be provided to affected employees under Section
42-18 406.005.
42-19 (b) The notice required under this section shall be filed
42-20 with the department [commission] in accordance with Section
42-21 406.009.
42-22 (c) Termination of coverage takes effect on the later of:
42-23 (1) the 30th day after the date of filing of notice
42-24 with the department [commission] under Subsection (a); or
42-25 (2) the cancellation date of the policy.
42-26 SECTION 3.027. Section 406.008, Labor Code, is amended to
42-27 read as follows:
43-1 Sec. 406.008. CANCELLATION OR NONRENEWAL OF COVERAGE BY
43-2 INSURANCE COMPANY; NOTICE. (a) An insurance company that cancels
43-3 a policy of workers' compensation insurance or that does not renew
43-4 the policy by the anniversary date of the policy shall deliver
43-5 notice of the cancellation or nonrenewal by certified mail or in
43-6 person to the employer and the department [commission] not later
43-7 than:
43-8 (1) the 30th day before the date on which the
43-9 cancellation or nonrenewal takes effect; or
43-10 (2) the 10th day before the date on which the
43-11 cancellation or nonrenewal takes effect if the insurance company
43-12 cancels or does not renew because of:
43-13 (A) fraud in obtaining coverage;
43-14 (B) misrepresentation of the amount of payroll
43-15 for purposes of premium calculation;
43-16 (C) failure to pay a premium when due;
43-17 (D) an increase in the hazard for which the
43-18 employer seeks coverage that results from an act or omission of the
43-19 employer and that would produce an increase in the rate, including
43-20 an increase because of a failure to comply with:
43-21 (i) reasonable recommendations for loss
43-22 control; or
43-23 (ii) recommendations designed to reduce a
43-24 hazard under the employer's control within a reasonable period; or
43-25 (E) a determination made by the commissioner of
43-26 insurance that the continuation of the policy would place the
43-27 insurer in violation of the law or would be hazardous to the
44-1 interest of subscribers, creditors, or the general public.
44-2 (b) The notice required under this section shall be filed
44-3 with the department [commission].
44-4 (c) Failure of the insurance company to give notice as
44-5 required by this section extends the policy until the date on which
44-6 the required notice is provided to the employer and the department
44-7 [commission].
44-8 SECTION 3.028. Sections 406.009(a), (b), (c), and (d), Labor
44-9 Code, are amended to read as follows:
44-10 (a) The department [commission] shall collect and maintain
44-11 the information required under this subchapter and shall monitor
44-12 compliance with the requirements of this subchapter.
44-13 (b) The commissioner [commission] may adopt rules as
44-14 necessary to enforce this subchapter.
44-15 (c) The department [commission] may designate a data
44-16 collection agent, implement an electronic reporting and public
44-17 information access program, and adopt rules as necessary to
44-18 implement the data collection requirements of this subchapter. The
44-19 department [executive director] may establish the form, manner, and
44-20 procedure for the transmission of information to the department
44-21 [commission as authorized by Section 402.042(b)(11)].
44-22 (d) The department [commission] may require an employer or
44-23 insurance carrier subject to this subtitle to identify or confirm
44-24 an employer's coverage status and claim administration contact
44-25 information as necessary to achieve the purposes of this subtitle.
44-26 SECTION 3.029. Section 406.010(c), Labor Code, is amended to
44-27 read as follows:
45-1 (c) The commissioner [commission] by rule shall further
45-2 specify the requirements of this section.
45-3 SECTION 3.030. Section 406.011(a), Labor Code, is amended to
45-4 read as follows:
45-5 (a) The commissioner [commission] by rule may require an
45-6 insurance carrier to designate a representative in Austin to act as
45-7 the insurance carrier's agent before the department [commission] in
45-8 Austin. Notice to the designated agent constitutes notice to the
45-9 insurance carrier.
45-10 SECTION 3.031. Section 406.012, Labor Code, is amended to
45-11 read as follows:
45-12 Sec. 406.012. ENFORCEMENT OF SUBCHAPTER. The department
45-13 [commission] shall enforce the administrative penalties established
45-14 under this subchapter in accordance with Chapter 415.
45-15 SECTION 3.032. Section 406.051(c), Labor Code, is amended to
45-16 read as follows:
45-17 (c) The employer may not transfer:
45-18 (1) the obligation to accept a report of injury under
45-19 Section 409.001;
45-20 (2) the obligation to maintain records of injuries
45-21 under Section 409.006;
45-22 (3) the obligation to report injuries to the insurance
45-23 carrier under Section 409.005;
45-24 (4) liability for a violation of Section 415.006 or
45-25 415.008 or of Chapter 451; or
45-26 (5) the obligation to comply with a department
45-27 [commission] order.
46-1 SECTION 3.033. Section 406.073(b), Labor Code, is amended to
46-2 read as follows:
46-3 (b) The employer shall file the agreement with the
46-4 department [executive director] on request.
46-5 SECTION 3.034. Sections 406.074(a) and (b), Labor Code, are
46-6 amended to read as follows:
46-7 (a) The department [executive director] may enter into an
46-8 agreement with an appropriate agency of another jurisdiction with
46-9 respect to:
46-10 (1) conflicts of jurisdiction;
46-11 (2) assumption of jurisdiction in a case in which the
46-12 contract of employment arises in one state and the injury is
46-13 incurred in another;
46-14 (3) procedures for proceeding against a foreign
46-15 employer who fails to comply with this subtitle; and
46-16 (4) procedures for the appropriate agency to use to
46-17 proceed against an employer of this state who fails to comply with
46-18 the workers' compensation laws of the other jurisdiction.
46-19 (b) An executed agreement that has been adopted as a rule by
46-20 the commissioner [commission] binds all subject employers and
46-21 employees.
46-22 SECTION 3.035. Section 406.093(b), Labor Code, is amended to
46-23 read as follows:
46-24 (b) The commissioner [commission] by rule shall adopt
46-25 procedures relating to the method of payment of benefits to legally
46-26 incompetent employees.
46-27 SECTION 3.036. Section 406.095(b), Labor Code, is amended to
47-1 read as follows:
47-2 (b) The commissioner [commission] by rule shall establish
47-3 the procedures and requirements for an election under this section.
47-4 SECTION 3.037. Sections 406.144(c) and (d), Labor Code, are
47-5 amended to read as follows:
47-6 (c) An agreement under this section shall be filed with the
47-7 department [commission] either by personal delivery or by
47-8 registered or certified mail and is considered filed on receipt by
47-9 the department [commission].
47-10 (d) The hiring contractor shall send a copy of an agreement
47-11 under this section to the hiring contractor's workers' compensation
47-12 insurance carrier on filing of the agreement with the department
47-13 [commission].
47-14 SECTION 3.038. Sections 406.145(a), (b), (c), (d), and (f),
47-15 Labor Code, are amended to read as follows:
47-16 (a) A hiring contractor and an independent subcontractor may
47-17 make a joint agreement declaring that the subcontractor is an
47-18 independent contractor as defined in Section 406.141(2) and that
47-19 the subcontractor is not the employee of the hiring contractor. If
47-20 the joint agreement is signed by both the hiring contractor and the
47-21 subcontractor and filed with the department [commission], the
47-22 subcontractor, as a matter of law, is an independent contractor and
47-23 not an employee, and is not entitled to workers' compensation
47-24 insurance coverage through the hiring contractor unless an
47-25 agreement is entered into under Section 406.144 to provide workers'
47-26 compensation insurance coverage. The department [commission] shall
47-27 prescribe forms for the joint agreement.
48-1 (b) A joint agreement shall be delivered to the department
48-2 [commission] by personal delivery or registered or certified mail
48-3 and is considered filed on receipt by the department [commission].
48-4 (c) The hiring contractor shall send a copy of a joint
48-5 agreement signed under this section to the hiring contractor's
48-6 workers' compensation insurance carrier on filing of the joint
48-7 agreement with the department [commission].
48-8 (d) The department [commission] shall maintain a system for
48-9 accepting and maintaining the joint agreements.
48-10 (f) If a subsequent hiring agreement is made to which the
48-11 joint agreement does not apply, the hiring contractor and
48-12 independent contractor shall notify the department [commission] and
48-13 the hiring contractor's workers' compensation insurance carrier in
48-14 writing.
48-15 SECTION 3.039. Section 406.162(b), Labor Code, is amended to
48-16 read as follows:
48-17 (b) The comptroller shall prepare a consumer price index for
48-18 this state and shall certify the applicable index factor to the
48-19 department [commission] before October 1 of each year. The
48-20 department [commission] shall adjust the gross annual payroll
48-21 requirement under Subsection (a)(2)(B) accordingly.
48-22 SECTION 3.040. Section 407.001(3), Labor Code, is amended to
48-23 read as follows:
48-24 (3) "Impaired employer" means a certified
48-25 self-insurer:
48-26 (A) who has suspended payment of compensation as
48-27 determined by the department [commission];
49-1 (B) who has filed for relief under bankruptcy
49-2 laws;
49-3 (C) against whom bankruptcy proceedings have
49-4 been filed; or
49-5 (D) for whom a receiver has been appointed by a
49-6 court of this state.
49-7 SECTION 3.041. Section 407.021, Labor Code, is amended to
49-8 read as follows:
49-9 Sec. 407.021. DIVISION. The division of self-insurance
49-10 regulation is a division of the department [commission].
49-11 SECTION 3.042. Section 407.022, Labor Code, is amended to
49-12 read as follows:
49-13 Sec. 407.022. DIRECTOR. (a) The commissioner [executive
49-14 director of the commission] shall appoint the director of the
49-15 division.
49-16 (b) The director shall exercise all the rights, powers, and
49-17 duties imposed or conferred on the department [commission] by this
49-18 chapter, other than by Section 407.023.
49-19 SECTION 3.043. Section 407.023, Labor Code, is amended to
49-20 read as follows:
49-21 Sec. 407.023. EXCLUSIVE POWERS AND DUTIES OF COMMISSIONER
49-22 [COMMISSION]. (a) The commissioner [commission, by majority
49-23 vote,] shall:
49-24 (1) approve or deny a recommendation by the director
49-25 concerning the issuance or revocation of a certificate of authority
49-26 to self-insure; and
49-27 (2) certify that a certified self-insurer has
50-1 suspended payment of compensation or has otherwise become an
50-2 impaired employer.
50-3 (b) The commissioner [commission] may not delegate the
50-4 powers and duties imposed by this section.
50-5 SECTION 3.044. Sections 407.041(a), (b), and (c), Labor
50-6 Code, are amended to read as follows:
50-7 (a) An employer who desires to self-insure under this
50-8 chapter must submit an application to the department [commission]
50-9 for a certificate of authority to self-insure.
50-10 (b) The application must be:
50-11 (1) submitted on a form adopted by the department
50-12 [commission]; and
50-13 (2) accompanied by a nonrefundable $1,000 application
50-14 fee.
50-15 (c) Not later than the 60th day after the date on which the
50-16 application is received, the director shall recommend approval or
50-17 denial of the application to the commissioner [commission].
50-18 SECTION 3.045. Section 407.042, Labor Code, is amended to
50-19 read as follows:
50-20 Sec. 407.042. ISSUANCE OF CERTIFICATE. With the approval of
50-21 the Texas Certified Self-Insurer Guaranty Association, [and by
50-22 majority vote,] the commissioner [commission] shall issue a
50-23 certificate of authority to self-insure to an applicant who meets
50-24 the certification requirements under this chapter and pays the
50-25 required fee.
50-26 SECTION 3.046. Section 407.043, Labor Code, is amended to
50-27 read as follows:
51-1 Sec. 407.043. PROCEDURES ON DENIAL OF APPLICATION. (a) If
51-2 the commissioner [commission] determines that an applicant for a
51-3 certificate of authority to self-insure does not meet the
51-4 certification requirements, the department [commission] shall
51-5 notify the applicant in writing of its determination, stating the
51-6 specific reasons for the denial and the conditions to be met before
51-7 approval may be granted.
51-8 (b) The applicant is entitled to a reasonable period, as
51-9 determined by the department [commission], to meet the conditions
51-10 for approval before the application is considered rejected for
51-11 purposes of appeal.
51-12 SECTION 3.047. Section 407.044(a), Labor Code, is amended to
51-13 read as follows:
51-14 (a) A certificate of authority to self-insure is valid for
51-15 one year after the date of issuance and may be renewed under
51-16 procedures prescribed by the department [commission].
51-17 SECTION 3.048. Section 407.045, Labor Code, is amended to
51-18 read as follows:
51-19 Sec. 407.045. WITHDRAWAL FROM SELF-INSURANCE. (a) A
51-20 certified self-insurer may withdraw from self-insurance at any time
51-21 with the approval of the commissioner [commission]. The
51-22 commissioner [commission] shall approve the withdrawal if the
51-23 certified self-insurer shows to the satisfaction of the
51-24 commissioner [commission] that the certified self-insurer has
51-25 established an adequate program to pay all incurred losses,
51-26 including unreported losses, that arise out of accidents or
51-27 occupational diseases first distinctly manifested during the period
52-1 of operation as a certified self-insurer.
52-2 (b) A certified self-insurer who withdraws from
52-3 self-insurance shall surrender to the department [commission] the
52-4 certificate of authority to self-insure.
52-5 SECTION 3.049. Sections 407.046(a), (b), and (d), Labor
52-6 Code, are amended to read as follows:
52-7 (a) The commissioner [commission by majority vote] may
52-8 revoke the certificate of authority to self-insure of a certified
52-9 self-insurer who fails to comply with requirements or conditions
52-10 established by this chapter or a rule adopted by the commissioner
52-11 [commission] under this chapter.
52-12 (b) If the commissioner [commission] believes that a ground
52-13 exists to revoke a certificate of authority to self-insure, the
52-14 commissioner [commission] shall refer the matter to the State
52-15 Office of Administrative Hearings. That office shall hold a
52-16 hearing to determine if the certificate should be revoked. The
52-17 hearing shall be conducted in the manner provided for a contested
52-18 case hearing under Chapter 2001, Government Code (the
52-19 administrative procedure law).
52-20 (d) If the certified self-insurer fails to show cause why
52-21 the certificate should not be revoked, the commissioner
52-22 [commission] immediately shall revoke the certificate.
52-23 SECTION 3.050. Section 407.047(b), Labor Code, is amended to
52-24 read as follows:
52-25 (b) The security required under Sections 407.064 and 407.065
52-26 shall be maintained with the department [commission] or under the
52-27 department's [commission's] control until each claim for workers'
53-1 compensation benefits is paid, is settled, or lapses under this
53-2 subtitle.
53-3 SECTION 3.051. Sections 407.061(a), (c), (e), and (f), Labor
53-4 Code, are amended to read as follows:
53-5 (a) To be eligible for a certificate of authority to
53-6 self-insure, an applicant for an initial or renewal certificate
53-7 must present evidence satisfactory to the commissioner [commission]
53-8 and the association of sufficient financial strength and liquidity,
53-9 under standards adopted by the commissioner [commission], to ensure
53-10 that all workers' compensation obligations incurred by the
53-11 applicant under this chapter are met promptly.
53-12 (c) The applicant must present a plan for claims
53-13 administration that is acceptable to the commissioner [commission]
53-14 and that designates a qualified claims servicing contractor.
53-15 (e) The applicant must provide to the department
53-16 [commission] a copy of each contract entered into with a person
53-17 that provides claims services, underwriting services, or accident
53-18 prevention services if the provider of those services is not an
53-19 employee of the applicant. The contract must be acceptable to the
53-20 commissioner [commission] and must be submitted in a standard form
53-21 adopted by the department [commission], if the department
53-22 [commission] adopts such a form.
53-23 (f) The commissioner [commission] shall adopt rules for the
53-24 requirements for the financial statements required by Subsection
53-25 (b)(2).
53-26 SECTION 3.052. Section 407.062, Labor Code, is amended to
53-27 read as follows:
54-1 Sec. 407.062. FINANCIAL STRENGTH AND LIQUIDITY REQUIREMENTS.
54-2 In assessing the financial strength and liquidity of an applicant,
54-3 the commissioner [commission] shall consider:
54-4 (1) the applicant's organizational structure and
54-5 management background;
54-6 (2) the applicant's profit and loss history;
54-7 (3) the applicant's compensation loss history;
54-8 (4) the source and reliability of the financial
54-9 information submitted by the applicant;
54-10 (5) the number of employees affected by
54-11 self-insurance;
54-12 (6) the applicant's access to excess insurance
54-13 markets;
54-14 (7) financial ratios, indexes, or other financial
54-15 measures that the commissioner [commission] finds appropriate; and
54-16 (8) any other information considered appropriate by
54-17 the commissioner [commission].
54-18 SECTION 3.053. Section 407.063(a), Labor Code, is amended to
54-19 read as follows:
54-20 (a) In addition to meeting the other certification
54-21 requirements imposed under this chapter, an applicant for an
54-22 initial certificate of authority to self-insure must present
54-23 evidence satisfactory to the commissioner [commission] of a total
54-24 unmodified workers' compensation insurance premium in this state in
54-25 the calendar year of application of at least $500,000.
54-26 SECTION 3.054. Section 407.064(b), Labor Code, is amended to
54-27 read as follows:
55-1 (b) If an applicant who has provided a letter of credit as
55-2 all or part of the security required under this section desires to
55-3 cancel the existing letter of credit and substitute a different
55-4 letter of credit or another form of security, the applicant shall
55-5 notify the department [commission] in writing not later than the
55-6 60th day before the effective date of the cancellation of the
55-7 original letter of credit.
55-8 SECTION 3.055. Sections 407.081(a), (b), (c), (d), (f), and
55-9 (g), Labor Code, are amended to read as follows:
55-10 (a) Each certified self-insurer shall file an annual report
55-11 with the department [commission]. The department [commission]
55-12 shall prescribe the form of the report and shall furnish blank
55-13 forms for the preparation of the report to each certified
55-14 self-insurer.
55-15 (b) The report must:
55-16 (1) include payroll information, in the form
55-17 prescribed by this chapter and the department [commission];
55-18 (2) state the number of injuries sustained in the
55-19 three preceding calendar years; and
55-20 (3) indicate separately the amount paid during each
55-21 year for income benefits, medical benefits, death benefits, burial
55-22 benefits, and other proper expenses related to worker injuries.
55-23 (c) Each certified self-insurer shall file with the
55-24 department [commission] as part of the annual report annual
55-25 independent financial statements that reflect the financial
55-26 condition of the self-insurer. The department [commission] shall
55-27 make a financial statement filed under this subsection available
56-1 for public review.
56-2 (d) The department [commission] may require that the report
56-3 include additional financial and statistical information.
56-4 (f) The report must include an estimate of future liability
56-5 for compensation. The estimate must be signed and sworn to by a
56-6 certified casualty actuary every third year, or more frequently if
56-7 required by the department [commission].
56-8 (g) If the department [commission] considers it necessary,
56-9 it may order a certified self-insurer whose financial condition or
56-10 claims record warrants closer supervision to report as provided by
56-11 this section more often than annually.
56-12 SECTION 3.056. Sections 407.082(a), (c), and (d), Labor
56-13 Code, are amended to read as follows:
56-14 (a) Each certified self-insurer shall maintain the books,
56-15 records, and payroll information necessary to compile the annual
56-16 report required under Section 407.081 and any other information
56-17 reasonably required by the department [commission].
56-18 (c) The material maintained by the certified self-insurer
56-19 shall be open to examination by an authorized agent or
56-20 representative of the department [commission] at reasonable times
56-21 to ascertain the correctness of the information.
56-22 (d) The examination may be conducted at any location,
56-23 including the department's [commission's] Austin offices, or, at
56-24 the certified self-insurer's option, in the offices of the
56-25 certified self-insurer. The certified self-insurer shall pay the
56-26 reasonable expenses, including travel expenses, of an inspector who
56-27 conducts an inspection at its offices.
57-1 SECTION 3.057. Section 407.101(b), Labor Code, is amended to
57-2 read as follows:
57-3 (b) The department [commission] shall deposit the
57-4 application fee for a certificate of authority to self-insure in
57-5 the state treasury to the credit of the workers' compensation
57-6 self-insurance fund.
57-7 SECTION 3.058. Section 407.102, Labor Code, is amended to
57-8 read as follows:
57-9 Sec. 407.102. REGULATORY FEE. (a) Each certified
57-10 self-insurer shall pay an annual fee to cover the administrative
57-11 costs incurred by the department [commission] in implementing this
57-12 chapter.
57-13 (b) The department [commission] shall base the fee on the
57-14 total amount of income benefit payments made in the preceding
57-15 calendar year. The department [commission] shall assess each
57-16 certified self-insurer a pro rata share based on the ratio that the
57-17 total amount of income benefit payments made by that certified
57-18 self-insurer bears to the total amount of income benefit payments
57-19 made by all certified self-insurers.
57-20 SECTION 3.059. Sections 407.103(a) and (d), Labor Code, are
57-21 amended to read as follows:
57-22 (a) Each certified self-insurer shall pay a self-insurer
57-23 maintenance tax for the administration of the department
57-24 [commission] and to support the prosecution of workers'
57-25 compensation insurance fraud in this state. Not more than two
57-26 percent of the total tax base of all certified self-insurers, as
57-27 computed under Subsection (b), may be assessed for a maintenance
58-1 tax under this section.
58-2 (d) In setting the rate of maintenance tax assessment for
58-3 insurance companies, the department [commission] may not consider
58-4 revenue or expenditures related to the division.
58-5 SECTION 3.060. Sections 407.104(b), (c), and (e), Labor
58-6 Code, are amended to read as follows:
58-7 (b) The department [commission] shall compute the fee and
58-8 taxes of a certified self-insurer and notify the certified
58-9 self-insurer of the amounts due. The taxes and fees shall be
58-10 remitted to the department [commission].
58-11 (c) The regulatory fee imposed under Section 407.102 shall
58-12 be deposited in the state treasury to the credit of the workers'
58-13 compensation self-insurance fund. The self-insurer maintenance tax
58-14 shall be deposited in the state treasury to the credit of the
58-15 department [commission].
58-16 (e) If the certificate of authority to self-insure of a
58-17 certified self-insurer is terminated, the insurance commissioner or
58-18 the commissioner [executive director of the commission] shall
58-19 proceed immediately to collect taxes due under this subtitle, using
58-20 legal process as necessary.
58-21 SECTION 3.061. Sections 407.122(b) and (c), Labor Code, are
58-22 amended to read as follows:
58-23 (b) The board of directors is composed of the following
58-24 voting members:
58-25 (1) three certified self-insurers;
58-26 (2) the commissioner [one commission member
58-27 representing wage earners;]
59-1 [(3) one commission member representing employers];
59-2 and
59-3 (3) [(4)] the public counsel of the office of public
59-4 insurance counsel.
59-5 (c) The [executive director of the commission and the]
59-6 director of the division of self-insurance regulation serves
59-7 [serve] as a nonvoting member [members] of the board of directors.
59-8 SECTION 3.062. Section 407.123(b), Labor Code, is amended to
59-9 read as follows:
59-10 (b) Rules adopted by the board are subject to the approval
59-11 of the commissioner [commission].
59-12 SECTION 3.063. Sections 407.124(a) and (c), Labor Code, are
59-13 amended to read as follows:
59-14 (a) On determination by the commissioner [commission] that a
59-15 certified self-insurer has become an impaired employer, the
59-16 director shall secure release of the security deposit required by
59-17 this chapter and shall promptly estimate:
59-18 (1) the amount of additional funds needed to
59-19 supplement the security deposit;
59-20 (2) the available assets of the impaired employer for
59-21 the purpose of making payment of all incurred liabilities for
59-22 compensation; and
59-23 (3) the funds maintained by the association for the
59-24 emergency payment of compensation liabilities.
59-25 (c) A certified self-insurer designated as an impaired
59-26 employer is exempt from assessments beginning on the date of the
59-27 designation until the commissioner [commission] determines that the
60-1 employer is no longer impaired.
60-2 SECTION 3.064. Section 407.126(d), Labor Code, is amended to
60-3 read as follows:
60-4 (d) The board of directors shall administer the trust fund
60-5 in accordance with rules adopted by the commissioner [commission].
60-6 SECTION 3.065. Section 407.127(a), Labor Code, is amended to
60-7 read as follows:
60-8 (a) If the commissioner [commission] determines that the
60-9 payment of benefits and claims administration shall be made through
60-10 the association, the association assumes the workers' compensation
60-11 obligations of the impaired employer and shall begin the payment of
60-12 the obligations for which it is liable not later than the 30th day
60-13 after the date of notification by the director.
60-14 SECTION 3.066. Section 407.133(a), Labor Code, is amended to
60-15 read as follows:
60-16 (a) The commissioner [commission, after notice and hearing
60-17 and by majority vote,] may suspend or revoke the certificate of
60-18 authority to self-insure of a certified self-insurer who fails to
60-19 pay an assessment. The association promptly shall report such a
60-20 failure to the director.
60-21 SECTION 3.067. Section 408.003(c), Labor Code, is amended to
60-22 read as follows:
60-23 (c) The employer shall notify the department [commission]
60-24 and the insurance carrier on forms prescribed by the department
60-25 [commission] of the initiation of and amount of payments made under
60-26 this section.
60-27 SECTION 3.068. Sections 408.004(a), (b), (d), (e), and (f),
61-1 Labor Code, are amended to read as follows:
61-2 (a) The department [commission] may require an employee to
61-3 submit to medical examinations to resolve any question about:
61-4 (1) the appropriateness of the health care received by
61-5 the employee;
61-6 (2) the impairment caused by the compensable injury;
61-7 (3) the attainment of maximum medical improvement; or
61-8 (4) similar issues.
61-9 (b) The department [commission] may require an employee to
61-10 submit to a medical examination at the request of the insurance
61-11 carrier, but only after the insurance carrier has attempted and
61-12 failed to receive the permission and concurrence of the employee
61-13 for the examination. Except as otherwise provided by this
61-14 subsection, the insurance carrier is entitled to the examination
61-15 only once in a 180-day period. The commissioner [commission] may
61-16 adopt rules that require an employee to submit to not more than
61-17 three medical examinations in a 180-day period under specified
61-18 circumstances, including to determine whether there has been a
61-19 change in the employee's condition, whether it is necessary to
61-20 change the employee's diagnosis, and whether treatment should be
61-21 extended to another body part or system. The commissioner
61-22 [commission] by rule shall adopt a system for monitoring requests
61-23 made under this subsection by insurance carriers. That system must
61-24 ensure that good cause exists for any additional medical
61-25 examination allowed under this subsection that is not requested by
61-26 the employee. A subsequent examination must be performed by the
61-27 same doctor unless otherwise approved by the department
62-1 [commission].
62-2 (d) An injured employee is entitled to have a doctor of the
62-3 employee's choice present at an examination required by the
62-4 commission at the request of an insurance carrier. The insurance
62-5 carrier shall pay a fee set by the department [commission] to the
62-6 doctor selected by the employee.
62-7 (e) An employee who, without good cause as determined by the
62-8 department [commission], fails or refuses to appear at the time
62-9 scheduled for an examination under Subsection (a) or (b) commits a
62-10 violation. A violation under this subsection is a Class D
62-11 administrative violation. An employee is not entitled to temporary
62-12 income benefits, and an insurance carrier may suspend the payment
62-13 of temporary income benefits, during and for a period in which the
62-14 employee fails to submit to an examination under Subsection (a) or
62-15 (b) unless the department [commission] determines that the employee
62-16 had good cause for the failure to submit to the examination. The
62-17 department [commission] may order temporary income benefits to be
62-18 paid for the period that the department [commission] determines the
62-19 employee had good cause. The commissioner [commission] by rule
62-20 shall ensure that an employee receives reasonable notice of an
62-21 examination and of the insurance carrier's basis for suspension of
62-22 payment, and that the employee is provided a reasonable opportunity
62-23 to reschedule an examination missed by the employee for good cause.
62-24 (f) If the report of a doctor selected by an insurance
62-25 carrier indicates that an employee can return to work immediately
62-26 or has reached maximum medical improvement, the insurance carrier
62-27 may suspend or reduce the payment of temporary income benefits on
63-1 the 14th day after the date on which the insurance carrier files a
63-2 notice of suspension with the department [commission] as provided
63-3 by this subsection. The department [commission] shall hold an
63-4 expedited benefit review conference, by personal appearance or by
63-5 telephone, not later than the 10th day after the date on which the
63-6 department [commission] receives the insurance carrier's notice of
63-7 suspension. If a benefit review conference is not held by the 14th
63-8 day after the date on which the department [commission] receives
63-9 the insurance carrier's notice of suspension, an interlocutory
63-10 order, effective from the date of the report certifying maximum
63-11 medical improvement, is automatically entered for the continuation
63-12 of temporary income benefits until a benefit review conference is
63-13 held, and the insurance carrier is eligible for reimbursement for
63-14 any overpayment of benefits as provided by Chapter 410. The
63-15 department [commission] is not required to automatically schedule a
63-16 contested case hearing as required by Section 410.025(b) if a
63-17 benefit review conference is scheduled under this subsection. If a
63-18 benefit review conference is held not later than the 14th day, the
63-19 department [commission] may enter an interlocutory order for the
63-20 continuation of benefits, and the insurance carrier is eligible for
63-21 reimbursement for any overpayments of benefits as provided by
63-22 Chapter 410. The commissioner [commission] shall adopt rules as
63-23 necessary to implement this subsection under which:
63-24 (1) an insurance carrier is required to notify the
63-25 employee and the treating doctor of the suspension of benefits
63-26 under this subsection by certified mail or another verifiable
63-27 delivery method;
64-1 (2) the department [commission] makes a reasonable
64-2 attempt to obtain the treating doctor's opinion before the
64-3 department [commission] makes a determination regarding the entry
64-4 of an interlocutory order; and
64-5 (3) the department [commission] may allow abbreviated
64-6 contested case hearings by personal appearance or telephone to
64-7 consider issues relating to overpayment of benefits under this
64-8 section.
64-9 SECTION 3.069. Section 408.005(e), Labor Code, is amended to
64-10 read as follows:
64-11 (e) The director of the division of hearings shall approve a
64-12 settlement if the director is satisfied that:
64-13 (1) the settlement accurately reflects the agreement
64-14 between the parties;
64-15 (2) the settlement reflects adherence to all
64-16 appropriate provisions of law and the policies of the department
64-17 [commission]; and
64-18 (3) under the law and facts, the settlement is in the
64-19 best interest of the claimant.
64-20 SECTION 3.070. Sections 408.022(a), (b), and (c), Labor
64-21 Code, are amended to read as follows:
64-22 (a) Except in an emergency, the department [commission]
64-23 shall require an employee to receive medical treatment from a
64-24 doctor chosen from a list of doctors approved by the department
64-25 [commission]. A doctor may perform only those procedures that are
64-26 within the scope of the practice for which the doctor is licensed.
64-27 The employee is entitled to the employee's initial choice of a
65-1 doctor from the department's [commission's] list.
65-2 (b) If an employee is dissatisfied with the initial choice
65-3 of a doctor from the department's [commission's] list, the employee
65-4 may notify the department [commission] and request authority to
65-5 select an alternate doctor. The notification must be in writing
65-6 stating the reasons for the change, except notification may be by
65-7 telephone when a medical necessity exists for immediate change.
65-8 (c) The commissioner [commission] shall prescribe criteria
65-9 to be used by the department [commission] in granting the employee
65-10 authority to select an alternate doctor. The criteria may include:
65-11 (1) whether treatment by the current doctor is
65-12 medically inappropriate;
65-13 (2) the professional reputation of the doctor;
65-14 (3) whether the employee is receiving appropriate
65-15 medical care to reach maximum medical improvement; and
65-16 (4) whether a conflict exists between the employee and
65-17 the doctor to the extent that the doctor-patient relationship is
65-18 jeopardized or impaired.
65-19 SECTION 3.071. Section 408.023, Labor Code, is amended to
65-20 read as follows:
65-21 Sec. 408.023. LIST OF APPROVED DOCTORS. (a) Each doctor
65-22 licensed in this state on January 1, 1993, is on the department's
65-23 [commission's] list of approved doctors unless subsequently deleted
65-24 and not reinstated. The name of a doctor shall be placed on the
65-25 list of approved doctors when that doctor becomes licensed in this
65-26 state. A doctor not licensed in this state but licensed in another
65-27 state or jurisdiction who treats employees may apply to the
66-1 department [commission] to be included on the list.
66-2 (b) The commissioner [commission] shall establish criteria
66-3 for deleting a doctor from the list of approved doctors. The
66-4 criteria may include anything the commissioner [commission]
66-5 considers relevant, including:
66-6 (1) sanctions of the doctor by the department
66-7 [commission] for violations of Chapter 413 or Chapter 415;
66-8 (2) sanctions by the Medicare or Medicaid program for:
66-9 (A) substandard medical care;
66-10 (B) overcharging; or
66-11 (C) overutilization of medical services;
66-12 (3) evidence from the department's [commission's]
66-13 medical records that the doctor's charges, fees, diagnoses, or
66-14 treatments are substantially different from those the department
66-15 [commission] finds to be fair and reasonable; and
66-16 (4) suspension of the doctor's license by the
66-17 appropriate licensing authority.
66-18 (c) The department [commission] shall establish procedures
66-19 for a doctor to apply for reinstatement to the list.
66-20 SECTION 3.072. Section 408.024, Labor Code, is amended to
66-21 read as follows:
66-22 Sec. 408.024. NONCOMPLIANCE WITH SELECTION REQUIREMENTS.
66-23 Except as otherwise provided, and after notice and an opportunity
66-24 for hearing, the department [commission] may relieve an insurance
66-25 carrier of liability for health care that is furnished by a health
66-26 care provider or another person selected in a manner inconsistent
66-27 with the requirements of this subchapter.
67-1 SECTION 3.073. Sections 408.025(a), (b), and (d), Labor
67-2 Code, are amended to read as follows:
67-3 (a) The commissioner [commission] by rule shall adopt
67-4 requirements for reports and records that are required to be filed
67-5 with the department [commission] or provided to the injured
67-6 employee, the employee's attorney, or the insurance carrier by a
67-7 health care provider.
67-8 (b) The commissioner [commission] by rule shall adopt
67-9 requirements for reports and records that are to be made available
67-10 by a health care provider to another health care provider to
67-11 prevent unnecessary duplication of tests and examinations.
67-12 (d) On the request of an injured employee, the employee's
67-13 attorney, or the insurance carrier, a health care provider shall
67-14 furnish records relating to treatment or hospitalization for which
67-15 compensation is being sought. The department [commission] may
67-16 regulate the charge for furnishing a report or record, but the
67-17 charge may not be less than the fair and reasonable charge for
67-18 furnishing the report or record. A health care provider may
67-19 disclose to the insurance carrier of an affected employer records
67-20 relating to the diagnosis or treatment of the injured employee
67-21 without the authorization of the injured employee to determine the
67-22 amount of payment or the entitlement to payment.
67-23 SECTION 3.074. Section 408.026, Labor Code, is amended to
67-24 read as follows:
67-25 Sec. 408.026. SPINAL SURGERY SECOND OPINION. (a) Except in
67-26 a medical emergency, an insurance carrier is liable for medical
67-27 costs related to spinal surgery only if:
68-1 (1) before surgery, the employee obtains from a doctor
68-2 approved by the insurance carrier or the department [commission] a
68-3 second opinion that concurs with the treating doctor's
68-4 recommendation;
68-5 (2) the insurance carrier waives the right to an
68-6 examination or fails to request an examination before the 15th day
68-7 after the date of the notification that surgery is recommended; or
68-8 (3) the department [commission] determines that
68-9 extenuating circumstances exist and orders payment for surgery.
68-10 (b) The commissioner [commission] shall adopt rules
68-11 necessary to ensure that an examination required under this section
68-12 is performed without undue delay.
68-13 SECTION 3.075. Section 408.027(d), Labor Code, is amended
68-14 to read as follows:
68-15 (d) If an insurance carrier disputes the amount of payment
68-16 or the health care provider's entitlement to payment, the insurance
68-17 carrier shall send to the department [commission], the health care
68-18 provider, and the injured employee a report that sufficiently
68-19 explains the reasons for the reduction or denial of payment for
68-20 health care services provided to the employee. The insurance
68-21 carrier is entitled to a hearing as provided by Section 413.031(d).
68-22 SECTION 3.076. Section 408.041(c), Labor Code, is amended to
68-23 read as follows:
68-24 (c) If Subsection (a) or (b) cannot reasonably be applied
68-25 because the employee's employment has been irregular or because the
68-26 employee has lost time from work during the 13-week period
68-27 immediately preceding the injury because of illness, weather, or
69-1 another cause beyond the control of the employee, the department
69-2 [commission] may determine the employee's average weekly wage by
69-3 any method that the department [commission] considers fair, just,
69-4 and reasonable to all parties and consistent with the methods
69-5 established under this section.
69-6 SECTION 3.077. Section 408.043(c), Labor Code, is amended to
69-7 read as follows:
69-8 (c) If, for good reason, the department [commission]
69-9 determines that computing the average weekly wage for a seasonal
69-10 employee as provided by this section is impractical, the department
69-11 [commission] shall compute the average weekly wage as of the time
69-12 of the injury in a manner that is fair and just to both parties.
69-13 SECTION 3.078. Section 408.045, Labor Code, is amended to
69-14 read as follows:
69-15 Sec. 408.045. NONPECUNIARY WAGES. The department
69-16 [commission] may not include nonpecuniary wages in computing an
69-17 employee's average weekly wage during a period in which the
69-18 employer continues to provide the nonpecuniary wages.
69-19 SECTION 3.079. Section 408.061(f), Labor Code, is amended to
69-20 read as follows:
69-21 (f) The department [commission] shall compute the maximum
69-22 weekly income benefits for each state fiscal year not later than
69-23 September 1 of each year.
69-24 SECTION 3.080. Section 408.062(b), Labor Code, is amended to
69-25 read as follows:
69-26 (b) The department [commission] shall compute the minimum
69-27 weekly income benefit for each state fiscal year not later than
70-1 September 1 of each year.
70-2 SECTION 3.081. Section 408.063(a), Labor Code, is amended to
70-3 read as follows:
70-4 (a) To expedite the payment of income benefits, the
70-5 commissioner [commission] may by rule establish reasonable
70-6 presumptions relating to the wages earned by an employee, including
70-7 the presumption that an employee's last paycheck accurately
70-8 reflects the employee's usual wage.
70-9 SECTION 3.082. Sections 408.081(b) and (c), Labor Code, are
70-10 amended to read as follows:
70-11 (b) Except as otherwise provided by this section or this
70-12 subtitle, income benefits shall be paid weekly as and when they
70-13 accrue without order from the department [commission]. Interest on
70-14 accrued but unpaid benefits shall be paid, without order of the
70-15 department [commission], at the time the accrued benefits are paid.
70-16 (c) The commissioner [commission] by rule shall establish
70-17 requirements for agreements under which income benefits may be paid
70-18 monthly. Income benefits may be paid monthly only:
70-19 (1) on the request of the employee and the agreement
70-20 of the employee and the insurance carrier; and
70-21 (2) in compliance with the requirements adopted by the
70-22 commissioner [commission].
70-23 SECTION 3.083. Sections 408.084(a) and (b), Labor Code, are
70-24 amended to read as follows:
70-25 (a) At the request of the insurance carrier, the department
70-26 [commission] may order that impairment income benefits and
70-27 supplemental income benefits be reduced in a proportion equal to
71-1 the proportion of a documented impairment that resulted from
71-2 earlier compensable injuries.
71-3 (b) The department [commission] shall consider the
71-4 cumulative impact of the compensable injuries on the employee's
71-5 overall impairment in determining a reduction under this section.
71-6 SECTION 3.084. Section 408.085, Labor Code, is amended to
71-7 read as follows:
71-8 Sec. 408.085. ADVANCE OF BENEFITS FOR HARDSHIP. (a) If
71-9 there is a likelihood that income benefits will be paid, the
71-10 department [commission] may grant an employee suffering financial
71-11 hardship advances as provided by this subtitle against the amount
71-12 of income benefits to which the employee may be entitled. An
71-13 advance may be ordered before or after the employee attains maximum
71-14 medical improvement. An insurance carrier shall pay the advance
71-15 ordered.
71-16 (b) An employee must apply to the department [commission]
71-17 for an advance on a form prescribed by the department [commission].
71-18 The application must describe the hardship that is the grounds for
71-19 the advance.
71-20 (c) An advance under this section may not exceed an amount
71-21 equal to four times the maximum weekly benefit for temporary income
71-22 benefits as computed in Section 408.061. The department
71-23 [commission] may not grant more than three advances to a particular
71-24 employee based on the same injury.
71-25 (d) The department [commission] may not grant an advance to
71-26 an employee who is receiving, on the date of the application under
71-27 Subsection (b), at least 90 percent of the employee's net preinjury
72-1 wages under Section 408.003 or 408.129.
72-2 SECTION 3.085. Section 408.086, Labor Code, is amended to
72-3 read as follows:
72-4 Sec. 408.086. DEPARTMENT [COMMISSION] DETERMINATION OF
72-5 EXTENDED UNEMPLOYMENT OR UNDEREMPLOYMENT. (a) During the period
72-6 that impairment income benefits or supplemental income benefits are
72-7 being paid to an employee, the department [commission] shall
72-8 determine at least annually whether any extended unemployment or
72-9 underemployment is a direct result of the employee's impairment.
72-10 (b) To make this determination, the department [commission]
72-11 may require periodic reports from the employee and the insurance
72-12 carrier and, at the insurance carrier's expense, may require
72-13 physical or other examinations, vocational assessments, or other
72-14 tests or diagnoses necessary to perform its duty under this section
72-15 and Subchapter H.
72-16 SECTION 3.086. Section 408.102(b), Labor Code, is amended to
72-17 read as follows:
72-18 (b) The commissioner [commission] by rule shall establish a
72-19 presumption that maximum medical improvement has been reached based
72-20 on a lack of medical improvement in the employee's condition.
72-21 SECTION 3.087. Section 408.103(b), Labor Code, is amended to
72-22 read as follows:
72-23 (b) A temporary income benefit under Subsection (a)(2) may
72-24 not exceed the employee's actual earnings for the previous year.
72-25 It is presumed that the employee's actual earnings for the previous
72-26 year are equal to:
72-27 (1) the sum of the employee's wages as reported in the
73-1 most recent four quarterly wage reports to the Texas Workforce
73-2 [Employment] Commission divided by 52;
73-3 (2) the employee's wages in the single quarter of the
73-4 most recent four quarters in which the employee's earnings were
73-5 highest, divided by 13, if the department [commission] finds that
73-6 the employee's most recent four quarters' earnings reported in the
73-7 Texas Workforce [Employment] Commission wage reports are not
73-8 representative of the employee's usual earnings; or
73-9 (3) the amount the department [commission] determines
73-10 from other credible evidence to be the actual earnings for the
73-11 previous year if the Texas Workforce [Employment] Commission does
73-12 not have a wage report reflecting at least one quarter's earnings
73-13 because the employee worked outside the state during the previous
73-14 year.
73-15 SECTION 3.088. Sections 408.104(a) and (c), Labor Code, are
73-16 amended to read as follows:
73-17 (a) On application by either the employee or the insurance
73-18 carrier, the department [commission] by order may extend the
73-19 104-week period described by Section 401.011(30)(B) if the employee
73-20 has had spinal surgery, or has been approved for spinal surgery
73-21 under Section 408.026 and commissioner [commission] rules, within
73-22 12 weeks before the expiration of the 104-week period. If an order
73-23 is issued under this section, the order shall extend the statutory
73-24 period for maximum medical improvement to a date certain, based on
73-25 medical evidence presented to the department [commission].
73-26 (c) The commissioner [commission] shall adopt rules to
73-27 implement this section, including rules establishing procedures for
74-1 requesting and disputing an extension.
74-2 SECTION 3.089. Sections 408.122(b) and (c), Labor Code, are
74-3 amended to read as follows:
74-4 (b) To be eligible to serve as a designated doctor, a doctor
74-5 must meet specific qualifications, including training in the
74-6 determination of impairment ratings. The department [executive
74-7 director] shall develop qualification standards and administrative
74-8 policies to implement this subsection, and the commissioner
74-9 [commission] may adopt rules as necessary. To the extent possible,
74-10 a designated doctor must be in the same discipline and licensed by
74-11 the same board of examiners as the employee's doctor of choice.
74-12 (c) If a dispute exists as to whether the employee has
74-13 reached maximum medical improvement, the department [commission]
74-14 shall direct the employee to be examined by a designated doctor
74-15 chosen by mutual agreement of the parties. If the parties are
74-16 unable to agree on a designated doctor, the department [commission]
74-17 shall direct the employee to be examined by a designated doctor
74-18 chosen by the department [commission]. The designated doctor shall
74-19 report to the department [commission]. The report of the
74-20 designated doctor has presumptive weight, and the department
74-21 [commission] shall base its determination of whether the employee
74-22 has reached maximum medical improvement on the report unless the
74-23 great weight of the other medical evidence is to the contrary.
74-24 SECTION 3.090. Sections 408.123(b) and (c), Labor Code, are
74-25 amended to read as follows:
74-26 (b) A certifying doctor shall issue a written report
74-27 certifying that maximum medical improvement has been reached,
75-1 stating the employee's impairment rating, and providing any other
75-2 information required by the department [commission] to:
75-3 (1) the department [commission];
75-4 (2) the employee; and
75-5 (3) the insurance carrier.
75-6 (c) If an employee is not certified as having reached
75-7 maximum medical improvement before the expiration of 102 weeks
75-8 after the date income benefits begin to accrue, the department
75-9 [commission] shall notify the treating doctor of the requirements
75-10 of this subchapter.
75-11 SECTION 3.091. Section 408.124, Labor Code, is amended to
75-12 read as follows:
75-13 Sec. 408.124. IMPAIRMENT RATING GUIDELINES. (a) An award
75-14 of an impairment income benefit, whether by the department
75-15 [commission] or a court, shall be made on an impairment rating
75-16 determined using the impairment rating guidelines described in this
75-17 section.
75-18 (b) For determining the existence and degree of an
75-19 employee's impairment, the department [commission] shall use
75-20 "Guides to the Evaluation of Permanent Impairment," third edition,
75-21 second printing, dated February 1989, published by the American
75-22 Medical Association.
75-23 (c) Notwithstanding Subsection (b), the commissioner
75-24 [commission] by rule may adopt the fourth edition of the "Guides to
75-25 the Evaluation of Permanent Impairment," published by the American
75-26 Medical Association, for determining the existence and degree of an
75-27 employee's impairment.
76-1 SECTION 3.092. Sections 408.125(a), (b), (c), (d), (e), and
76-2 (f), Labor Code, are amended to read as follows:
76-3 (a) If an impairment rating is disputed, the department
76-4 [commission] shall direct the employee to be examined by a
76-5 designated doctor chosen by mutual agreement of the parties.
76-6 (b) If the parties are unable to agree on a designated
76-7 doctor, the department [commission] shall direct the employee to be
76-8 examined by a designated doctor chosen by the department
76-9 [commission].
76-10 (c) The designated doctor shall report in writing to the
76-11 department [commission].
76-12 (d) If the designated doctor is chosen by the parties, the
76-13 department [commission] shall adopt the impairment rating made by
76-14 the designated doctor.
76-15 (e) If the designated doctor is chosen by the department
76-16 [commission], the report of the designated doctor shall have
76-17 presumptive weight, and the department [commission] shall base the
76-18 impairment rating on that report unless the great weight of the
76-19 other medical evidence is to the contrary. If the great weight of
76-20 the medical evidence contradicts the impairment rating contained in
76-21 the report of the designated doctor chosen by the department
76-22 [commission], the department [commission] shall adopt the
76-23 impairment rating of one of the other doctors.
76-24 (f) To avoid undue influence on a person selected as a
76-25 designated doctor under this section, only the injured employee or
76-26 an appropriate member of the staff of the department [commission]
76-27 may communicate with the designated doctor about the case regarding
77-1 the injured employee's medical condition or history before the
77-2 examination of the injured employee by the designated doctor. After
77-3 that examination is completed, communication with the designated
77-4 doctor regarding the injured employee's medical condition or
77-5 history may be made only through appropriate department
77-6 [commission] staff members. The designated doctor may initiate
77-7 communication with any doctor who has previously treated or
77-8 examined the injured employee for the work-related injury.
77-9 SECTION 3.093. Section 408.127(c), Labor Code, is amended to
77-10 read as follows:
77-11 (c) The commissioner [commission] shall adopt rules and
77-12 forms to ensure the full reporting and the accuracy of reductions
77-13 and reimbursements made under this section.
77-14 SECTION 3.094. Sections 408.129(a), (b), and (d), Labor
77-15 Code, are amended to read as follows:
77-16 (a) On approval by the department [commission] of a written
77-17 request received from an employee, an insurance carrier shall
77-18 accelerate the payment of impairment income benefits to the
77-19 employee. The accelerated payment may not exceed a rate of payment
77-20 equal to that of the employee's net preinjury wage.
77-21 (b) The department [commission] shall approve the request
77-22 and order the acceleration of the benefits if the department
77-23 [commission] determines that the acceleration is:
77-24 (1) required to relieve hardship; and
77-25 (2) in the overall best interest of the employee.
77-26 (d) The department [commission] may prescribe forms
77-27 necessary to implement this section.
78-1 SECTION 3.095. Section 408.141, Labor Code, is amended to
78-2 read as follows:
78-3 Sec. 408.141. AWARD OF SUPPLEMENTAL INCOME BENEFITS. An
78-4 award of a supplemental income benefit, whether by the department
78-5 [commission] or a court, shall be made in accordance with this
78-6 subchapter.
78-7 SECTION 3.096. Sections 408.143(a) and (b), Labor Code, are
78-8 amended to read as follows:
78-9 (a) After the department's [commission's] initial
78-10 determination of supplemental income benefits, the employee must
78-11 file a statement with the insurance carrier stating:
78-12 (1) that the employee has earned less than 80 percent
78-13 of the employee's average weekly wage as a direct result of the
78-14 employee's impairment;
78-15 (2) the amount of wages the employee earned in the
78-16 filing period provided by Subsection (b); and
78-17 (3) that the employee has in good faith sought
78-18 employment commensurate with the employee's ability to work.
78-19 (b) The statement required under this section must be filed
78-20 quarterly on a form and in the manner provided by the department
78-21 [commission]. The department [commission] may modify the filing
78-22 period as appropriate to an individual case.
78-23 SECTION 3.097. Section 408.147(c), Labor Code, is amended to
78-24 read as follows:
78-25 (c) If an insurance carrier disputes the department's [a
78-26 commission] determination that an employee is entitled to
78-27 supplemental income benefits or the amount of supplemental income
79-1 benefits due and the employee prevails on any disputed issue, the
79-2 insurance carrier is liable for reasonable and necessary attorney's
79-3 fees incurred by the employee as a result of the insurance
79-4 carrier's dispute and for supplemental income benefits accrued but
79-5 not paid and interest on that amount, according to Section 408.064.
79-6 Attorney's fees awarded under this subsection are not subject to
79-7 Sections 408.221(b), (e), and (h).
79-8 SECTION 3.098. Section 408.148, Labor Code, is amended to
79-9 read as follows:
79-10 Sec. 408.148. EMPLOYEE DISCHARGE AFTER TERMINATION. The
79-11 department [commission] may reinstate supplemental income benefits
79-12 to an employee who is discharged within 12 months of the date of
79-13 losing entitlement to supplemental income benefits under Section
79-14 408.146(c) if the department [commission] finds that the employee
79-15 was discharged at that time with the intent to deprive the employee
79-16 of supplemental income benefits.
79-17 SECTION 3.099. Section 408.149, Labor Code, is amended to
79-18 read as follows:
79-19 Sec. 408.149. STATUS REVIEW; BENEFIT REVIEW CONFERENCE. (a)
79-20 Not more than once in each period of 12 calendar months, an
79-21 employee and an insurance carrier each may request the department
79-22 [commission] to review the status of the employee and determine
79-23 whether the employee's unemployment or underemployment is a direct
79-24 result of impairment from the compensable injury.
79-25 (b) Either party may request a benefit review conference to
79-26 contest a determination of the department [commission] at any time,
79-27 subject only to the limits placed on the insurance carrier by
80-1 Section 408.147.
80-2 SECTION 3.100. Section 408.150(a), Labor Code, is amended to
80-3 read as follows:
80-4 (a) The department [commission] shall refer an employee to
80-5 the Texas Rehabilitation Commission with a recommendation for
80-6 appropriate services if the department [commission] determines that
80-7 an employee entitled to supplemental income benefits could be
80-8 materially assisted by vocational rehabilitation or training in
80-9 returning to employment or returning to employment more nearly
80-10 approximating the employee's preinjury employment. The department
80-11 [commission] shall also notify insurance carriers of the need for
80-12 vocational rehabilitation or training services. The insurance
80-13 carrier may provide services through a private provider of
80-14 vocational rehabilitation services under Section 409.012.
80-15 SECTION 3.101. Sections 408.151(b) and (c), Labor Code, are
80-16 amended to read as follows:
80-17 (b) If a dispute exists as to whether the employee's medical
80-18 condition has improved sufficiently to allow the employee to return
80-19 to work, the department [commission] shall direct the employee to
80-20 be examined by a designated doctor chosen by the department
80-21 [commission]. The designated doctor shall report to the department
80-22 [commission]. The report of the designated doctor has presumptive
80-23 weight, and the commission shall base its determination of whether
80-24 the employee's medical condition has improved sufficiently to allow
80-25 the employee to return to work on that report unless the great
80-26 weight of the other medical evidence is to the contrary.
80-27 (c) The department [commission] may require an employee to
81-1 whom Subsection (a) applies to submit to a medical examination
81-2 under Section 408.004 only to determine whether the employee's
81-3 medical condition is a direct result of impairment from a
81-4 compensable injury.
81-5 SECTION 3.102. Section 408.161(d), Labor Code, is amended to
81-6 read as follows:
81-7 (d) An insurance carrier may pay lifetime income benefits
81-8 through an annuity if the annuity agreement meets the terms and
81-9 conditions for annuity agreements adopted by the commissioner
81-10 [commission] by rule. The establishment of an annuity under this
81-11 subsection does not relieve the insurance carrier of the liability
81-12 under this title for ensuring that the lifetime income benefits are
81-13 paid.
81-14 SECTION 3.103. Sections 408.181(c) and (d), Labor Code, are
81-15 amended to read as follows:
81-16 (c) The commissioner [commission] by rule shall establish
81-17 requirements for agreements under which death benefits may be paid
81-18 monthly. Death benefits may be paid monthly only:
81-19 (1) on the request of the legal beneficiary and the
81-20 agreement of the legal beneficiary and the insurance carrier; and
81-21 (2) in compliance with the requirements adopted by the
81-22 commissioner [commission].
81-23 (d) An insurance carrier may pay death benefits through an
81-24 annuity if the annuity agreement meets the terms and conditions for
81-25 annuity agreements adopted by the commissioner [commission] by
81-26 rule. The establishment of an annuity under this subsection does
81-27 not relieve the insurance carrier of the liability under this title
82-1 for ensuring that the death benefits are paid.
82-2 SECTION 3.104. Section 408.182(f), Labor Code, is amended to
82-3 read as follows:
82-4 (f) In this section:
82-5 (1) "Eligible child" means a child of a deceased
82-6 employee if the child is:
82-7 (A) a minor;
82-8 (B) enrolled as a full-time student in an
82-9 accredited educational institution and is less than 25 years of
82-10 age; or
82-11 (C) a dependent of the deceased employee at the
82-12 time of the employee's death.
82-13 (2) "Eligible grandchild" means a grandchild of a
82-14 deceased employee who is a dependent of the deceased employee and
82-15 whose parent is not an eligible child.
82-16 (3) "Eligible spouse" means the surviving spouse of a
82-17 deceased employee unless the spouse abandoned the employee for
82-18 longer than the year immediately preceding the death without good
82-19 cause, as determined by the department [commission].
82-20 SECTION 3.105. Section 408.183(b), Labor Code, is amended to
82-21 read as follows:
82-22 (b) An eligible spouse is entitled to receive death benefits
82-23 for life or until remarriage. On remarriage, the eligible spouse
82-24 is entitled to receive 104 weeks of death benefits, commuted as
82-25 provided by commissioner [commission] rule.
82-26 SECTION 3.106. Section 408.187(c), Labor Code, is amended to
82-27 read as follows:
83-1 (c) The department [commission] shall require the insurance
83-2 carrier to pay the costs of a procedure ordered under this section.
83-3 SECTION 3.107. Section 408.202, Labor Code, is amended to
83-4 read as follows:
83-5 Sec. 408.202. ASSIGNABILITY OF BENEFITS. Benefits are not
83-6 assignable, except a legal beneficiary may, with the department's
83-7 [commission] approval, assign the right to death benefits.
83-8 SECTION 3.108. Sections 408.221(a)-(f), Labor Code, are
83-9 amended to read as follows:
83-10 (a) An attorney's fee, including a contingency fee, for
83-11 representing a claimant before the department [commission] or court
83-12 under this subtitle must be approved by the department [commission]
83-13 or court.
83-14 (b) Except as otherwise provided, an attorney's fee under
83-15 this section is based on the attorney's time and expenses according
83-16 to written evidence presented to the department [commission] or
83-17 court. Except as provided by Section 408.147(c), the attorney's
83-18 fee shall be paid from the claimant's recovery.
83-19 (c) In approving an attorney's fee under this section, the
83-20 department [commission] or court shall consider:
83-21 (1) the time and labor required;
83-22 (2) the novelty and difficulty of the questions
83-23 involved;
83-24 (3) the skill required to perform the legal services
83-25 properly;
83-26 (4) the fee customarily charged in the locality for
83-27 similar legal services;
84-1 (5) the amount involved in the controversy;
84-2 (6) the benefits to the claimant that the attorney is
84-3 responsible for securing; and
84-4 (7) the experience and ability of the attorney
84-5 performing the services.
84-6 (d) The commissioner [commission] by rule or the court may
84-7 provide for the commutation of an attorney's fee, except that the
84-8 attorney's fee shall be paid in periodic payments in a claim
84-9 involving death benefits if the only dispute is as to the proper
84-10 beneficiary or beneficiaries.
84-11 (e) The commissioner [commission] by rule shall provide
84-12 guidelines for maximum attorney's fees for specific services in
84-13 accordance with this section.
84-14 (f) An attorney's fee may not be allowed in a case involving
84-15 a fatal injury or lifetime income benefit if the insurance carrier
84-16 admits liability on all issues and tenders payment of maximum
84-17 benefits in writing under this subtitle while the claim is pending
84-18 before the department [commission].
84-19 SECTION 3.109. Section 408.222, Labor Code, is amended to
84-20 read as follows:
84-21 Sec. 408.222. ATTORNEY'S FEES PAID TO DEFENSE COUNSEL. (a)
84-22 The amount of an attorney's fee for defending an insurance carrier
84-23 in a workers' compensation action brought under this subtitle must
84-24 be approved by the department [commission] or court and determined
84-25 by the department [commission] or court to be reasonable and
84-26 necessary.
84-27 (b) In determining whether a fee is reasonable under this
85-1 section, the department [commission] or court shall consider issues
85-2 analogous to those listed under Section 408.221(c). The defense
85-3 counsel shall present written evidence to the department
85-4 [commission] or court relating to:
85-5 (1) the time spent and expenses incurred in defending
85-6 the case; and
85-7 (2) other evidence considered necessary by the
85-8 department [commission] or court in making a determination under
85-9 this section.
85-10 SECTION 3.110. Section 409.002, Labor Code, is amended to
85-11 read as follows:
85-12 Sec. 409.002. FAILURE TO FILE NOTICE OF INJURY. Failure to
85-13 notify an employer as required by Section 409.001(a) relieves the
85-14 employer and the employer's insurance carrier of liability under
85-15 this subtitle unless:
85-16 (1) the employer, a person eligible to receive notice
85-17 under Section 409.001(b), or the employer's insurance carrier has
85-18 actual knowledge of the employee's injury;
85-19 (2) the department [commission] determines that good
85-20 cause exists for failure to provide notice in a timely manner; or
85-21 (3) the employer or the employer's insurance carrier
85-22 does not contest the claim.
85-23 SECTION 3.111. Section 409.003, Labor Code, is amended to
85-24 read as follows:
85-25 Sec. 409.003. CLAIM FOR COMPENSATION. An employee or a
85-26 person acting on the employee's behalf shall file with the
85-27 department [commission] a claim for compensation for an injury not
86-1 later than one year after the date on which:
86-2 (1) the injury occurred; or
86-3 (2) if the injury is an occupational disease, the
86-4 employee knew or should have known that the disease was related to
86-5 the employee's employment.
86-6 SECTION 3.112. Section 409.004, Labor Code, is amended to
86-7 read as follows:
86-8 Sec. 409.004. FAILURE TO FILE CLAIM FOR COMPENSATION.
86-9 Failure to file a claim for compensation with the department
86-10 [commission] as required under Section 409.003 relieves the
86-11 employer and the employer's insurance carrier of liability under
86-12 this subtitle unless:
86-13 (1) good cause exists for failure to file a claim in a
86-14 timely manner; or
86-15 (2) the employer or the employer's insurance carrier
86-16 does not contest the claim.
86-17 SECTION 3.113. Sections 409.005(d), (e), (f), (h), and (i),
86-18 Labor Code, are amended to read as follows:
86-19 (d) The insurance carrier shall file the report of the
86-20 injury on behalf of the policyholder. Except as provided by
86-21 Subsection (e), the insurance carrier must electronically file the
86-22 report with the department [commission] not later than the seventh
86-23 day after the date on which the carrier receives the report from
86-24 the employer.
86-25 (e) The commissioner [executive director] may waive the
86-26 electronic filing requirement under Subsection (d) and allow an
86-27 insurance carrier to mail or deliver the report to the department
87-1 [commission] not later than the seventh day after the date on which
87-2 the carrier receives the report from the employer.
87-3 (f) A report required under this section may not be
87-4 considered to be an admission by or evidence against an employer or
87-5 an insurance carrier in a proceeding before the department
87-6 [commission] or a court in which the facts set out in the report
87-7 are contradicted by the employer or insurance carrier.
87-8 (h) The commissioner [commission] may adopt rules relating
87-9 to:
87-10 (1) the information that must be contained in a report
87-11 required under this section, including the summary of rights and
87-12 responsibilities required under Subsection (g); and
87-13 (2) the development and implementation of an
87-14 electronic filing system for injury reports under this section.
87-15 (i) An employer and insurance carrier shall file subsequent
87-16 reports as required by commissioner [commission] rule.
87-17 SECTION 3.114. Sections 409.006(b) and (c), Labor Code, are
87-18 amended to read as follows:
87-19 (b) The record shall be available to the department
87-20 [commission] at reasonable times and under conditions prescribed by
87-21 the department [commission].
87-22 (c) The commissioner [commission] may adopt rules relating
87-23 to the information that must be contained in an employer record
87-24 under this section.
87-25 SECTION 3.115. Section 409.007(a), Labor Code, is amended to
87-26 read as follows:
87-27 (a) A person must file a claim for death benefits with the
88-1 department [commission] not later than the first anniversary of the
88-2 date of the employee's death.
88-3 SECTION 3.116. Section 409.009, Labor Code, is amended to
88-4 read as follows:
88-5 Sec. 409.009. SUBCLAIMS. A person may file a written claim
88-6 with the department [commission] as a subclaimant if the person
88-7 has:
88-8 (1) provided compensation, including health care
88-9 provided by a health care insurer, directly or indirectly, to or
88-10 for an employee or legal beneficiary; and
88-11 (2) sought and been refused reimbursement from the
88-12 insurance carrier.
88-13 SECTION 3.117. Section 409.010, Labor Code, is amended to
88-14 read as follows:
88-15 Sec. 409.010. INFORMATION PROVIDED TO EMPLOYEE OR LEGAL
88-16 BENEFICIARY. Immediately on receiving notice of an injury or death
88-17 from any person, the department [commission] shall mail to the
88-18 employee or legal beneficiary a clear and concise description of:
88-19 (1) the services provided by the department
88-20 [commission], including the services of the ombudsman program;
88-21 (2) the department's [commission's] procedures; and
88-22 (3) the person's rights and responsibilities under
88-23 this subtitle.
88-24 SECTION 3.118. Sections 409.011(a) and (c), Labor Code, are
88-25 amended to read as follows:
88-26 (a) Immediately on receiving notice of an injury or death
88-27 from any person, the department [commission] shall mail to the
89-1 employer a description of:
89-2 (1) the services provided by the department
89-3 [commission];
89-4 (2) the department's [commission's] procedures; and
89-5 (3) the employer's rights and responsibilities under
89-6 this subtitle.
89-7 (c) The department [commission] is not required to provide
89-8 the information to an employer more than once during a calendar
89-9 year.
89-10 SECTION 3.119. Section 409.012, Labor Code, is amended to
89-11 read as follows:
89-12 Sec. 409.012. VOCATIONAL REHABILITATION INFORMATION. (a)
89-13 The department [commission] shall analyze each report of injury
89-14 received from an employer under this chapter to determine whether
89-15 the injured employee would be assisted by vocational
89-16 rehabilitation.
89-17 (b) If the department [commission] determines that an
89-18 injured employee would be assisted by vocational rehabilitation,
89-19 the department [commission] shall notify the injured employee in
89-20 writing of the services and facilities available through the Texas
89-21 Rehabilitation Commission and private providers of vocational
89-22 rehabilitation. The department [commission] shall notify the Texas
89-23 Rehabilitation Commission and the affected insurance carrier that
89-24 the injured employee has been identified as one who could be
89-25 assisted by vocational rehabilitation.
89-26 (c) The department [commission] shall cooperate with the
89-27 Texas Rehabilitation Commission and private providers of vocational
90-1 rehabilitation in the provision of services and facilities to
90-2 employees by the Texas Rehabilitation Commission.
90-3 (d) A private provider of vocational rehabilitation services
90-4 may register with the department [commission].
90-5 (e) The commissioner [commission] by rule may require that a
90-6 private provider of vocational rehabilitation services maintain
90-7 certain credentials and qualifications in order to provide services
90-8 in connection with a workers' compensation insurance claim.
90-9 SECTION 3.120. Section 409.013, Labor Code, is amended to
90-10 read as follows:
90-11 Sec. 409.013. PLAIN LANGUAGE INFORMATION; NOTIFICATION OF
90-12 INJURED WORKER. (a) The department [commission] shall develop
90-13 information for public dissemination about the benefit process and
90-14 the compensation procedures established under this chapter. The
90-15 information must be written in plain language and must be available
90-16 in English and Spanish.
90-17 (b) On receipt of a report under Section 409.005, the
90-18 department [commission] shall contact the affected employee by mail
90-19 or by telephone and shall provide the information required under
90-20 Subsection (a) to that employee, together with any other
90-21 information that may be prepared by the department [commission] for
90-22 public dissemination that relates to the employee's situation, such
90-23 as information relating to back injuries or occupational diseases.
90-24 SECTION 3.121. Sections 409.021(a) and (b), Labor Code, are
90-25 amended to read as follows:
90-26 (a) An insurance carrier shall initiate compensation under
90-27 this subtitle promptly. Not later than the seventh day after the
91-1 date on which an insurance carrier receives written notice of an
91-2 injury, the insurance carrier shall:
91-3 (1) begin the payment of benefits as required by this
91-4 subtitle; or
91-5 (2) notify the department [commission] and the
91-6 employee in writing of its refusal to pay and advise the employee
91-7 of:
91-8 (A) the right to request a benefit review
91-9 conference; and
91-10 (B) the means to obtain additional information
91-11 from the department [commission].
91-12 (b) An insurance carrier shall notify the department
91-13 [commission] in writing of the initiation of income or death
91-14 benefit payments in the manner prescribed by commissioner
91-15 [commission] rules.
91-16 SECTION 3.122. Section 409.022(c), Labor Code, is amended to
91-17 read as follows:
91-18 (c) An insurance carrier commits a violation if the
91-19 insurance carrier does not have reasonable grounds for a refusal to
91-20 pay benefits, as determined by the department [commission]. A
91-21 violation under this subsection is a Class B administrative
91-22 violation.
91-23 SECTION 3.123. Section 409.023(a), Labor Code, is amended to
91-24 read as follows:
91-25 (a) An insurance carrier shall continue to pay benefits
91-26 promptly as and when the benefits accrue without a final decision,
91-27 order, or other action of the department [commission], except as
92-1 otherwise provided.
92-2 SECTION 3.124. Section 409.0231(b), Labor Code, is amended to
92-3 read as follows:
92-4 (b) The commissioner [commission] shall adopt rules in
92-5 consultation with the Texas Department of Information Resources as
92-6 necessary to implement this section, including rules prescribing a
92-7 period of benefits that is of sufficient duration to allow payment
92-8 by electronic funds transfer.
92-9 SECTION 3.125. Section 409.024, Labor Code, is amended to
92-10 read as follows:
92-11 Sec. 409.024. TERMINATION OR REDUCTION OF BENEFITS; NOTICE;
92-12 ADMINISTRATIVE VIOLATION. (a) An insurance carrier shall file with
92-13 the department [commission] a notice of termination or reduction of
92-14 benefits, including the reasons for the termination or reduction,
92-15 not later than the 10th day after the date on which benefits are
92-16 terminated or reduced.
92-17 (b) An insurance carrier commits a violation if the
92-18 insurance carrier does not have reasonable grounds to terminate or
92-19 reduce benefits, as determined by the department [commission]. A
92-20 violation under this subsection is a Class B administrative
92-21 violation.
92-22 SECTION 3.126. Section 409.041(a), Labor Code, is amended to
92-23 read as follows:
92-24 (a) The department [commission] shall maintain an ombudsman
92-25 program as provided by this subchapter to assist injured workers
92-26 and persons claiming death benefits in obtaining benefits under
92-27 this subtitle.
93-1 SECTION 3.127. Sections 409.042(a) and (c), Labor Code, are
93-2 amended to read as follows:
93-3 (a) At least one specially qualified employee in each
93-4 department [commission] office shall be designated an ombudsman who
93-5 shall perform the duties under this section as the person's primary
93-6 responsibility.
93-7 (c) The commissioner [commission] by rule shall adopt
93-8 training guidelines and continuing education requirements for
93-9 ombudsmen. Training provided under this subsection must:
93-10 (1) include education regarding this subtitle, rules
93-11 adopted under this subtitle, and appeals panel decisions, with
93-12 emphasis on benefits and the dispute resolution process; and
93-13 (2) require an ombudsman undergoing training to be
93-14 observed and monitored by an experienced ombudsman during daily
93-15 activities conducted under this subchapter.
93-16 SECTION 3.128. Section 409.043(a), Labor Code, is amended to
93-17 read as follows:
93-18 (a) Each employer shall notify its employees of the
93-19 ombudsman program in a manner prescribed by the commissioner
93-20 [commission].
93-21 SECTION 3.129. Section 409.044, Labor Code, is amended to
93-22 read as follows:
93-23 Sec. 409.044. PUBLIC INFORMATION. The department
93-24 [commission] shall widely disseminate information about the
93-25 ombudsman program.
93-26 SECTION 3.130. Section 410.002, Labor Code, is amended to
93-27 read as follows:
94-1 Sec. 410.002. LAW GOVERNING LIABILITY PROCEEDINGS. A
94-2 proceeding before the department [commission] to determine the
94-3 liability of an insurance carrier for compensation for an injury or
94-4 death under this subtitle is governed by this chapter.
94-5 SECTION 3.131. Section 410.004, Labor Code, is amended to
94-6 read as follows:
94-7 Sec. 410.004. DIVISION OF HEARINGS. The division shall
94-8 conduct benefit review conferences, contested case hearings,
94-9 arbitration, and appeals within the department [commission] related
94-10 to workers' compensation claims.
94-11 SECTION 3.132. Section 410.005(a), Labor Code, is amended to
94-12 read as follows:
94-13 (a) Unless the department [commission] determines that good
94-14 cause exists for the selection of a different location, a benefit
94-15 review conference or a contested case hearing may not be conducted
94-16 at a site more than 75 miles from the claimant's residence at the
94-17 time of the injury.
94-18 SECTION 3.133. Section 410.021, Labor Code, is amended to
94-19 read as follows:
94-20 Sec. 410.021. PURPOSE. A benefit review conference is a
94-21 nonadversarial, informal dispute resolution proceeding designed to:
94-22 (1) explain, orally and in writing, the rights of the
94-23 respective parties to a workers' compensation claim and the
94-24 procedures necessary to protect those rights;
94-25 (2) discuss the facts of the claim, review available
94-26 information in order to evaluate the claim, and delineate the
94-27 disputed issues; and
95-1 (3) mediate and resolve disputed issues by agreement
95-2 of the parties in accordance with this subtitle and the policies of
95-3 the department [commission].
95-4 SECTION 3.134. Sections 410.022(b) and (c), Labor Code, are
95-5 amended to read as follows:
95-6 (b) A benefit review officer must:
95-7 (1) be an employee of the department [commission]; and
95-8 (2) be trained in the principles and procedures of
95-9 dispute mediation.
95-10 (c) The department [commission] shall institute and maintain
95-11 an education and training program for benefit review officers and
95-12 shall consult or contract with the Federal Mediation and
95-13 Conciliation Service or other appropriate organizations for this
95-14 purpose.
95-15 SECTION 3.135. Section 410.023, Labor Code, is amended to
95-16 read as follows:
95-17 Sec. 410.023. REQUEST FOR BENEFIT REVIEW CONFERENCE. On
95-18 receipt of a request from a party or on its own motion, the
95-19 department [commission] may direct the parties to a disputed
95-20 workers' compensation claim to meet in a benefit review conference
95-21 to attempt to reach agreement on disputed issues involved in the
95-22 claim.
95-23 SECTION 3.136. Section 410.024, Labor Code, is amended to
95-24 read as follows:
95-25 Sec. 410.024. BENEFIT REVIEW CONFERENCE AS PREREQUISITE TO
95-26 FURTHER PROCEEDINGS ON CERTAIN CLAIMS. (a) Except as otherwise
95-27 provided by law or commissioner [commission] rule, the parties to a
96-1 disputed compensation claim are not entitled to a contested case
96-2 hearing or arbitration on the claim unless a benefit review
96-3 conference is conducted as provided by this subchapter.
96-4 (b) The commissioner [commission] by rule shall adopt
96-5 guidelines relating to claims that do not require a benefit review
96-6 conference and may proceed directly to a contested case hearing or
96-7 arbitration.
96-8 SECTION 3.137. Section 410.025, Labor Code, is amended to
96-9 read as follows:
96-10 Sec. 410.025. SCHEDULING OF BENEFIT REVIEW CONFERENCE;
96-11 NOTICE. (a) The commissioner [commission] by rule shall prescribe
96-12 the time within which a benefit review conference must be
96-13 scheduled.
96-14 (b) At the time a benefit review conference is scheduled,
96-15 the department [commission] shall schedule a contested case hearing
96-16 to be held not later than the 60th day after the date of the
96-17 benefit review conference if the disputed issues are not resolved
96-18 at the benefit review conference.
96-19 (c) The department [commission] shall send written notice of
96-20 the benefit review conference to the parties to the claim and the
96-21 employer.
96-22 (d) The commissioner [commission] by rule shall provide for
96-23 expedited proceedings in cases in which compensability or liability
96-24 for essential medical treatment is in dispute.
96-25 SECTION 3.138. Section 410.026(a), Labor Code, is amended to
96-26 read as follows:
96-27 (a) A benefit review officer shall:
97-1 (1) mediate disputes between the parties and assist in
97-2 the adjustment of the claim consistent with this subtitle and the
97-3 policies of the department [commission];
97-4 (2) thoroughly inform all parties of their rights and
97-5 responsibilities under this subtitle, especially in a case in which
97-6 the employee is not represented by an attorney or other
97-7 representative; and
97-8 (3) ensure that all documents and information relating
97-9 to the employee's wages, medical condition, and any other
97-10 information pertinent to the resolution of disputed issues are
97-11 contained in the claim file at the conference, especially in a case
97-12 in which the employee is not represented by an attorney or other
97-13 representative.
97-14 SECTION 3.139. Section 410.027(a), Labor Code, is amended to
97-15 read as follows:
97-16 (a) The commissioner [commission] shall adopt rules for
97-17 conducting benefit review conferences.
97-18 SECTION 3.140. Section 410.030, Labor Code, is amended to
97-19 read as follows:
97-20 Sec. 410.030. BINDING EFFECT OF AGREEMENT. (a) An agreement
97-21 signed in accordance with Section 410.029 is binding on the
97-22 insurance carrier through the conclusion of all matters relating to
97-23 the claim, unless the department [commission] or a court, on a
97-24 finding of fraud, newly discovered evidence, or other good and
97-25 sufficient cause, relieves the insurance carrier of the effect of
97-26 the agreement.
97-27 (b) The agreement is binding on the claimant, if represented
98-1 by an attorney, to the same extent as on the insurance carrier. If
98-2 the claimant is not represented by an attorney, the agreement is
98-3 binding on the claimant through the conclusion of all matters
98-4 relating to the claim while the claim is pending before the
98-5 department [commission], unless the department [commission] for
98-6 good cause relieves the claimant of the effect of the agreement.
98-7 SECTION 3.141. Section 410.034(b), Labor Code, is amended to
98-8 read as follows:
98-9 (b) The commissioner [commission] by rule shall prescribe
98-10 the times within which the agreement and report must be filed.
98-11 SECTION 3.142. Section 410.102, Labor Code, is amended to
98-12 read as follows:
98-13 Sec. 410.102. ARBITRATORS; QUALIFICATIONS. (a) An
98-14 arbitrator must be an employee of the department [commission],
98-15 except that the department [commission] may contract with qualified
98-16 arbitrators on a determination of special need.
98-17 (b) An arbitrator must:
98-18 (1) be a member of the National Academy of
98-19 Arbitrators;
98-20 (2) be on an approved list of the American Arbitration
98-21 Association or Federal Mediation and Conciliation Service; or
98-22 (3) meet qualifications established by the
98-23 commissioner [commission] by rule [and be approved by an
98-24 affirmative vote of at least two commission members representing
98-25 employers of labor and at least two commission members representing
98-26 wage earners].
98-27 (c) The department [commission] shall require that each
99-1 arbitrator have appropriate training in the workers' compensation
99-2 laws of this state. The department [commission] shall establish
99-3 procedures to carry out this subsection.
99-4 SECTION 3.143. Section 410.103, Labor Code, is amended to
99-5 read as follows:
99-6 Sec. 410.103. DUTIES OF ARBITRATOR. An arbitrator shall:
99-7 (1) protect the interests of all parties;
99-8 (2) ensure that all relevant evidence has been
99-9 disclosed to the arbitrator and to all parties; and
99-10 (3) render an award consistent with this subtitle and
99-11 the policies of the department [commission].
99-12 SECTION 3.144. Sections 410.104(b) and (c), Labor Code, are
99-13 amended to read as follows:
99-14 (b) To elect arbitration, the parties must file the election
99-15 with the department [commission] not later than the 20th day after
99-16 the last day of the benefit review conference. The department
99-17 [commission] shall prescribe a form for that purpose.
99-18 (c) An election to engage in arbitration under this
99-19 subchapter is irrevocable and binding on all parties for the
99-20 resolution of all disputes arising out of the claims that are under
99-21 the jurisdiction of the department [commission].
99-22 SECTION 3.145. Section 410.105, Labor Code, is amended to
99-23 read as follows:
99-24 Sec. 410.105. LISTS OF ARBITRATORS. (a) The department
99-25 [commission] shall establish regional lists of arbitrators who meet
99-26 the qualifications prescribed under Sections 410.102(a) and (b).
99-27 Each regional list shall be initially prepared in a random name
100-1 order, and subsequent additions to a list shall be added
100-2 chronologically.
100-3 (b) The department [commission] shall review the lists of
100-4 arbitrators annually and determine if each arbitrator is fair and
100-5 impartial and makes awards that are consistent with and in
100-6 accordance with this subtitle and the rules of the commissioner
100-7 [commission]. The commissioner may [commission shall] remove an
100-8 arbitrator [if after review the arbitrator does not receive an
100-9 affirmative vote of at least two commission members representing
100-10 employers of labor and at least two commission members representing
100-11 wage earners].
100-12 (c) The department's [commission's] lists are confidential
100-13 and are not subject to disclosure under Chapter 552, Government
100-14 Code. The lists may not be revealed by any department [commission]
100-15 employee to any person who is not a commission employee. The lists
100-16 are exempt from discovery in civil litigation unless the party
100-17 seeking the discovery establishes reasonable cause to believe that
100-18 a violation of the requirements of this section or Section 410.106,
100-19 410.107, 410.108, or 410.109(b) occurred and that the violation is
100-20 relevant to the issues in dispute.
100-21 SECTION 3.146. Section 410.106, Labor Code, is amended to
100-22 read as follows:
100-23 Sec. 410.106. SELECTION OF ARBITRATOR. The department
100-24 [commission] shall assign the arbitrator for a particular case by
100-25 selecting the next name after the previous case's selection in
100-26 consecutive order. The department [commission] may not change the
100-27 order of names once the order is established under this subchapter,
101-1 except that once each arbitrator on the list has been assigned to a
101-2 case, the names shall be randomly reordered.
101-3 SECTION 3.147. Section 410.107(a), Labor Code, is amended to
101-4 read as follows:
101-5 (a) The department [commission] shall assign an arbitrator
101-6 to a pending case not later than the 30th day after the date on
101-7 which the election for arbitration is filed with the department
101-8 [commission].
101-9 SECTION 3.148. Section 410.108(a), Labor Code, is amended to
101-10 read as follows:
101-11 (a) Each party is entitled, in its sole discretion, to one
101-12 rejection of the arbitrator in each case. If a party rejects the
101-13 arbitrator, the department [commission] shall assign another
101-14 arbitrator as provided by Section 410.106.
101-15 SECTION 3.149. Section 410.109, Labor Code, is amended to
101-16 read as follows:
101-17 Sec. 410.109. SCHEDULING OF ARBITRATION. (a) The arbitrator
101-18 shall schedule arbitration to be held not later than the 30th day
101-19 after the date of the arbitrator's assignment and shall notify the
101-20 parties and the department [commission] of the scheduled date.
101-21 (b) If an arbitrator is unable to schedule arbitration in
101-22 accordance with Subsection (a), the department [commission] shall
101-23 appoint the next arbitrator on the applicable list. Each party is
101-24 entitled to reject the arbitrator appointed under this subsection
101-25 in the manner provided under Section 410.108.
101-26 SECTION 3.150. Section 410.111, Labor Code, is amended to
101-27 read as follows:
102-1 Sec. 410.111. RULES. The commissioner [commission] shall
102-2 adopt rules for arbitration consistent with generally recognized
102-3 arbitration principles and procedures.
102-4 SECTION 3.151. Section 410.114(b), Labor Code, is amended to
102-5 read as follows:
102-6 (b) The department [commission] shall make an electronic
102-7 recording of the proceeding.
102-8 SECTION 3.152. Section 410.118(d), Labor Code, is amended to
102-9 read as follows:
102-10 (d) The arbitrator shall file a copy of the award as part of
102-11 the permanent claim file at the department [commission] and shall
102-12 notify the parties in writing of the decision.
102-13 SECTION 3.153. Section 410.119(b), Labor Code, is amended to
102-14 read as follows:
102-15 (b) An arbitrator's award is a final order of the department
102-16 [commission].
102-17 SECTION 3.154. Sections 410.121(a) and (b), Labor Code, are
102-18 amended to read as follows:
102-19 (a) On application of an aggrieved party, a court of
102-20 competent jurisdiction shall vacate an arbitrator's award on a
102-21 finding that:
102-22 (1) the award was procured by corruption, fraud, or
102-23 misrepresentation;
102-24 (2) the decision of the arbitrator was arbitrary and
102-25 capricious; or
102-26 (3) the award was outside the jurisdiction of the
102-27 department [commission].
103-1 (b) If an award is vacated, the case shall be remanded to
103-2 the department [commission] for another arbitration proceeding.
103-3 SECTION 3.155. Section 410.151(b), Labor Code, is amended to
103-4 read as follows:
103-5 (b) An issue that was not raised at a benefit review
103-6 conference or that was resolved at a benefit review conference may
103-7 not be considered unless:
103-8 (1) the parties consent; or
103-9 (2) if the issue was not raised, the department
103-10 [commission] determines that good cause existed for not raising the
103-11 issue at the conference.
103-12 SECTION 3.156. Section 410.153, Labor Code, is amended to
103-13 read as follows:
103-14 Sec. 410.153. APPLICATION OF ADMINISTRATIVE PROCEDURE ACT.
103-15 Chapter 2001, Government Code, applies to a contested case hearing
103-16 to the extent that the commissioner [commission] finds appropriate,
103-17 except that the following do not apply:
103-18 (1) Section 2001.054;
103-19 (2) Sections 2001.061 and 2001.062;
103-20 (3) Section 2001.202; and
103-21 (4) Subchapters F, G, I, and Z, except for Section
103-22 2001.141(c).
103-23 SECTION 3.157. Section 410.154, Labor Code, is amended to
103-24 read as follows:
103-25 Sec. 410.154. SCHEDULING OF HEARING. The department
103-26 [commission] shall schedule a contested case hearing in accordance
103-27 with Section 410.024 or 410.025(b).
104-1 SECTION 3.158. Section 410.155, Labor Code, is amended to
104-2 read as follows:
104-3 Sec. 410.155. CONTINUANCE. (a) A written request by a party
104-4 for a continuance of a contested case hearing to another date must
104-5 be directed to the department [commission].
104-6 (b) The department [commission] may grant a continuance only
104-7 if the department [commission] determines that there is good cause
104-8 for the continuance.
104-9 SECTION 3.159. Section 410.157, Labor Code, is amended to
104-10 read as follows:
104-11 Sec. 410.157. RULES. The commissioner [commission] shall
104-12 adopt rules governing procedures under which contested case
104-13 hearings are conducted.
104-14 SECTION 3.160. Section 410.158(a), Labor Code, is amended to
104-15 read as follows:
104-16 (a) Except as provided by Section 410.162, discovery is
104-17 limited to:
104-18 (1) depositions on written questions to any health
104-19 care provider;
104-20 (2) depositions of other witnesses as permitted by the
104-21 hearing officer for good cause shown; and
104-22 (3) interrogatories as prescribed by the department
104-23 [commission].
104-24 SECTION 3.161. Section 410.159, Labor Code, is amended to
104-25 read as follows:
104-26 Sec. 410.159. STANDARD INTERROGATORIES. (a) The
104-27 commissioner [commission] by rule shall prescribe standard form
105-1 sets of interrogatories to elicit information from claimants and
105-2 insurance carriers.
105-3 (b) Standard interrogatories shall be answered by each party
105-4 and served on the opposing party within the time prescribed by
105-5 commissioner [commission] rule, unless the parties agree otherwise.
105-6 SECTION 3.162. Section 410.160, Labor Code, is amended to
105-7 read as follows:
105-8 Sec. 410.160. EXCHANGE OF INFORMATION. Within the time
105-9 prescribed by commissioner [commission] rule, the parties shall
105-10 exchange:
105-11 (1) all medical reports and reports of expert
105-12 witnesses who will be called to testify at the hearing;
105-13 (2) all medical records;
105-14 (3) any witness statements;
105-15 (4) the identity and location of any witness known to
105-16 the parties to have knowledge of relevant facts; and
105-17 (5) all photographs or other documents that a party
105-18 intends to offer into evidence at the hearing.
105-19 SECTION 3.163. Section 410.161, Labor Code, is amended to
105-20 read as follows:
105-21 Sec. 410.161. FAILURE TO DISCLOSE INFORMATION. A party who
105-22 fails to disclose information known to the party or documents that
105-23 are in the party's possession, custody, or control at the time
105-24 disclosure is required by Sections 410.158-410.160 may not
105-25 introduce the evidence at any subsequent proceeding before the
105-26 department [commission] or in court on the claim unless good cause
105-27 is shown for not having disclosed the information or documents
106-1 under those sections.
106-2 SECTION 3.164. Sections 410.168(d) and (e), Labor Code, are
106-3 amended to read as follows:
106-4 (d) On a form that the commissioner [commission] by rule
106-5 prescribes, the hearing officer shall issue a separate written
106-6 decision regarding attorney's fees and any matter related to
106-7 attorney's fees. The decision regarding attorney's fees and the
106-8 form may not be made known to a jury in a judicial review of an
106-9 award, including an appeal.
106-10 (e) The commissioner [commission] by rule shall prescribe
106-11 the times within which the hearing officer must file the decisions
106-12 with the division.
106-13 SECTION 3.165. Section 410.203(d), Labor Code, is amended to
106-14 read as follows:
106-15 (d) A hearing on remand shall be accelerated and the
106-16 commissioner [commission] shall adopt rules to give priority to the
106-17 hearing over other proceedings.
106-18 SECTION 3.166. Section 410.204(b), Labor Code, is amended to
106-19 read as follows:
106-20 (b) A copy of the decision of the appeals panel shall be
106-21 sent to each party not later than the seventh day after the date
106-22 the decision is filed with the department [commission].
106-23 SECTION 3.167. Section 410.206, Labor Code, is amended to
106-24 read as follows:
106-25 Sec. 410.206. CLERICAL ERROR. The commissioner [executive
106-26 director] may revise a decision in a contested case hearing on a
106-27 finding of clerical error.
107-1 SECTION 3.168. Section 410.207, Labor Code, is amended to
107-2 read as follows:
107-3 Sec. 410.207. CONTINUATION OF COMMISSION JURISDICTION.
107-4 During judicial review of an appeals panel decision on any disputed
107-5 issue relating to a workers' compensation claim, the department
107-6 [commission] retains jurisdiction of all other issues related to
107-7 the claim.
107-8 SECTION 3.169. Sections 410.208(a) and (c), Labor Code, are
107-9 amended to read as follows:
107-10 (a) If an insurance carrier refuses or fails to comply with
107-11 a final order or decision of the department [commission], the
107-12 claimant may bring suit in the county of the claimant's residence
107-13 or the county in which the injury occurred to enforce the award as
107-14 a final and binding order of the department [commission].
107-15 (c) A person commits a violation if the person fails or
107-16 refuses to comply with a department [commission] order or decision
107-17 within 20 days after the date the order or decision becomes final.
107-18 A violation under this subsection is a Class A administrative
107-19 violation.
107-20 SECTION 3.170. Section 410.209, Labor Code, is amended to
107-21 read as follows:
107-22 Sec. 410.209. REIMBURSEMENT FOR OVERPAYMENT. The subsequent
107-23 injury fund shall reimburse an insurance carrier for any
107-24 overpayments of benefits made under an interlocutory order or
107-25 decision if that order or decision is reversed or modified by final
107-26 arbitration, order, or decision of the department [commission] or a
107-27 court. The commissioner [commission] shall adopt rules to provide
108-1 for a periodic reimbursement schedule, providing for reimbursement
108-2 at least annually.
108-3 SECTION 3.171. Section 410.253, Labor Code, is amended to
108-4 read as follows:
108-5 Sec. 410.253. SERVICE. A copy of the petition shall be
108-6 simultaneously filed with the court and the commissioner
108-7 [commission] and served on any opposing party.
108-8 SECTION 3.172. Section 410.254, Labor Code, is amended to
108-9 read as follows:
108-10 Sec. 410.254. [COMMISSION] INTERVENTION. On timely motion
108-11 initiated by the commissioner [executive director], the department
108-12 [commission] shall be permitted to intervene in any judicial
108-13 proceeding under this subchapter or Subchapter G.
108-14 SECTION 3.173. The heading to Section 410.258, Labor Code, is
108-15 amended to read as follows:
108-16 Sec. 410.258. NOTIFICATION OF DEPARTMENT [COMMISSION] OF
108-17 PROPOSED JUDGMENTS AND SETTLEMENTS; RIGHT TO INTERVENE.
108-18 SECTION 3.174. Sections 410.258(a), (b), (c), (d), and (e),
108-19 Labor Code, are amended to read as follows:
108-20 (a) The party who initiated a proceeding under this
108-21 subchapter or Subchapter G must file any proposed judgment or
108-22 settlement made by the parties to the proceeding, including a
108-23 proposed default judgment, with the commissioner [executive
108-24 director of the commission] not later than the 30th day before the
108-25 date on which the court is scheduled to enter the judgment or
108-26 approve the settlement. The proposed judgment or settlement must
108-27 be mailed to the commissioner [executive director] by certified
109-1 mail, return receipt requested.
109-2 (b) The department [commission] may intervene in a
109-3 proceeding under Subsection (a) not later than the 30th day after
109-4 the date of receipt of the proposed judgment or settlement.
109-5 (c) The department [commission] shall review the proposed
109-6 judgment or settlement to determine compliance with all appropriate
109-7 provisions of the law. If the department [commission] determines
109-8 that the proposal is not in compliance with the law, the department
109-9 [commission] may intervene as a matter of right in the proceeding
109-10 not later than the 30th day after the date of receipt of the
109-11 proposed judgment or settlement. The court may limit the extent of
109-12 the department's [commission's] intervention to providing the
109-13 information described by Subsection (e).
109-14 (d) If the department [commission] does not intervene before
109-15 the 31st day after the date of receipt of the proposed judgment or
109-16 settlement, the court shall enter the judgment or approve the
109-17 settlement if the court determines that the proposed judgment or
109-18 settlement is in compliance with all appropriate provisions of the
109-19 law.
109-20 (e) If the department [commission] intervenes in the
109-21 proceeding, the department [commission] shall inform the court of
109-22 each reason the department [commission] believes the proposed
109-23 judgment or settlement is not in compliance with the law. The
109-24 court shall give full consideration to the information provided by
109-25 the department [commission] before entering a judgment or approving
109-26 a settlement.
109-27 SECTION 3.175. Section 410.301(a), Labor Code, is amended to
110-1 read as follows:
110-2 (a) Judicial review of a final decision of a department
110-3 [commission] appeals panel regarding compensability or eligibility
110-4 for or the amount of income or death benefits shall be conducted as
110-5 provided by this subchapter.
110-6 SECTION 3.176. Section 410.302, Labor Code, is amended to
110-7 read as follows:
110-8 Sec. 410.302. LIMITATION OF ISSUES. A trial under this
110-9 subchapter is limited to issues decided by the department
110-10 [commission] appeals panel and on which judicial review is sought.
110-11 The pleadings must specifically set forth the determinations of the
110-12 appeals panel by which the party is aggrieved.
110-13 SECTION 3.177. Section 410.304, Labor Code, is amended to
110-14 read as follows:
110-15 Sec. 410.304. CONSIDERATION OF APPEALS PANEL DECISION. (a)
110-16 In a jury trial, the court, before submitting the case to the jury,
110-17 shall inform the jury in the court's instructions, charge, or
110-18 questions to the jury of the department [commission] appeals panel
110-19 decision on each disputed issue described by Section 410.301(a)
110-20 that is submitted to the jury.
110-21 (b) In a trial to the court without a jury, the court in
110-22 rendering its judgment on an issue described by Section 410.301(a)
110-23 shall consider the decision of the department [commission] appeals
110-24 panel.
110-25 SECTION 3.178. Sections 410.306(b) and (c), Labor Code, are
110-26 amended to read as follows:
110-27 (b) The department [commission] on payment of a reasonable
111-1 fee shall make available to the parties a certified copy of the
111-2 department's [commission's] record. All facts and evidence the
111-3 record contains are admissible to the extent allowed under the
111-4 Texas Rules of Civil Evidence.
111-5 (c) Except as provided by Section 410.307, evidence of
111-6 extent of impairment shall be limited to that presented to the
111-7 department [commission]. The court or jury, in its determination
111-8 of the extent of impairment, shall adopt one of the impairment
111-9 ratings under Subchapter G, Chapter 408.
111-10 SECTION 3.179. Sections 410.307(a) and (d), Labor Code, are
111-11 amended to read as follows:
111-12 (a) Evidence of the extent of impairment is not limited to
111-13 that presented to the department [commission] if the court, after a
111-14 hearing, finds that there is a substantial change of condition.
111-15 The court's finding of a substantial change of condition may be
111-16 based only on:
111-17 (1) medical evidence from the same doctor or doctors
111-18 whose testimony or opinion was presented to the department
111-19 [commission];
111-20 (2) evidence that has come to the party's knowledge
111-21 since the contested case hearing;
111-22 (3) evidence that could not have been discovered
111-23 earlier with due diligence by the party; and
111-24 (4) evidence that would probably produce a different
111-25 result if it is admitted into evidence at the trial.
111-26 (d) If the court finds a substantial change of condition
111-27 under this section, new medical evidence of the extent of
112-1 impairment must be from and is limited to the same doctor or
112-2 doctors who made impairment ratings before the department
112-3 [commission] under Section 408.123.
112-4 SECTION 3.180. Section 410.308(a), Labor Code, is amended to
112-5 read as follows:
112-6 (a) The department [commission] or the Texas Department of
112-7 Insurance shall furnish any interested party in the claim with a
112-8 certified copy of the notice of the employer securing compensation
112-9 with the insurance carrier, filed with the department [commission].
112-10 SECTION 3.181. Section 411.001(1), Labor Code, is amended to
112-11 read as follows:
112-12 (1) "Division" means the division of workers' health
112-13 and safety of the department [commission].
112-14 SECTION 3.182. Section 411.013, Labor Code, is amended to
112-15 read as follows:
112-16 Sec. 411.013. FEDERAL CONTRACTS AND PROGRAMS. With the
112-17 approval of the commissioner [commission], the division may:
112-18 (1) enter into contracts with the federal government
112-19 to perform occupational safety projects; and
112-20 (2) apply for federal funds through any federal
112-21 program relating to occupational safety.
112-22 SECTION 3.183. Section 411.032, Labor Code, is amended to
112-23 read as follows:
112-24 Sec. 411.032. EMPLOYER INJURY AND OCCUPATIONAL DISEASE
112-25 REPORT; ADMINISTRATIVE VIOLATION. (a) An employer shall file with
112-26 the department [commission] a report of each:
112-27 (1) on-the-job injury that results in the employee's
113-1 absence from work for more than one day; and
113-2 (2) occupational disease of which the employer has
113-3 knowledge.
113-4 (b) The commissioner [commission] shall adopt rules and
113-5 prescribe the form and manner of reports filed under this section.
113-6 (c) An employer commits an administrative violation if the
113-7 employer fails to report to the department [commission] as required
113-8 under Subsection (a) unless good cause exists, as determined by the
113-9 department [commission], for the failure. A violation under this
113-10 subsection is a Class D administrative violation.
113-11 SECTION 3.184. Section 411.035, Labor Code, is amended to
113-12 read as follows:
113-13 Sec. 411.035. USE OF INJURY REPORT. A report made under
113-14 Section 411.032 may not be considered to be an admission by or
113-15 evidence against an employer or an insurance carrier in a
113-16 proceeding before the department [commission] or a court in which
113-17 the facts set out in the report are contradicted by the employer or
113-18 insurance carrier.
113-19 SECTION 3.185. Section 411.0415, Labor Code, is amended to
113-20 read as follows:
113-21 Sec. 411.0415. EXEMPTION FOR CERTAIN EMPLOYERS; HEARING.
113-22 (a) The department [executive director] may exclude from
113-23 identification as a hazardous employer an employer who presents
113-24 evidence satisfactory to the department [commission] that the
113-25 injury frequencies of the employer substantially exceed those that
113-26 may reasonably be expected in that employer's business or industry
113-27 only because of a fatality that:
114-1 (1) occurred because of factors beyond the employer's
114-2 control; or
114-3 (2) was outside the course and scope of the deceased
114-4 individual's employment.
114-5 (b) The commissioner [commission] by rule shall analyze and
114-6 list fatalities that may not be related to the work environment,
114-7 including:
114-8 (1) heart attacks;
114-9 (2) common diseases of life;
114-10 (3) homicides;
114-11 (4) suicides;
114-12 (5) vehicle accidents involving a third party;
114-13 (6) common carrier accidents; and
114-14 (7) natural events.
114-15 (c) If the department [commission] determines that the case
114-16 history of the employee's fatality indicates that the employer or
114-17 the work environment was a proximate cause of the fatality, the
114-18 department [commission] may request a hearing under Section
114-19 411.049. If the hearing establishes that a proximate cause of the
114-20 fatality was a factor or factors within the employer's control and
114-21 was within the course and scope of the employment, the department
114-22 [commission] may identify the employer for the hazardous employer
114-23 program if that fatality causes the employer to be designated as a
114-24 hazardous employer.
114-25 SECTION 3.186. Section 411.042(b), Labor Code, is amended to
114-26 read as follows:
114-27 (b) The commissioner [commission] by rule shall require a
115-1 minimum interval of at least six months before a subsequent audit
115-2 to identify an employer who was previously identified as a
115-3 hazardous employer.
115-4 SECTION 3.187. Section 411.043(b), Labor Code, is amended to
115-5 read as follows:
115-6 (b) The safety consultant shall file a written report with
115-7 the department [commission] and the employer setting out any
115-8 hazardous conditions or practices identified by the safety
115-9 consultation.
115-10 SECTION 3.188. Section 411.045(a), Labor Code, is amended to
115-11 read as follows:
115-12 (a) Not earlier than six months or later than nine months
115-13 after the formulation of an accident prevention plan under Section
115-14 411.043, the division shall conduct a follow-up inspection of the
115-15 employer's premises. The department [commission] may require the
115-16 participation of the safety consultant who performed the initial
115-17 consultation and formulated the safety plan.
115-18 SECTION 3.189. Section 411.048, Labor Code, is amended to
115-19 read as follows:
115-20 Sec. 411.048. COSTS CHARGED TO EMPLOYER. (a) The department
115-21 [commission] shall charge an employer that is a political
115-22 subdivision for reimbursement of the reasonable cost of services
115-23 provided by the division, including a reasonable allocation of the
115-24 department's [commission's] administrative costs, in formulating
115-25 and monitoring the implementation of a plan under Section 411.043
115-26 or 411.047, investigating an accident under Section 411.044, or in
115-27 conducting a follow-up inspection under Section 411.045.
116-1 (b) The department [commission] shall charge a private
116-2 employer for reimbursement of the reasonable cost of services
116-3 provided by the division, including a reasonable allocation of the
116-4 department's [commission's] administrative costs, in providing
116-5 safety and health services under this program at the request of the
116-6 private employer. This subsection does not apply to services
116-7 provided to the employer under Section 411.018.
116-8 SECTION 3.190. Section 411.049(a), Labor Code, is amended to
116-9 read as follows:
116-10 (a) An employer may request a hearing to contest findings
116-11 made by the department [commission] under this subchapter.
116-12 SECTION 3.191. Section 411.050, Labor Code, is amended to
116-13 read as follows:
116-14 Sec. 411.050. ADMISSIBILITY OF IDENTIFICATION AS HAZARDOUS
116-15 EMPLOYER. The identification of an employer as a hazardous employer
116-16 under this subchapter is not admissible in any judicial proceeding
116-17 unless:
116-18 (1) the department [commission] has determined that
116-19 the employer is not in compliance with this subchapter; and
116-20 (2) that determination has not been reversed or
116-21 superseded at the time of the event giving rise to the judicial
116-22 proceeding.
116-23 SECTION 3.192. Section 411.062, Labor Code, is amended to
116-24 read as follows:
116-25 Sec. 411.062. FIELD SAFETY REPRESENTATIVE; QUALIFICATIONS.
116-26 (a) The commissioner [commission] by rule shall establish
116-27 qualifications for field safety representatives. The rules must
117-1 include education and experience requirements for those
117-2 representatives.
117-3 (b) Each field safety representative must meet the
117-4 qualifications established by the commissioner [commission].
117-5 SECTION 3.193. Section 411.064(c), Labor Code, is amended to
117-6 read as follows:
117-7 (c) The insurance company shall reimburse the department
117-8 [commission] for the reasonable cost of the reinspection, including
117-9 a reasonable allocation of the department's [commission's]
117-10 administrative costs incurred in conducting the inspections.
117-11 SECTION 3.194. Section 411.065(b), Labor Code, is amended to
117-12 read as follows:
117-13 (b) The information must include:
117-14 (1) the amount of money spent by the insurance company
117-15 on accident prevention services;
117-16 (2) the number and qualifications of field safety
117-17 representatives employed by the insurance company;
117-18 (3) the number of site inspections performed;
117-19 (4) accident prevention services for which the
117-20 insurance company contracts;
117-21 (5) a breakdown of the premium size of the risks to
117-22 which services were provided;
117-23 (6) evidence of the effectiveness of and
117-24 accomplishments in accident prevention; and
117-25 (7) any additional information required by the
117-26 department [commission].
117-27 SECTION 3.195. The heading to Section 411.067, Labor Code, is
118-1 amended to read as follows:
118-2 Sec. 411.067. DEPARTMENT [COMMISSION] PERSONNEL.
118-3 SECTION 3.196. Section 411.067(a), Labor Code, is amended to
118-4 read as follows:
118-5 (a) The department [commission] shall employ the personnel
118-6 necessary to enforce this subchapter, including at least 10 safety
118-7 inspectors to perform inspections at a job site and at an insurance
118-8 company to determine the adequacy of the accident prevention
118-9 services provided by the insurance company.
118-10 SECTION 3.197. Section 411.081(b), Labor Code, is amended to
118-11 read as follows:
118-12 (b) Each employer shall notify its employees of this service
118-13 in a manner prescribed by the department [commission].
118-14 SECTION 3.198. Section 411.092, Labor Code, is amended to
118-15 read as follows:
118-16 Sec. 411.092. ENFORCEMENT; RULES. The department
118-17 [commission] shall enforce Section 411.091 and the commissioner may
118-18 adopt rules for that purpose.
118-19 SECTION 3.199. Section 411.104(b), Labor Code, is amended to
118-20 read as follows:
118-21 (b) In addition to the duties specified in this chapter, the
118-22 division shall perform other duties as required by the department
118-23 [commission].
118-24 SECTION 3.200. Section 411.105, Labor Code, is amended to
118-25 read as follows:
118-26 Sec. 411.105. CONFIDENTIAL INFORMATION; PENALTY. (a) The
118-27 department [commission] and its employees may not disclose at a
119-1 public hearing or otherwise information relating to secret
119-2 processes, methods of manufacture, or products.
119-3 (b) The commissioner [A member] or an employee of the
119-4 department [commission] commits an offense if the commissioner
119-5 [member] or employee wilfully discloses or conspires to disclose
119-6 information made confidential under this section. An offense under
119-7 this subsection is a misdemeanor punishable by a fine not to exceed
119-8 $1,000 and by forfeiture of the person's appointment as
119-9 commissioner [a member] or as an employee of the department
119-10 [commission].
119-11 SECTION 3.201. Section 411.106, Labor Code, is amended to
119-12 read as follows:
119-13 Sec. 411.106. SAFETY CLASSIFICATION. (a) To establish a
119-14 safety classification for employers, the department [commission]
119-15 shall:
119-16 (1) obtain medical and compensation cost information
119-17 regularly compiled by the Texas Department of Insurance in
119-18 performing that agency's rate-making duties and functions regarding
119-19 employer liability and workers' compensation insurance; and
119-20 (2) collect and compile information relating to:
119-21 (A) the frequency rate of accidents;
119-22 (B) the existence and implementation of private
119-23 safety programs;
119-24 (C) the number of work-hour losses because of
119-25 injuries; and
119-26 (D) other facts showing accident experience.
119-27 (b) From the information obtained under Subsection (a), the
120-1 department [commission] shall classify employers as appropriate to
120-2 implement this subchapter.
120-3 SECTION 3.202. Section 411.107, Labor Code, is amended to
120-4 read as follows:
120-5 Sec. 411.107. ELIMINATION OF SAFETY IMPEDIMENTS. The
120-6 department [commission] may endeavor to eliminate an impediment to
120-7 occupational or industrial safety that is reported to the
120-8 department [commission] by an affected employer. In attempting to
120-9 eliminate an impediment the department [commission] may advise and
120-10 consult with an employer, or a representative of an employer, who
120-11 is directly involved.
120-12 SECTION 3.203. Section 411.108, Labor Code, is amended to
120-13 read as follows:
120-14 Sec. 411.108. ACCIDENT REPORTS. The department [commission]
120-15 may require an employer and any other appropriate person to report
120-16 accidents, personal injuries, fatalities, or other statistics and
120-17 information relating to accidents on forms prescribed by and
120-18 covering periods designated by the department [commission].
120-19 SECTION 3.204. Sections 412.041(f), (g), and (j), Labor Code,
120-20 are amended to read as follows:
120-21 (f) In administering and enforcing Chapter 501, the director
120-22 shall act in the capacity of employer and insurer. (effective for
120-23 dates of injury before September 1, 1995.)
120-24 (1) The director shall act as an adversary before the
120-25 department [commission] and courts and present the legal defenses
120-26 and positions of the state as an employer and insurer.
120-27 (2) For the purposes of this subsection and Chapter
121-1 501, the director is entitled to the legal counsel of the attorney
121-2 general.
121-3 (3) The director is subject to the rules, orders, and
121-4 decisions of the department [commission] in the same manner as a
121-5 private employer, insurer, or association.
121-6 (g) In administering and enforcing Chapter 501, the director
121-7 shall act in the capacity of insurer. (effective for dates of
121-8 injury on or after September 1, 1995.)
121-9 (1) The director shall act as an adversary before the
121-10 department [commission] and courts and present the legal defenses
121-11 and positions of the state as an insurer.
121-12 (2) For purposes of this subsection and Chapter 501,
121-13 the director is entitled to legal counsel of the attorney general.
121-14 (3) The director is subject to the rules, orders, and
121-15 decisions of the department [commission] in the same manner as an
121-16 insurer or association.
121-17 (j) The director shall furnish copies of all rules to the
121-18 commissioner [commission] and to the administrative heads of all
121-19 state agencies affected by this chapter and Chapter 501.
121-20 SECTION 3.205. Section 413.001, Labor Code, is amended to
121-21 read as follows:
121-22 Sec. 413.001. DEFINITION. In this chapter, "division" means
121-23 the division of medical review of the department [commission].
121-24 SECTION 3.206. Section 413.002, Labor Code, is amended to
121-25 read as follows:
121-26 Sec. 413.002. DIVISION OF MEDICAL REVIEW. (a) The
121-27 department [commission] shall maintain a division of medical review
122-1 to ensure compliance with the rules and to implement this chapter
122-2 under the policies adopted by the department [commission].
122-3 (b) The division shall monitor health care providers,
122-4 insurance carriers, and workers' compensation claimants who receive
122-5 medical services to ensure the compliance of those persons with
122-6 rules adopted by the commissioner [commission] relating to health
122-7 care, including medical policies and fee guidelines.
122-8 (c) In monitoring health care providers who serve as
122-9 designated doctors under Chapter 408, the division shall evaluate
122-10 the compliance of those providers with this subtitle and with rules
122-11 adopted by the commissioner [commission] relating to medical
122-12 policies, fee guidelines, and impairment ratings.
122-13 SECTION 3.207. Section 413.003, Labor Code, is amended to
122-14 read as follows:
122-15 Sec. 413.003. AUTHORITY TO CONTRACT. The department
122-16 [commission] may contract with a private or public entity to
122-17 perform a duty or function of the division.
122-18 SECTION 3.208. Section 413.004, Labor Code, is amended to
122-19 read as follows:
122-20 Sec. 413.004. COORDINATION WITH PROVIDERS. The division
122-21 shall coordinate its activities with health care providers as
122-22 necessary to perform its duties under this chapter. The
122-23 coordination may include:
122-24 (1) conducting educational seminars on department
122-25 [commission] rules and procedures; or
122-26 (2) providing information to and requesting assistance
122-27 from professional peer review organizations.
123-1 SECTION 3.209. Sections 413.005(a), (b), and (d), Labor Code,
123-2 are amended to read as follows:
123-3 (a) The medical advisory committee advises the division in
123-4 developing and administering the medical policies, fee guidelines,
123-5 and utilization guidelines established under Section 413.011. The
123-6 committee shall advise the department [commission] or professional
123-7 organization in the review and revision of medical policies and fee
123-8 guidelines required under Section 413.012.
123-9 (b) The medical advisory committee is composed of members
123-10 appointed by the commissioner [commission] as follows:
123-11 (1) a representative of a public health care facility;
123-12 (2) a representative of a private health care
123-13 facility;
123-14 (3) a doctor of medicine;
123-15 (4) a doctor of osteopathic medicine;
123-16 (5) a chiropractor;
123-17 (6) a dentist;
123-18 (7) a physical therapist;
123-19 (8) a pharmacist;
123-20 (9) a podiatrist;
123-21 (10) an occupational therapist;
123-22 (11) a medical equipment supplier;
123-23 (12) a registered nurse;
123-24 (13) a representative of employers;
123-25 (14) a representative of employees;
123-26 (15) a representative of an insurance carrier; and
123-27 (16) two representatives of the general public.
124-1 (d) The commissioner [commission] shall designate the
124-2 presiding officer of the medical advisory committee.
124-3 SECTION 3.210. Section 413.006, Labor Code, is amended to
124-4 read as follows:
124-5 Sec. 413.006. ADVISORY COMMITTEES. The commissioner
124-6 [commission] may appoint advisory committees in addition to the
124-7 medical advisory committee as it considers necessary.
124-8 SECTION 3.211. Sections 413.007(a) and (c), Labor Code, are
124-9 amended to read as follows:
124-10 (a) The division shall maintain a statewide data base of
124-11 medical charges, actual payments, and treatment protocols that may
124-12 be used by:
124-13 (1) the department [commission] in adopting the
124-14 medical policies and fee guidelines; and
124-15 (2) the division in administering the medical
124-16 policies, fee guidelines, or rules.
124-17 (c) The division shall ensure that the data base is
124-18 available for public access for a reasonable fee established by the
124-19 department [commission]. The identities of injured workers and
124-20 beneficiaries may not be disclosed.
124-21 SECTION 3.212. Sections 413.008(a) and (b), Labor Code, are
124-22 amended to read as follows:
124-23 (a) On request from the department [commission] for specific
124-24 information, an insurance carrier shall provide to the division any
124-25 information in its possession, custody, or control that reasonably
124-26 relates to the department's [commission's] duties under this
124-27 subtitle and to health care:
125-1 (1) treatment;
125-2 (2) services;
125-3 (3) fees; and
125-4 (4) charges.
125-5 (b) The department [commission] shall keep confidential
125-6 information that is confidential by law.
125-7 SECTION 3.213. Section 413.011, Labor Code, is amended to
125-8 read as follows:
125-9 Sec. 413.011. GUIDELINES AND MEDICAL POLICIES. (a) The
125-10 commissioner [commission] by rule shall establish medical policies
125-11 and guidelines relating to:
125-12 (1) fees charged or paid for medical services for
125-13 employees who suffer compensable injuries, including guidelines
125-14 relating to payment of fees for specific medical treatments or
125-15 services;
125-16 (2) use of medical services by employees who suffer
125-17 compensable injuries; and
125-18 (3) fees charged or paid for providing expert
125-19 testimony relating to an issue arising under this subtitle.
125-20 (b) Guidelines for medical services fees must be fair and
125-21 reasonable and designed to ensure the quality of medical care and
125-22 to achieve effective medical cost control. The guidelines may not
125-23 provide for payment of a fee in excess of the fee charged for
125-24 similar treatment of an injured individual of an equivalent
125-25 standard of living and paid by that individual or by someone acting
125-26 on that individual's behalf. The commissioner [commission] shall
125-27 consider the increased security of payment afforded by this
126-1 subtitle in establishing the fee guidelines.
126-2 (c) Medical policies adopted by the department [commission]
126-3 must be consistent with Sections 413.013, 413.020, 413.052, and
126-4 413.053.
126-5 (d) The commissioner [commission] by rule shall establish
126-6 medical policies relating to necessary treatments for injuries.
126-7 Medical policies shall be designed to ensure the quality of medical
126-8 care and to achieve effective medical cost control.
126-9 SECTION 3.214. Section 413.013, Labor Code, is amended to
126-10 read as follows:
126-11 Sec. 413.013. PROGRAMS. The commissioner [commission] by
126-12 rule shall establish:
126-13 (1) a program for prospective, concurrent, and
126-14 retrospective review and resolution of a dispute regarding health
126-15 care treatments and services;
126-16 (2) a program for the systematic monitoring of the
126-17 necessity of treatments administered and fees charged and paid for
126-18 medical treatments or services, including the authorization of
126-19 prospective, concurrent, or retrospective review under the medical
126-20 policies of the department [commission] to ensure that the medical
126-21 policies or guidelines are not exceeded;
126-22 (3) a program to detect practices and patterns by
126-23 insurance carriers in unreasonably denying authorization of payment
126-24 for medical services requested or performed if authorization is
126-25 required by the medical policies of the department [commission];
126-26 and
126-27 (4) a program to increase the intensity of review for
127-1 compliance with the medical policies or fee guidelines for any
127-2 health care provider that has established a practice or pattern in
127-3 charges and treatments inconsistent with the medical policies and
127-4 fee guidelines.
127-5 SECTION 3.215. Section 413.014, Labor Code, is amended to
127-6 read as follows:
127-7 Sec. 413.014. PREAUTHORIZATION. (a) The commissioner
127-8 [commission] by rule shall specify which health care treatments and
127-9 services require express preauthorization by the insurance carrier.
127-10 Treatments and services for a medical emergency do not require
127-11 express preauthorization.
127-12 (b) The insurance carrier is not liable for those specified
127-13 treatments and services unless preauthorization is sought by the
127-14 claimant or health care provider and either obtained from the
127-15 insurance carrier or ordered by the department [commission].
127-16 SECTION 3.216. Section 413.015(b), Labor Code, is amended to
127-17 read as follows:
127-18 (b) The commissioner [commission] shall provide by rule for
127-19 the review and audit of the payment by insurance carriers of
127-20 charges for medical services provided under this subtitle to ensure
127-21 compliance of health care providers and insurance carriers with the
127-22 medical policies and fee guidelines adopted by the department
127-23 [commission].
127-24 SECTION 3.217. Section 413.016(b), Labor Code, is amended to
127-25 read as follows:
127-26 (b) If the division determines that an insurance carrier has
127-27 paid medical charges that are inconsistent with the medical
128-1 policies or fee guidelines adopted by the department [commission],
128-2 the division shall refer the insurance carrier alleged to have
128-3 violated this subtitle to the division of compliance and practices.
128-4 If the insurance carrier reduced a charge of a health care provider
128-5 that was within the guidelines, the insurance carrier shall be
128-6 directed to submit the difference to the provider unless the
128-7 reduction is in accordance with an agreement between the health
128-8 care provider and the insurance carrier.
128-9 SECTION 3.218. Section 413.017, Labor Code, is amended to
128-10 read as follows:
128-11 Sec. 413.017. PRESUMPTION OF REASONABLENESS. The following
128-12 medical services are presumed reasonable:
128-13 (1) medical services consistent with the medical
128-14 policies and fee guidelines adopted by the department [commission];
128-15 and
128-16 (2) medical services that are provided subject to
128-17 prospective, concurrent, or retrospective review as required by the
128-18 medical policies of the department [commission] and that are
128-19 authorized by an insurance carrier.
128-20 SECTION 3.219. Sections 413.018(a), (c), (d), and (e), Labor
128-21 Code, are amended to read as follows:
128-22 (a) The commissioner [commission] by rule shall provide for
128-23 the periodic review of medical care provided in claims in which
128-24 guidelines for expected or average return to work time frames are
128-25 exceeded.
128-26 (c) The department [commission] shall implement a program to
128-27 encourage employers and treating doctors to discuss the
129-1 availability of modified duty to encourage the safe and more timely
129-2 return to work of injured employees. The department [commission]
129-3 may require a treating or examining doctor, on the request of the
129-4 employer, insurance carrier, or department [commission], to provide
129-5 a functional capacity evaluation of an injured employee and to
129-6 determine the employee's ability to engage in physical activities
129-7 found in the workplace or in activities that are required in a
129-8 modified duty setting.
129-9 (d) The department [commission] shall provide through the
129-10 department's [commission's] health and safety information and
129-11 medical review outreach programs information to employers regarding
129-12 effective return to work programs. This section does not require
129-13 an employer to provide modified duty or an employee to accept a
129-14 modified duty assignment. An employee who does not accept an
129-15 employer's offer of modified duty determined by the department
129-16 [commission] to be a bona fide job offer is subject to Section
129-17 408.103(e).
129-18 (e) The commissioner [commission] may adopt rules and the
129-19 department may prescribe forms as necessary to implement this
129-20 section.
129-21 SECTION 3.220. Section 413.020, Labor Code, is amended to
129-22 read as follows:
129-23 Sec. 413.020. DEPARTMENT [COMMISSION] CHARGES. The
129-24 commissioner [commission] by rule shall establish procedures to
129-25 enable the department [commission] to charge:
129-26 (1) an insurance carrier a reasonable fee for access
129-27 to or evaluation of health care treatment, fees, or charges under
130-1 this subtitle; and
130-2 (2) a health care provider who exceeds a fee or
130-3 utilization guideline established under this subtitle or an
130-4 insurance carrier who unreasonably disputes charges that are
130-5 consistent with a fee or utilization guideline established under
130-6 this subtitle a reasonable fee for review of health care treatment,
130-7 fees, or charges under this subtitle.
130-8 SECTION 3.221. Sections 413.031(a) and (c), Labor Code, are
130-9 amended to read as follows:
130-10 (a) A party, including a health care provider, is entitled
130-11 to a review of a medical service provided or for which
130-12 authorization of payment is sought if a health care provider is:
130-13 (1) denied payment or paid a reduced amount for the
130-14 medical service rendered;
130-15 (2) denied authorization for the payment for the
130-16 service requested or performed if authorization is required by the
130-17 medical policies of the department [commission]; or
130-18 (3) ordered by the division to refund a payment
130-19 received for a medical service rendered.
130-20 (c) A review of a medical service under this section shall
130-21 be provided by a health care provider professional review
130-22 organization if requested by the health care practitioner or if
130-23 ordered by the department [commission].
130-24 SECTION 3.222. Section 413.041, Labor Code, is amended to
130-25 read as follows:
130-26 Sec. 413.041. DISCLOSURE. A health care provider who refers
130-27 a workers' compensation claimant to another health care provider in
131-1 which the referring provider has more than a five percent financial
131-2 interest shall file an annual disclosure statement with the
131-3 department [commission] as provided by commissioner [commission]
131-4 rules and shall disclose the interest to the insurance carrier at
131-5 the time of the referral. The referring provider shall specify the
131-6 degree of the financial interest and shall provide other
131-7 information as required by commissioner [commission] rules.
131-8 SECTION 3.223. Section 413.044, Labor Code, is amended to
131-9 read as follows:
131-10 Sec. 413.044. SANCTIONS ON DESIGNATED DOCTOR. In addition to
131-11 or in lieu of an administrative penalty under Section 415.021 or a
131-12 sanction imposed under Section 415.023, the department [commission]
131-13 may impose sanctions against a person who serves as a designated
131-14 doctor under Chapter 408 who, after an evaluation conducted under
131-15 Section 413.002(c), is determined by the division to be out of
131-16 compliance with this subtitle or with rules adopted by the
131-17 commissioner [commission] relating to medical policies, fee
131-18 guidelines, and impairment ratings.
131-19 SECTION 3.224. Section 413.051, Labor Code, is amended to
131-20 read as follows:
131-21 Sec. 413.051. CONTRACTS WITH REVIEW ORGANIZATIONS AND HEALTH
131-22 CARE PROVIDERS. (a) The department [commission] may contract with
131-23 a health care provider professional review organization or other
131-24 entity to develop, maintain, or review medical policies or fee
131-25 guidelines or to review compliance with the medical policies or fee
131-26 guidelines.
131-27 (b) For purposes of review or resolution of a dispute as to
132-1 compliance with the medical policies or fee guidelines, the
132-2 department [commission] may contract only with a health care
132-3 provider professional review organization that includes in the
132-4 review process health care practitioners who are licensed in the
132-5 category under review and are of the same field or specialty as the
132-6 category under review.
132-7 (c) The department [commission] may contract with a health
132-8 care provider for medical consultant services, including:
132-9 (1) independent medical examinations;
132-10 (2) medical case reviews; or
132-11 (3) establishment of medical policies and fee
132-12 guidelines.
132-13 SECTION 3.225. Section 413.052, Labor Code, is amended to
132-14 read as follows:
132-15 Sec. 413.052. PRODUCTION OF DOCUMENTS. The commissioner
132-16 [commission] by rule shall establish procedures to enable the
132-17 commission to compel the production of documents.
132-18 SECTION 3.226. Section 413.053, Labor Code, is amended to
132-19 read as follows:
132-20 Sec. 413.053. STANDARDS OF REPORTING AND BILLING. The
132-21 commissioner [commission] by rule shall establish standards of
132-22 reporting and billing governing [both form and] content.
132-23 SECTION 3.227. Section 413.054(a), Labor Code, is amended to
132-24 read as follows:
132-25 (a) A person who performs services for the department
132-26 [commission] as a designated doctor, an independent medical
132-27 examiner, a doctor performing a medical case review, or a member of
133-1 a peer review panel has the same immunity from liability as the
133-2 commissioner [a commission member] under Section 402.012 [402.010].
133-3 SECTION 3.228. Sections 413.055(a) and (b), Labor Code, are
133-4 amended to read as follows:
133-5 (a) The department [executive director], as provided by
133-6 commissioner [commission] rule, may enter an interlocutory order
133-7 for the payment of all or part of medical benefits. The order may
133-8 address accrued benefits, future benefits, or both accrued benefits
133-9 and future benefits.
133-10 (b) The subsequent injury fund shall reimburse an insurance
133-11 carrier for any overpayments of benefits made under an order
133-12 entered under Subsection (a) if the order is reversed or modified
133-13 by final arbitration, order, or decision of the department
133-14 [commission] or a court. The commissioner [commission] shall adopt
133-15 rules to provide for a periodic reimbursement schedule, providing
133-16 for reimbursement at least annually.
133-17 SECTION 3.229. Section 414.002(a), Labor Code, is amended to
133-18 read as follows:
133-19 (a) The division shall monitor for compliance with
133-20 department [commission] rules, this subtitle, and other laws
133-21 relating to workers' compensation the conduct of persons subject to
133-22 this subtitle, including [other than] persons monitored by the
133-23 division of medical review. Persons to be monitored include:
133-24 (1) persons claiming benefits under this subtitle;
133-25 (2) employers;
133-26 (3) insurance carriers; and
133-27 (4) attorneys and other representatives of parties.
134-1 SECTION 3.230. Section 414.003, Labor Code, is amended to
134-2 read as follows:
134-3 Sec. 414.003. COMPILATION AND USE OF INFORMATION. (a) The
134-4 division shall compile and maintain statistical and other
134-5 information as necessary to detect practices or patterns of conduct
134-6 by persons subject to monitoring under this chapter that:
134-7 (1) violate this subtitle or commissioner [commission]
134-8 rules; or
134-9 (2) otherwise adversely affect the workers'
134-10 compensation system of this state.
134-11 (b) The department [commission] shall use the information
134-12 compiled under this section to impose appropriate penalties and
134-13 other sanctions under Chapters 415 and 416.
134-14 SECTION 3.231. Section 414.005, Labor Code, is amended to
134-15 read as follows:
134-16 Sec. 414.005. INVESTIGATION UNIT. The division shall
134-17 maintain an investigation unit to conduct investigations relating
134-18 to alleged violations of this subtitle or commissioner [commission]
134-19 rules, with particular emphasis on violations of Chapters 415 and
134-20 416.
134-21 SECTION 3.232. Section 415.001, Labor Code, is amended to
134-22 read as follows:
134-23 Sec. 415.001. ADMINISTRATIVE VIOLATION BY REPRESENTATIVE OF
134-24 EMPLOYEE OR LEGAL BENEFICIARY. A representative of an employee or
134-25 legal beneficiary commits an administrative violation if the person
134-26 wilfully or intentionally:
134-27 (1) fails without good cause to attend a dispute
135-1 resolution proceeding within the department [commission];
135-2 (2) attends a dispute resolution proceeding within the
135-3 department [commission] without complete authority or fails to
135-4 exercise authority to effectuate an agreement or settlement;
135-5 (3) commits an act of barratry under Section 38.12,
135-6 Penal Code;
135-7 (4) withholds from the employee's or legal
135-8 beneficiary's weekly benefits or from advances amounts not
135-9 authorized to be withheld by the department [commission];
135-10 (5) enters into a settlement or agreement without the
135-11 knowledge, consent, and signature of the employee or legal
135-12 beneficiary;
135-13 (6) takes a fee or withholds expenses in excess of the
135-14 amounts authorized by the department [commission];
135-15 (7) refuses or fails to make prompt delivery to the
135-16 employee or legal beneficiary of funds belonging to the employee or
135-17 legal beneficiary as a result of a settlement, agreement, order, or
135-18 award;
135-19 (8) violates the Texas Disciplinary Rules of
135-20 Professional Conduct of the State Bar of Texas;
135-21 (9) misrepresents the provisions of this subtitle to
135-22 an employee, an employer, a health care provider, or a legal
135-23 beneficiary;
135-24 (10) violates a commissioner [commission] rule; or
135-25 (11) fails to comply with this subtitle.
135-26 SECTION 3.233. Section 415.002, Labor Code, is amended to
135-27 read as follows:
136-1 Sec. 415.002. ADMINISTRATIVE VIOLATION BY AN INSURANCE
136-2 CARRIER. (a) An insurance carrier or its representative commits an
136-3 administrative violation if that person wilfully or intentionally:
136-4 (1) misrepresents a provision of this subtitle to an
136-5 employee, an employer, a health care provider, or a legal
136-6 beneficiary;
136-7 (2) terminates or reduces benefits without
136-8 substantiating evidence that the action is reasonable and
136-9 authorized by law;
136-10 (3) instructs an employer not to file a document
136-11 required to be filed with the department [commission];
136-12 (4) instructs or encourages an employer to violate a
136-13 claimant's right to medical benefits under this subtitle;
136-14 (5) fails to tender promptly full death benefits if a
136-15 legitimate dispute does not exist as to the liability of the
136-16 insurance carrier;
136-17 (6) allows an employer, other than a self-insured
136-18 employer, to dictate the methods by which and the terms on which a
136-19 claim is handled and settled;
136-20 (7) fails to confirm medical benefits coverage to a
136-21 person or facility providing medical treatment to a claimant if a
136-22 legitimate dispute does not exist as to the liability of the
136-23 insurance carrier;
136-24 (8) fails, without good cause, to attend a dispute
136-25 resolution proceeding within the department [commission];
136-26 (9) attends a dispute resolution proceeding within the
136-27 department [commission] without complete authority or fails to
137-1 exercise authority to effectuate agreement or settlement;
137-2 (10) adjusts a workers' compensation claim in a manner
137-3 contrary to license requirements for an insurance adjuster,
137-4 including the requirements of Chapter 407, Acts of the 63rd
137-5 Legislature, Regular Session, 1973 (Article 21.07-4, Vernon's Texas
137-6 Insurance Code), or the rules of the Texas Department [State Board]
137-7 of Insurance;
137-8 (11) fails to process claims promptly in a reasonable
137-9 and prudent manner;
137-10 (12) fails to initiate or reinstate benefits when due
137-11 if a legitimate dispute does not exist as to the liability of the
137-12 insurance carrier;
137-13 (13) misrepresents the reason for not paying benefits
137-14 or terminating or reducing the payment of benefits;
137-15 (14) dates documents to misrepresent the actual date
137-16 of the initiation of benefits;
137-17 (15) makes a notation on a draft or other instrument
137-18 indicating that the draft or instrument represents a final
137-19 settlement of a claim if the claim is still open and pending before
137-20 the department [commission];
137-21 (16) fails or refuses to pay benefits from week to
137-22 week as and when due directly to the person entitled to the
137-23 benefits;
137-24 (17) fails to pay an order awarding benefits;
137-25 (18) controverts a claim if the evidence clearly
137-26 indicates liability;
137-27 (19) unreasonably disputes the reasonableness and
138-1 necessity of health care;
138-2 (20) violates a commissioner [commission] rule; or
138-3 (21) fails to comply with a provision of this
138-4 subtitle.
138-5 (b) An insurance carrier or its representative does not
138-6 commit an administrative violation under Subsection (a)(6) by
138-7 allowing an employer to:
138-8 (1) freely discuss a claim;
138-9 (2) assist in the investigation and evaluation of a
138-10 claim; or
138-11 (3) attend a proceeding of the department [commission]
138-12 and participate at the proceeding in accordance with this subtitle.
138-13 SECTION 3.234. Section 415.003, Labor Code, is amended to
138-14 read as follows:
138-15 Sec. 415.003. ADMINISTRATIVE VIOLATION BY HEALTH CARE
138-16 PROVIDER. A health care provider commits an administrative
138-17 violation if the person wilfully or intentionally:
138-18 (1) submits a charge for health care that was not
138-19 furnished;
138-20 (2) administers improper, unreasonable, or medically
138-21 unnecessary treatment or services;
138-22 (3) makes an unnecessary referral;
138-23 (4) violates the department's [commission's] fee and
138-24 treatment guidelines;
138-25 (5) violates a commissioner [commission] rule; or
138-26 (6) fails to comply with a provision of this subtitle.
138-27 SECTION 3.235. Sections 415.0035(a) and (b), Labor Code, are
139-1 amended to read as follows:
139-2 (a) An insurance carrier or its representative commits an
139-3 administrative violation if that person:
139-4 (1) fails to submit to the department [commission] a
139-5 settlement or agreement of the parties;
139-6 (2) fails to timely notify the department [commission]
139-7 of the termination or reduction of benefits and the reason for that
139-8 action; or
139-9 (3) denies preauthorization in a manner that is not in
139-10 accordance with rules adopted by the commissioner [commission]
139-11 under Section 413.014.
139-12 (b) A health care provider commits an administrative
139-13 violation if that person:
139-14 (1) fails or refuses to timely file required reports
139-15 or records; or
139-16 (2) fails to file with the department [commission] the
139-17 annual disclosure statement required by Section 413.041.
139-18 SECTION 3.236. Section 415.007(a), Labor Code, is amended to
139-19 read as follows:
139-20 (a) An attorney who represents a claimant before the
139-21 department [commission] may not lend money to the claimant during
139-22 the pendency of the workers' compensation claim.
139-23 SECTION 3.237. Section 415.008(e), Labor Code, is amended to
139-24 read as follows:
139-25 (e) If an administrative violation proceeding is pending
139-26 under this section against an employee or person claiming death
139-27 benefits, the department [commission] may not take final action on
140-1 the person's benefits.
140-2 SECTION 3.238. Section 415.010(a), Labor Code, is amended to
140-3 read as follows:
140-4 (a) A party to an agreement approved by the department
140-5 [commission] commits a violation if the person knowingly breaches a
140-6 provision of the agreement.
140-7 SECTION 3.239. Sections 415.021(a), (b), and (c), Labor
140-8 Code, are amended to read as follows:
140-9 (a) The department [commission] may assess an administrative
140-10 penalty against a person who commits an administrative violation.
140-11 (b) The department [commission] may assess an administrative
140-12 penalty not to exceed $10,000 and may enter a cease and desist
140-13 order against a person who:
140-14 (1) commits repeated administrative violations;
140-15 (2) allows, as a business practice, the commission of
140-16 repeated administrative violations; or
140-17 (3) violates an order or decision of the department
140-18 [commission].
140-19 (c) In assessing an administrative penalty, the department
140-20 [commission] shall consider:
140-21 (1) the seriousness of the violation, including the
140-22 nature, circumstances, consequences, extent, and gravity of the
140-23 prohibited act;
140-24 (2) the history and extent of previous administrative
140-25 violations;
140-26 (3) the demonstrated good faith of the violator,
140-27 including actions taken to rectify the consequences of the
141-1 prohibited act;
141-2 (4) the economic benefit resulting from the prohibited
141-3 act;
141-4 (5) the penalty necessary to deter future violations;
141-5 and
141-6 (6) other matters that justice may require.
141-7 SECTION 3.240. Section 415.023(b), Labor Code, is amended to
141-8 read as follows:
141-9 (b) The commissioner [commission] may adopt rules providing
141-10 for:
141-11 (1) a reduction or denial of fees;
141-12 (2) public or private reprimand by the commission;
141-13 (3) suspension from practice before the commission; or
141-14 (4) restriction, suspension, or revocation of the
141-15 right to receive reimbursement under this subtitle.
141-16 SECTION 3.241. Section 415.024, Labor Code, is amended to
141-17 read as follows:
141-18 Sec. 415.024. BREACH OF SETTLEMENT AGREEMENT; ADMINISTRATIVE
141-19 VIOLATION. A material and substantial breach of a settlement
141-20 agreement that establishes a compliance plan is a Class A
141-21 administrative violation. In determining the amount of the
141-22 penalty, the department [commission] shall consider the total
141-23 volume of claims handled by the insurance carrier.
141-24 SECTION 3.242. Section 415.032(b), Labor Code, is amended to
141-25 read as follows:
141-26 (b) Not later than the 20th day after the date on which
141-27 notice is received, the charged party shall:
142-1 (1) remit the amount of the penalty to the department
142-2 [commission]; or
142-3 (2) submit to the department [commission] a written
142-4 request for a hearing.
142-5 SECTION 3.243. Section 415.033, Labor Code, is amended to
142-6 read as follows:
142-7 Sec. 415.033. FAILURE TO RESPOND. If, without good cause, a
142-8 charged party fails to respond as required under Section 415.032,
142-9 the penalty is due and the department [commission] shall initiate
142-10 enforcement proceedings.
142-11 SECTION 3.244. Section 415.034(a), Labor Code, is amended to
142-12 read as follows:
142-13 (a) On the request of the charged party or the department
142-14 [executive director], the State Office of Administrative Hearings
142-15 shall set a hearing. The hearing shall be conducted in the manner
142-16 provided for a contested case under Chapter 2001, Government Code
142-17 (the administrative procedure law).
142-18 SECTION 3.245. Sections 415.035(b) and (d), Labor Code, are
142-19 amended to read as follows:
142-20 (b) If an administrative penalty is assessed, the person
142-21 charged shall:
142-22 (1) forward the amount of the penalty to the
142-23 department [executive director] for deposit in an escrow account;
142-24 or
142-25 (2) post with the department [executive director] a
142-26 bond for the amount of the penalty, effective until all judicial
142-27 review of the determination is final.
143-1 (d) If the court determines that the penalty should not have
143-2 been assessed or reduces the amount of the penalty, the department
143-3 [executive director] shall:
143-4 (1) remit the appropriate amount, plus accrued
143-5 interest, if the administrative penalty was paid; or
143-6 (2) release the bond.
143-7 SECTION 3.246. Section 416.001, Labor Code, is amended to
143-8 read as follows:
143-9 Sec. 416.001. CERTAIN CAUSES OF ACTION PRECLUDED. An action
143-10 taken by an insurance carrier under an order of the department
143-11 [commission] or recommendations of a benefit review officer under
143-12 Section 410.031, 410.032, or 410.033 may not be the basis of a
143-13 cause of action against the insurance carrier for a breach of the
143-14 duty of good faith and fair dealing.
143-15 SECTION 3.247. Sections 417.001(c) and (d), Labor Code, are
143-16 amended to read as follows:
143-17 (c) If a claimant receives benefits from the subsequent
143-18 injury fund, the department [commission] is:
143-19 (1) considered to be the insurance carrier under this
143-20 section for purposes of those benefits;
143-21 (2) subrogated to the rights of the claimant; and
143-22 (3) entitled to reimbursement in the same manner as
143-23 the insurance carrier.
143-24 (d) The department [commission] shall remit money recovered
143-25 under this section to the comptroller for deposit to the credit of
143-26 the subsequent injury fund.
143-27 SECTION 3.248. Section 417.003(b), Labor Code, is amended to
144-1 read as follows:
144-2 (b) An attorney who represents the claimant and is also to
144-3 represent the subrogated insurance carrier shall make a full
144-4 written disclosure to the claimant before employment as an attorney
144-5 by the insurance carrier. The claimant must acknowledge the
144-6 disclosure and consent to the representation. A signed copy of the
144-7 disclosure shall be furnished to all concerned parties and made a
144-8 part of the department [commission] file. A copy of the disclosure
144-9 with the claimant's consent shall be filed with the claimant's
144-10 pleading before a judgment is entered and approved by the court.
144-11 The claimant's attorney may not receive a fee under this section to
144-12 which the attorney is otherwise entitled under an agreement with
144-13 the insurance carrier unless the attorney complies with the
144-14 requirements of this subsection.
144-15 SECTION 3.249. Section 501.001, Labor Code, is amended to
144-16 read as follows:
144-17 Sec. 501.001. DEFINITIONS. In this chapter:
144-18 (1) ["Commission" means the Texas Workers'
144-19 Compensation Commission.]
144-20 [(2)] "Compensable injury" has the meaning assigned to
144-21 that term under Subtitle A.
144-22 (2) "Department" means the Texas Department of
144-23 Workers' Compensation.
144-24 (3) "Director" means the director of the State Office
144-25 of Risk Management.
144-26 (4) "Office" means the State Office of Risk
144-27 Management.
145-1 (5) "Employee" means a person who is:
145-2 (A) in the service of the state pursuant to an
145-3 election, appointment, or express oral or written contract of hire;
145-4 (B) paid from state funds but whose duties
145-5 require that the person work and frequently receive supervision in
145-6 a political subdivision of the state;
145-7 (C) a peace officer employed by a political
145-8 subdivision, while the peace officer is exercising authority
145-9 granted under Article 14.03(c), Code of Criminal Procedure; or
145-10 (D) a member of the state military forces, as
145-11 defined by Section 431.001, Government Code, who is engaged in
145-12 authorized training or duty.
145-13 (6) "State agency" includes a department, board,
145-14 commission, or institution of this state.
145-15 (7) "Board" means the risk management board.
145-16 SECTION 3.250. Section 501.026(d), Labor Code, is amended to
145-17 read as follows:
145-18 (d) A person entitled to benefits under this section may
145-19 receive the benefits only if the person seeks medical attention
145-20 from a doctor for the injury not later than 48 hours after the
145-21 occurrence of the injury or after the date the person knew or
145-22 should have known the injury occurred. The person shall comply
145-23 with the requirements of Section 409.001 by providing notice of the
145-24 injury to the department [commission] or the state agency with
145-25 which the officer or employee under Subsection (b) is associated.
145-26 SECTION 3.251. Section 501.050(a), Labor Code, is amended to
145-27 read as follows:
146-1 (a) In each case appealed from the department [commission]
146-2 to a county or district court:
146-3 (1) the clerk of the court shall mail to the
146-4 department [commission]:
146-5 (A) not later than the 20th day after the date
146-6 the case is filed, a notice containing the style, number, and date
146-7 of filing of the case; and
146-8 (B) not later than the 20th day after the date
146-9 the judgment is rendered, a certified copy of the judgment; and
146-10 (2) the attorney preparing the judgment shall file the
146-11 original and a copy of the judgment with the clerk.
146-12 SECTION 3.252. Section 502.001(1), Labor Code, is amended to
146-13 read as follows:
146-14 (1) "Department" means the Texas Department of
146-15 Workers' Compensation ["Commission" means the Texas Workers'
146-16 Compensation Commission].
146-17 SECTION 3.253. The heading to Section 502.063, Labor Code, is
146-18 amended to read as follows:
146-19 Sec. 502.063. CERTIFIED COPIES OF DEPARTMENT [COMMISSION]
146-20 DOCUMENTS.
146-21 SECTION 3.254. Sections 502.063(a) and (c), Labor Code, are
146-22 amended to read as follows:
146-23 (a) The department [commission] shall furnish a certified
146-24 copy of an order, award, decision, or paper on file in the
146-25 department's [commission's] office to a person entitled to the copy
146-26 on written request and payment of the fee for the copy. The fee is
146-27 the same as that charged for similar services by the secretary of
147-1 state's office.
147-2 (c) A fee or salary may not be paid to the commissioner or
147-3 an [a member or] employee of the department [commission] for making
147-4 a copy under Subsection (a) that exceeds the fee charged for the
147-5 copy.
147-6 SECTION 3.255. Section 502.065(a), Labor Code, is amended to
147-7 read as follows:
147-8 (a) In addition to a report of an injury filed with the
147-9 department [commission] under Section 409.005(a), an institution
147-10 shall file a supplemental report that contains:
147-11 (1) the name, age, sex, and occupation of the injured
147-12 employee;
147-13 (2) the character of work in which the employee was
147-14 engaged at the time of the injury;
147-15 (3) the place, date, and hour of the injury; and
147-16 (4) the nature and cause of the injury.
147-17 SECTION 3.256. Sections 502.066(a) and (e), Labor Code, are
147-18 amended to read as follows:
147-19 (a) The department [commission] may require an employee who
147-20 claims to have been injured to submit to an examination by the
147-21 department [commission] or a person acting under the department's
147-22 [commission's] authority at a reasonable time and place in this
147-23 state.
147-24 (e) The institution shall pay the fee set by the department
147-25 [commission] of a physician or chiropractor selected by the
147-26 employee under Subsection (b) or (d).
147-27 SECTION 3.257. Section 502.067(a), Labor Code, is amended to
148-1 read as follows:
148-2 (a) The department [commission] may order or direct the
148-3 institution to reduce or suspend the compensation of an injured
148-4 employee who:
148-5 (1) persists in insanitary or injurious practices that
148-6 tend to imperil or retard the employee's recovery; or
148-7 (2) refuses to submit to medical, surgical,
148-8 chiropractic, or other remedial treatment recognized by the state
148-9 that is reasonably essential to promote the employee's recovery.
148-10 SECTION 3.258. Section 502.068, Labor Code, is amended to
148-11 read as follows:
148-12 Sec. 502.068. POSTPONEMENT OF HEARING. If an injured
148-13 employee is receiving benefits under this chapter and the
148-14 institution is providing hospitalization, medical treatment, or
148-15 chiropractic care to the employee, the department [commission] may
148-16 postpone the hearing on the employee's claim. An appeal may not be
148-17 taken from a department [commission] order under this section.
148-18 SECTION 3.259. Section 502.069(a), Labor Code, is amended to
148-19 read as follows:
148-20 (a) In each case appealed from the department [commission]
148-21 to a county or district court:
148-22 (1) the clerk of the court shall mail to the
148-23 department [commission]:
148-24 (A) not later than the 20th day after the date
148-25 the case is filed, a notice containing the style, number, and date
148-26 of filing of the case; and
148-27 (B) not later than the 20th day after the date
149-1 the judgment is rendered, a certified copy of the judgment; and
149-2 (2) the attorney preparing the judgment shall file the
149-3 original and a copy of the judgment with the clerk.
149-4 SECTION 3.260. Section 503.001(1), Labor Code, is amended to
149-5 read as follows:
149-6 (1) "Department" means the Texas Department of
149-7 Workers' Compensation ["Commission" means the Texas Workers'
149-8 Compensation Commission].
149-9 SECTION 3.261. The heading to Section 503.063, Labor Code, is
149-10 amended to read as follows:
149-11 Sec. 503.063. CERTIFIED COPIES OF DEPARTMENT [COMMISSION]
149-12 DOCUMENTS.
149-13 SECTION 3.262. Sections 503.063(a) and (c), Labor Code, are
149-14 amended to read as follows:
149-15 (a) The department [commission] shall furnish a certified
149-16 copy of an order, award, decision, or paper on file in the
149-17 department's [commission's] office to a person entitled to the copy
149-18 on written request and payment of the fee for the copy. The fee is
149-19 the same as that charged for similar services by the secretary of
149-20 state's office.
149-21 (c) A fee or salary may not be paid to the commissioner or
149-22 an [a member or] employee of the department [commission] for making
149-23 a copy under Subsection (a) that exceeds the fee charged for the
149-24 copy.
149-25 SECTION 3.263. Section 503.065(a), Labor Code, is amended to
149-26 read as follows:
149-27 (a) In addition to a report of an injury filed with the
150-1 department [commission] under Section 409.005(a), an institution
150-2 shall file a supplemental report that contains:
150-3 (1) the name, age, sex, and occupation of the injured
150-4 employee;
150-5 (2) the character of work in which the employee was
150-6 engaged at the time of the injury;
150-7 (3) the place, date, and hour of the injury; and
150-8 (4) the nature and cause of the injury.
150-9 SECTION 3.264. Sections 503.066(a) and (e), Labor Code, are
150-10 amended to read as follows:
150-11 (a) The department [commission] may require an employee who
150-12 claims to have been injured to submit to an examination by the
150-13 department [commission] or a person acting under the department's
150-14 [commission's] authority at a reasonable time and place in this
150-15 state.
150-16 (e) The institution shall pay the fee, as set by the
150-17 department [commission], of a physician selected by the employee
150-18 under Subsection (b) or (d).
150-19 SECTION 3.265. Section 503.067(a), Labor Code, is amended to
150-20 read as follows:
150-21 (a) The department [commission] may order or direct the
150-22 institution to reduce or suspend the compensation of an injured
150-23 employee who:
150-24 (1) persists in insanitary or injurious practices that
150-25 tend to imperil or retard the employee's recovery; or
150-26 (2) refuses to submit to medical, surgical, or other
150-27 remedial treatment recognized by the state that is reasonably
151-1 essential to promote the employee's recovery.
151-2 SECTION 3.266. Section 503.068, Labor Code, is amended to
151-3 read as follows:
151-4 Sec. 503.068. POSTPONEMENT OF HEARING. If an injured
151-5 employee is receiving benefits under this chapter and the
151-6 institution is providing hospitalization or medical treatment to
151-7 the employee, the department [commission] may postpone the hearing
151-8 on the employee's claim. An appeal may not be taken from a
151-9 department [commission] order under this section.
151-10 SECTION 3.267. Section 503.069(a), Labor Code, is amended to
151-11 read as follows:
151-12 (a) In each case appealed from the department [commission]
151-13 to a county or district court:
151-14 (1) the clerk of the court shall mail to the
151-15 department [commission]:
151-16 (A) not later than the 20th day after the date
151-17 the case is filed, a notice containing the style, number, and date
151-18 of filing of the case; and
151-19 (B) not later than the 20th day after the date
151-20 the judgment is rendered, a certified copy of the judgment; and
151-21 (2) the attorney preparing the judgment shall file the
151-22 original and a copy of the judgment with the clerk.
151-23 SECTION 3.268. Section 503.070(a), Labor Code, is amended to
151-24 read as follows:
151-25 (a) A party who does not consent to abide by the final
151-26 decision of the department [commission] shall file notice with the
151-27 department [commission] as required by Section 410.253 and bring
152-1 suit in the county in which the injury occurred to set aside the
152-2 final decision of the department [commission].
152-3 SECTION 3.269. Section 504.001(1), Labor Code, is amended to
152-4 read as follows:
152-5 (1) "Department" means the Texas Department of
152-6 Workers' Compensation ["Commission" means the Texas Workers'
152-7 Compensation Commission].
152-8 SECTION 3.270. The heading to Section 504.018, Labor Code, is
152-9 amended to read as follows:
152-10 Sec. 504.018. NOTICE TO DEPARTMENT [COMMISSION] AND
152-11 EMPLOYEES; EFFECT ON COMMON-LAW OR STATUTORY LIABILITY.
152-12 SECTION 3.271. Section 504.018(a), Labor Code, is amended to
152-13 read as follows:
152-14 (a) A political subdivision shall notify the department
152-15 [commission] of the method by which its employees will receive
152-16 benefits, the approximate number of employees covered, and the
152-17 estimated amount of payroll.
152-18 SECTION 3.272. The heading to Section 505.053, Labor Code, is
152-19 amended to read as follows:
152-20 Sec. 505.053. CERTIFIED COPIES OF TEXAS DEPARTMENT OF
152-21 WORKERS' COMPENSATION [COMMISSION] DOCUMENTS.
152-22 SECTION 3.273. Sections 505.053(a) and (c), Labor Code, are
152-23 amended to read as follows:
152-24 (a) The Texas Department of Workers' Compensation
152-25 [commission] shall furnish a certified copy of an order, award,
152-26 decision, or paper on file in that department's [the commission's]
152-27 office to a person entitled to the copy on written request and
153-1 payment of the fee for the copy. The fee shall be the same as that
153-2 charged for similar services by the secretary of state's office.
153-3 (c) A fee or salary may not be paid to a person in the Texas
153-4 Department of Workers' Compensation [commission] for making the
153-5 copies that exceeds the fee charged for the copies.
153-6 SECTION 3.274. Section 505.054(d), Labor Code, is amended to
153-7 read as follows:
153-8 (d) A physician designated under Subsection (c) who conducts
153-9 an examination shall file with the department a complete transcript
153-10 of the examination on a form furnished by the department. The
153-11 department shall maintain all reports under this subsection as part
153-12 of the department's permanent records. A report under this
153-13 subsection is admissible in evidence before the Texas Department of
153-14 Workers' Compensation [commission] and in an appeal from a final
153-15 award or ruling of that department [the commission] in which the
153-16 individual named in the examination is a claimant for compensation
153-17 under this chapter. A report under this subsection that is
153-18 admitted is prima facie evidence of the facts stated in the report.
153-19 SECTION 3.275. Section 505.055, Labor Code, is amended to
153-20 read as follows:
153-21 Sec. 505.055. REPORTS OF INJURIES. (a) A report of an
153-22 injury filed with the Texas Department of Workers' Compensation
153-23 [commission] under Section 409.005, in addition to the information
153-24 required by commissioner of workers' compensation [commission]
153-25 rules, must contain:
153-26 (1) the name, age, sex, and occupation of the injured
153-27 employee;
154-1 (2) the character of work in which the employee was
154-2 engaged at the time of the injury;
154-3 (3) the place, date, and hour of the injury; and
154-4 (4) the nature and cause of the injury.
154-5 (b) In addition to subsequent reports of an injury filed
154-6 with the Texas Department of Workers' Compensation [commission]
154-7 under Section 409.005(i) [409.005(e)], the department shall file a
154-8 subsequent report on a form obtained for that purpose:
154-9 (1) on the termination of incapacity of the injured
154-10 employee; or
154-11 (2) if the incapacity extends beyond 60 days.
154-12 SECTION 3.276. Sections 505.056(a) and (d), Labor Code, are
154-13 amended to read as follows:
154-14 (a) The Texas Department of Workers' Compensation
154-15 [commission] may require an employee who claims to have been
154-16 injured to submit to an examination by that department [the
154-17 commission] or a person acting under the [commission's] authority
154-18 of that department at a reasonable time and place in this state.
154-19 (d) On the request of an employee or the department, the
154-20 employee or the department is entitled to have a physician selected
154-21 by the employee or the department present to participate in an
154-22 examination under Subsection (a) or Section 408.004. The employee
154-23 is entitled to have a physician selected by the employee present to
154-24 participate in an examination under Subsection (c). The department
154-25 shall pay the fee set by the Texas Department of Workers'
154-26 Compensation [commission] of a physician selected by the employee
154-27 under this subsection.
155-1 SECTION 3.277. Section 505.057(a), Labor Code, is amended to
155-2 read as follows:
155-3 (a) The Texas Department of Workers' Compensation
155-4 [commission] may order or direct the department to reduce or
155-5 suspend the compensation of an injured employee if the employee:
155-6 (1) persists in insanitary or injurious practices that
155-7 tend to imperil or retard the employee's recovery; or
155-8 (2) refuses to submit to medical, surgical, or other
155-9 remedial treatment recognized by the state that is reasonably
155-10 essential to promote the employee's recovery.
155-11 SECTION 3.278. Section 505.058, Labor Code, is amended to
155-12 read as follows:
155-13 Sec. 505.058. POSTPONEMENT OF HEARING. If an injured
155-14 employee is receiving benefits under this chapter and the
155-15 department is providing hospitalization or medical treatment to the
155-16 employee, the Texas Department of Workers' Compensation
155-17 [commission] may postpone the hearing of the employee's claim. An
155-18 appeal may not be taken from an [a commission] order of the Texas
155-19 Department of Workers' Compensation under this section.
155-20 SECTION 3.279. Section 505.059(a), Labor Code, is amended to
155-21 read as follows:
155-22 (a) In each case appealed from the Texas Department of
155-23 Workers' Compensation [commission] to a county or district court:
155-24 (1) the clerk of the court shall mail to the Texas
155-25 Department of Workers' Compensation [commission]:
155-26 (A) not later than the 20th day after the date
155-27 the case is filed, a notice containing the style, number, and date
156-1 of filing of the case; and
156-2 (B) not later than the 20th day after the date
156-3 the judgment is rendered, a certified copy of the judgment; and
156-4 (2) the attorney preparing the judgment shall file the
156-5 original and a copy of the judgment with the clerk.
156-6 ARTICLE 4. REPEALER
156-7 SECTION 4.001. The following laws are repealed:
156-8 (1) Section 402.063, Labor Code; and
156-9 (2) Section 505.001(a)(1), Labor Code.
156-10 ARTICLE 5. TRANSITION PROVISIONS; EFFECTIVE DATE
156-11 SECTION 5.001. The change in designation of the Texas
156-12 Workers' Compensation Commission to the Texas Department of
156-13 Workers' Compensation does not affect or impair any act done or
156-14 taken, any rule, standard, or rate adopted, any order or
156-15 certificate issued, or any form approved by the Texas Workers'
156-16 Compensation Commission as a state agency, or any penalty assessed
156-17 by the Texas Workers' Compensation Commission as a state agency,
156-18 before the change in designation made by this Act.
156-19 SECTION 5.002. (a) The Texas Workers' Compensation
156-20 Commission is abolished on the effective date of this Act. The
156-21 term of a person who is serving on the Texas Workers' Compensation
156-22 Commission on the effective date of this Act expires on the date
156-23 the commissioner of workers' compensation is appointed and duly
156-24 qualified for office.
156-25 (b) A person who is serving as a member or as executive
156-26 director of the Texas Workers' Compensation Commission on August
156-27 31, 2001, is not eligible for appointment as commissioner under
157-1 Section 402.004, Labor Code, as added by this Act.
157-2 SECTION 5.003. All appropriations made by the legislature for
157-3 the use and benefit of the Texas Workers' Compensation Commission
157-4 are available for the use and benefit of the Texas Department of
157-5 Workers' Compensation.
157-6 SECTION 5.004. The governor shall appoint the commissioner of
157-7 workers' compensation not later than December 31, 2001.
157-8 SECTION 5.005. This Act takes effect September 1, 2001.