By Nixon H.B. No. 3151
77R5844 KSD-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the right of an insurance carrier to contest the
1-3 compensability of an injury in a workers' compensation case.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 409.021, Labor Code, is amended to read as
1-6 follows:
1-7 Sec. 409.021. INITIATION OF BENEFITS; INSURANCE CARRIER'S
1-8 REFUSAL; ADMINISTRATIVE VIOLATION. (a) An insurance carrier shall
1-9 initiate compensation under this subtitle promptly. Not later than
1-10 the seventh day after the date on which an insurance carrier
1-11 receives written notice of an injury, the insurance carrier shall:
1-12 (1) begin the payment of benefits as required by this
1-13 subtitle; or
1-14 (2) notify the commission and the employee in writing
1-15 of its refusal to pay and advise the employee of:
1-16 (A) the right to request a benefit review
1-17 conference; and
1-18 (B) the means to obtain additional information
1-19 from the commission.
1-20 (b) An insurance carrier who fails to begin the payment of
1-21 benefits or file a notice of refusal on or before the seventh day
1-22 after the date on which the insurance carrier is notified of the
1-23 injury does not waive the carrier's right to contest the
1-24 compensability of the injury but commits an administrative
2-1 violation subject to Subsection (f).
2-2 (c) An insurance carrier shall notify the commission in
2-3 writing of the initiation of income or death benefit payments in
2-4 the manner prescribed by commission rules.
2-5 (d) [(c)] If an insurance carrier does not contest the
2-6 compensability of an injury on or before the 60th day after the
2-7 date on which the insurance carrier is notified of the injury, the
2-8 insurance carrier waives its right to contest compensability. The
2-9 initiation of payments by an insurance carrier does not affect the
2-10 right of the insurance carrier to continue to investigate or deny
2-11 the compensability of an injury during the 60-day period.
2-12 (e) [(d)] An insurance carrier may reopen the issue of the
2-13 compensability of an injury if there is a finding of evidence that
2-14 could not reasonably have been discovered earlier.
2-15 (f) [(e)] An insurance carrier commits a violation if the
2-16 insurance carrier does not initiate payments or file a notice of
2-17 refusal as required by this section. A violation under this
2-18 subsection is a Class B administrative violation. Each day of
2-19 noncompliance constitutes a separate violation.
2-20 SECTION 2. This Act takes effect September 1, 2001, and
2-21 applies only to a claim for workers' compensation benefits based on
2-22 a compensable injury that occurs on or after that date. A claim
2-23 based on a compensable injury that occurs before the effective date
2-24 of this Act is governed by the law in effect on the date the
2-25 compensable injury occurred, and the former law is continued in
2-26 effect for that purpose.