By Duncan S.B. No. 851
77R7859 KSD-D
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 title and other laws regarding
1-17 workers' compensation are executed.
1-18 Sec. 402.002. COMPOSITION OF DEPARTMENT. The department is
1-19 composed of the commissioner and other officers and employees
1-20 required to efficiently implement:
1-21 (1) this title;
1-22 (2) other workers' compensation laws of this state;
1-23 and
1-24 (3) other laws granting jurisdiction or applicable to
2-1 the department or the commissioner.
2-2 Sec. 402.003. CHIEF EXECUTIVE. (a) The commissioner is the
2-3 department's chief executive and administrative officer. The
2-4 commissioner shall administer and enforce this title, other
2-5 workers' compensation laws of this state, and other laws granting
2-6 jurisdiction to or applicable to the department or the
2-7 commissioner.
2-8 (b) The commissioner has the powers and duties vested in the
2-9 department by this title and other workers' compensation laws of
2-10 this state.
2-11 Sec. 402.004. APPOINTMENT; TERM. (a) The governor, with the
2-12 advice and consent of the senate, shall appoint the commissioner.
2-13 The commissioner serves a two-year term that expires on February 1
2-14 of each odd-numbered year.
2-15 (b) The governor shall appoint the commissioner without
2-16 regard to the race, color, disability, sex, religion, age, or
2-17 national origin of the appointee.
2-18 Sec. 402.005. QUALIFICATIONS. (a) The commissioner must:
2-19 (1) be a competent and experienced administrator;
2-20 (2) be well informed and qualified in the field of
2-21 workers' compensation; and
2-22 (3) have at least 10 years of experience as an
2-23 executive in the administration of business or government or as a
2-24 practicing attorney or certified public accountant, with at least
2-25 five years of that experience in the field of insurance, with
2-26 preference for experience in the field of workers' compensation
2-27 insurance.
3-1 (b) A person who is a former member or former executive
3-2 director of the Texas Workers' Compensation Commission is not
3-3 eligible for appointment as commissioner under Section 402.004.
3-4 Sec. 402.006. INELIGIBILITY FOR PUBLIC OFFICE. The
3-5 commissioner is ineligible to be a candidate for a public elective
3-6 office in this state unless the commissioner has resigned and the
3-7 governor has accepted the resignation.
3-8 Sec. 402.007. BOND. Before taking office, the commissioner
3-9 must execute with a surety company licensed to do business in this
3-10 state a bond for $50,000 payable to this state and conditioned on
3-11 the faithful discharge of the commissioner's duties.
3-12 Sec. 402.008. COMPENSATION. The commissioner is entitled to
3-13 compensation as provided by the General Appropriations Act
3-14 [MEMBERSHIP REQUIREMENTS. (a) The Texas Workers' Compensation
3-15 Commission is composed of six members appointed by the governor
3-16 with the advice and consent of the senate.]
3-17 [(b) Appointments to the commission shall be made without
3-18 regard to the race, color, disability, sex, religion, age, or
3-19 national origin of the appointee. Section 401.011(16) does not
3-20 apply to the use of the term "disability" in this subsection.]
3-21 [(c) Three members of the commission must be employers of
3-22 labor and three members of the commission must be wage earners. A
3-23 person is not eligible for appointment as a member of the
3-24 commission if the person provides services subject to regulation by
3-25 the commission or charges fees that are subject to regulation by
3-26 the commission.]
3-27 [(d) In making appointments to the commission, the governor
4-1 shall attempt to reflect the social, geographic, and economic
4-2 diversity of the state. To ensure balanced representation, the
4-3 governor may consider:]
4-4 [(1) the geographic location of a prospective
4-5 appointee's domicile;]
4-6 [(2) the prospective appointee's experience as an
4-7 employer or wage earner;]
4-8 [(3) the number of employees employed by a prospective
4-9 member who would represent employers; and]
4-10 [(4) the type of work performed by a prospective
4-11 member who would represent wage earners.]
4-12 [(e) The governor shall consider the factors listed in
4-13 Subsection (d) in appointing a member to fill a vacancy on the
4-14 commission.]
4-15 [(f) In making an appointment to the commission, the
4-16 governor shall consider recommendations made by groups that
4-17 represent employers or wage earners.]
4-18 [Sec. 402.0015. TRAINING PROGRAM FOR COMMISSION MEMBERS. (a)
4-19 Before a member of the commission may assume the member's duties,
4-20 the member must complete the training program established under
4-21 this section.]
4-22 [(b) A training program established under this section must
4-23 provide information to the member regarding:]
4-24 [(1) the enabling legislation that created the
4-25 commission;]
4-26 [(2) the programs operated by the commission;]
4-27 [(3) the role and functions of the commission;]
5-1 [(4) the rules of the commission, with an emphasis on
5-2 the rules that relate to disciplinary and investigatory authority;]
5-3 [(5) the current budget for the commission;]
5-4 [(6) the results of the most recent formal audit of
5-5 the commission;]
5-6 [(7) the requirements of:]
5-7 [(A) the open meetings law, Chapter 551,
5-8 Government Code;]
5-9 [(B) the open records law, Chapter 552,
5-10 Government Code; and]
5-11 [(C) the administrative procedure law, Chapter
5-12 2001, Government Code;]
5-13 [(8) the requirements of the conflict of interest laws
5-14 and other laws relating to public officials; and]
5-15 [(9) any applicable ethics policies adopted by the
5-16 commission or the Texas Ethics Commission.]
5-17 [Sec. 402.002. TERMS; VACANCY. (a) Members of the
5-18 commission hold office for staggered six-year terms, with the terms
5-19 of one member representing employers and one member representing
5-20 wage earners expiring on February 1 of each odd-numbered year.]
5-21 [(b) If a vacancy occurs during a term, the governor shall
5-22 fill the vacancy for the unexpired term. The replacement must be
5-23 from the group represented by the member being replaced].
5-24 Sec. 402.009 [402.003]. EFFECT OF LOBBYING ACTIVITY. A
5-25 person may not serve as commissioner [a member of the commission]
5-26 or act as the general counsel to the department [commission] if the
5-27 person is required to register as a lobbyist under Chapter 305,
6-1 Government Code, because of the person's activities for
6-2 compensation on behalf of a profession that is regulated by or that
6-3 has fees regulated by the department [commission].
6-4 [Sec. 402.004. VOTING REQUIREMENTS. (a) The commission may
6-5 take action only by a majority vote of its membership.]
6-6 [(b) Decisions regarding the employment of an executive
6-7 director require the affirmative vote of at least two commissioners
6-8 representing employers and two commissioners representing wage
6-9 earners.]
6-10 Sec. 402.010. GROUNDS FOR REMOVAL. [402.005. REMOVAL OF
6-11 COMMISSION MEMBERS.] (a) It is a ground for removal from office if
6-12 the commissioner [the commission if a member]:
6-13 (1) does not have at the time of appointment the
6-14 qualifications required by Section 402.005 [for appointment to the
6-15 commission];
6-16 (2) does not maintain during service as commissioner
6-17 [on the commission] the qualifications required by Section 402.005
6-18 [for appointment to the commission];
6-19 (3) violates a prohibition established by Section
6-20 402.009 or 402.013 [402.003 or 402.012]; or
6-21 (4) cannot because of illness or incapacity discharge
6-22 the commissioner's [member's] duties for a substantial part of the
6-23 commissioner's term [for which the member is appointed; or]
6-24 [(5) is absent from more than half of the regularly
6-25 scheduled commission meetings that the member is eligible to attend
6-26 during a calendar year].
6-27 (b) The validity of an action of the commissioner
7-1 [commission] is not affected by the fact that it is taken when a
7-2 ground for removal of the commissioner [a commission member]
7-3 exists.
7-4 [(c) If the executive director of the commission knows that
7-5 a potential ground for removal exists, the executive director shall
7-6 notify the chairman of the commission of the potential ground. The
7-7 chairman shall then notify the governor and the attorney general
7-8 that a potential ground for removal exists. If the potential
7-9 ground for removal involves the chairman, the executive director
7-10 shall notify the next highest officer of the commission, who shall
7-11 notify the governor and the attorney general that a potential
7-12 ground for removal exists.]
7-13 Sec. 402.011 [402.006]. PROHIBITED GIFTS; ADMINISTRATIVE
7-14 VIOLATION. (a) The commissioner [A member] or an employee of the
7-15 department [commission] may not accept a gift, gratuity, or
7-16 entertainment from a person having an interest in a matter or
7-17 proceeding pending before the department [commission].
7-18 (b) A violation of Subsection (a) is a Class A
7-19 administrative violation and constitutes a ground for removal from
7-20 office or termination of employment.
7-21 [Sec. 402.007. MEETINGS. The commission shall meet at least
7-22 once in each calendar quarter and may meet at other times at the
7-23 call of the chairman or as provided by the rules of the commission.]
7-24 [Sec. 402.008. CHAIRMAN. (a) The governor shall designate a
7-25 member of the commission as the chairman of the commission to serve
7-26 in that capacity for a two-year term expiring February 1 of each
7-27 odd-numbered year. The governor shall alternate the chairmanship
8-1 between the members who are employers and the members who are wage
8-2 earners.]
8-3 [(b) The chairman may vote on all matters before the
8-4 commission.]
8-5 [Sec. 402.009. LEAVE OF ABSENCE. (a) An employer may not
8-6 terminate the employment of an employee who is appointed as a
8-7 member of the commission because of the exercise by the employee of
8-8 duties required as a commission member.]
8-9 [(b) A member of the commission is entitled to a leave of
8-10 absence from employment for the time required to perform commission
8-11 duties. During the leave of absence, the member may not be
8-12 subjected to loss of time, vacation time, or other benefits of
8-13 employment, other than salary.]
8-14 Sec. 402.012 [402.010]. CIVIL LIABILITY OF THE COMMISSIONER
8-15 [MEMBER]. The commissioner [A member of the commission] is not
8-16 liable in a civil action for an act performed in good faith in the
8-17 execution of duties as commissioner [a commission member].
8-18 [Sec. 402.011. REIMBURSEMENT. (a) A member of the
8-19 commission is entitled to reimbursement for actual and necessary
8-20 expenses incurred in performing functions as a member of the
8-21 commission. Reimbursement under this subsection may not exceed a
8-22 limit established in the General Appropriations Act.]
8-23 [(b) A member is entitled to reimbursement for actual lost
8-24 wages or use of leave benefits, if any, for:]
8-25 [(1) attendance at commission meetings and hearings;]
8-26 [(2) preparation for a commission meeting, not to
8-27 exceed two days in each calendar quarter;]
9-1 [(3) attendance at a subcommittee meeting, not to
9-2 exceed one day each month;]
9-3 [(4) attendance by the chair or vice chair of the
9-4 commission at a legislative committee meeting if attendance is
9-5 requested by the committee chair; and]
9-6 [(5) attendance at a meeting by a member appointed to
9-7 the Research and Oversight Council on Workers' Compensation or the
9-8 Texas Certified Self-Insured Guaranty Association.]
9-9 [(c) Reimbursement under Subsection (b) may not exceed $100
9-10 a day and $5,000 a year.]
9-11 [(d) A member of the commission is entitled to reimbursement
9-12 for actual and necessary expenses for attendance at not more than
9-13 five seminars in a calendar year if:]
9-14 [(1) the member is invited as a representative of the
9-15 commission to participate in a program offered at the seminar; and]
9-16 [(2) the member's participation is approved by the
9-17 chair of the commission.]
9-18 Sec. 402.013 [402.012]. CONFLICT OF INTEREST. (a) An
9-19 officer, employee, or paid consultant of a Texas trade association
9-20 whose members provide services subject to regulation by the
9-21 department [commission] or provide services whose fees are subject
9-22 to regulation by the department [commission] may not be the
9-23 commissioner [a member of the commission] or an employee of the
9-24 department [commission] who is exempt from the state's position
9-25 classification plan or is compensated at or above the amount
9-26 prescribed by the General Appropriations Act for step 1, salary
9-27 group A17 [17], of the position classification salary schedule.
10-1 (b) On acceptance of appointment as commissioner [to the
10-2 commission], a commissioner [an appointee] who is an officer,
10-3 employee, or paid consultant of a Texas trade association described
10-4 by Subsection (a) must resign the position or terminate the
10-5 contract with the trade association.
10-6 (c) For the purposes of this section, "Texas trade
10-7 association" means a nonprofit, cooperative, and voluntarily joined
10-8 association of business or professional competitors in this state
10-9 designed to assist its members and its industry or profession in
10-10 dealing with mutual business or professional problems and in
10-11 promoting their common interest. The term does not include a labor
10-12 union or an employees' association.
10-13 SECTION 1.002. Subchapter C, Chapter 402, Labor Code, is
10-14 amended to read as follows:
10-15 SUBCHAPTER C. DEPARTMENT [EXECUTIVE DIRECTOR AND] PERSONNEL
10-16 Sec. 402.041. APPOINTMENTS. (a) Subject to the General
10-17 Appropriations Act or other law, the commissioner shall appoint
10-18 deputies, assistants, and other personnel as necessary to carry out
10-19 the powers and duties of the commissioner and the department under
10-20 this title, other workers' compensation laws of this state, and
10-21 other laws granting jurisdiction or applicable to the department or
10-22 the commissioner.
10-23 (b) A person appointed under this section must have the
10-24 professional, administrative, and workers' compensation experience
10-25 necessary to qualify the person for the position to which the
10-26 person is appointed.
10-27 (c) A person appointed as an associate or deputy
11-1 commissioner or to hold an equivalent position must have at least
11-2 five years of the experience required for appointment as
11-3 commissioner under Section 402.005. At least two years of that
11-4 experience must be in work related to the position to be held.
11-5 Sec. 402.042. DIVISION OF RESPONSIBILITIES. The commissioner
11-6 shall develop and implement policies that clearly define the
11-7 respective responsibilities of the commissioner and the staff of
11-8 the department. [EXECUTIVE DIRECTOR. (a) The executive director
11-9 is the executive officer and administrative head of the commission.
11-10 The executive director exercises all rights, powers, and duties
11-11 imposed or conferred by law on the commission, except for
11-12 rulemaking and other rights, powers, and duties specifically
11-13 reserved under this subtitle to members of the commission.]
11-14 [(b) The executive director shall hire personnel as
11-15 necessary to administer this subtitle.]
11-16 [(c) The executive director serves at the pleasure of the
11-17 commission.]
11-18 [(d) The commission shall develop and implement policies
11-19 that clearly separate the policymaking responsibilities of the
11-20 commission and the management responsibilities of the executive
11-21 director and the staff of the commission.]
11-22 [Sec. 402.042. GENERAL POWERS AND DUTIES OF EXECUTIVE
11-23 DIRECTOR. (a) The executive director shall conduct the day-to-day
11-24 operations of the commission in accordance with policies
11-25 established by the commission and otherwise implement commission
11-26 policy.]
11-27 [(b) The executive director may:]
12-1 [(1) investigate misconduct;]
12-2 [(2) hold hearings;]
12-3 [(3) issue subpoenas to compel the attendance of
12-4 witnesses and the production of documents;]
12-5 [(4) administer oaths;]
12-6 [(5) take testimony directly or by deposition or
12-7 interrogatory;]
12-8 [(6) assess and enforce penalties established under
12-9 this subtitle;]
12-10 [(7) enter appropriate orders as authorized by this
12-11 subtitle;]
12-12 [(8) correct clerical errors in the entry of orders;]
12-13 [(9) institute an action in the commission's name to
12-14 enjoin the violation of this subtitle;]
12-15 [(10) initiate an action under Section 410.254 to
12-16 intervene in a judicial proceeding;]
12-17 [(11) prescribe the form, manner, and procedure for
12-18 transmission of information to the commission; and]
12-19 [(12) delegate all powers and duties as necessary.]
12-20 [(c) The executive director is the agent for service of
12-21 process on out-of-state employers.]
12-22 [Sec. 402.043. ADMINISTRATIVE ASSISTANTS. The executive
12-23 director shall employ and supervise:]
12-24 [(1) one person representing wage earners permanently
12-25 assigned to act as administrative assistant to the members of the
12-26 commission who represent wage earners; and]
12-27 [(2) one person representing employers permanently
13-1 assigned to act as administrative assistant to the members of the
13-2 commission who represent employers.]
13-3 Sec. 402.043 [Sec. 402.044]. CAREER LADDER; ANNUAL
13-4 PERFORMANCE EVALUATIONS. (a) The commissioner or the
13-5 commissioner's designee [executive director] shall develop an
13-6 intra-agency career ladder program that addresses opportunities for
13-7 mobility and advancement for employees within the department
13-8 [commission]. The program shall require intra-agency postings of
13-9 all positions concurrently with any public posting.
13-10 (b) The commissioner or the commissioner's designee
13-11 [executive director] shall develop a system of annual performance
13-12 evaluations that are based on documented employee performance. All
13-13 merit pay for department [commission] employees must be based on
13-14 the system established under this subsection.
13-15 Sec. 402.044 [Sec. 402.045]. EQUAL EMPLOYMENT OPPORTUNITY
13-16 POLICY STATEMENT. (a) The commissioner or the commissioner's
13-17 designee [executive director] shall prepare and maintain a written
13-18 policy statement to ensure implementation of a program of equal
13-19 employment opportunity under which all personnel transactions are
13-20 made without regard to race, color, disability, sex, religion, age,
13-21 or national origin. The policy statement must include:
13-22 (1) personnel policies, including policies related to
13-23 recruitment, evaluation, selection, appointment, training, and
13-24 promotion of personnel that are in compliance with the requirements
13-25 of Chapter 21;
13-26 (2) a comprehensive analysis of the department
13-27 [commission] work force that meets federal and state guidelines;
14-1 (3) procedures by which a determination can be made of
14-2 significant underuse in the department [commission] work force of
14-3 all persons for whom federal or state guidelines encourage a more
14-4 equitable balance; and
14-5 (4) reasonable methods to appropriately address those
14-6 areas of underuse.
14-7 (b) A policy statement prepared under this section must:
14-8 (1) cover an annual period;
14-9 (2) be updated annually;
14-10 (3) be reviewed by the Commission on Human Rights for
14-11 compliance with Subsection (a)(1); and
14-12 (4) be filed with the governor's office.
14-13 (c) The governor's office shall deliver a biennial report to
14-14 the legislature based on the information received under Subsection
14-15 (b). The report may be made separately or as part of other
14-16 biennial reports made to the legislature.
14-17 ARTICLE 2. CONFORMING AMENDMENTS WITHIN CHAPTER 402, LABOR CODE
14-18 SECTION 2.001. The heading to Chapter 402, Labor Code, is
14-19 amended to read as follows:
14-20 CHAPTER 402. TEXAS DEPARTMENT OF WORKERS' COMPENSATION
14-21 [COMMISSION]
14-22 SECTION 2.002. Section 402.021, Labor Code, is amended to
14-23 read as follows:
14-24 Sec. 402.021. DEPARTMENT [COMMISSION] DIVISIONS. (a) The
14-25 department [commission] shall have:
14-26 (1) a division of workers' health and safety;
14-27 (2) a division of medical review;
15-1 (3) a division of compliance and practices; and
15-2 (4) a division of hearings.
15-3 (b) In addition to the divisions listed by Subsection (a),
15-4 the commissioner [executive director, with the approval of the
15-5 commission,] may establish divisions within the department
15-6 [commission] for effective administration and performance of
15-7 department [commission] functions. The commissioner [executive
15-8 director] may allocate and reallocate functions among the
15-9 divisions.
15-10 (c) The commissioner [executive director] shall appoint the
15-11 directors of the divisions of the department [commission]. The
15-12 directors serve at the pleasure of the commissioner [executive
15-13 director].
15-14 SECTION 2.003. Section 402.022, Labor Code, is amended to
15-15 read as follows:
15-16 Sec. 402.022. PUBLIC INTEREST INFORMATION. (a) The
15-17 commissioner [executive director] shall prepare information of
15-18 public interest describing the functions of the department
15-19 [commission] and the procedures by which complaints are filed with
15-20 and resolved by the department [commission].
15-21 (b) The commissioner [executive director] shall make the
15-22 information available to the public and appropriate state agencies.
15-23 SECTION 2.004. Section 402.023, Labor Code, is amended to
15-24 read as follows:
15-25 Sec. 402.023. COMPLAINT INFORMATION. (a) The commissioner
15-26 [executive director] shall keep an information file about each
15-27 written complaint filed with the department [commission] that is
16-1 unrelated to a specific workers' compensation claim. The
16-2 information must include:
16-3 (1) the date the complaint is received;
16-4 (2) the name of the complainant;
16-5 (3) the subject matter of the complaint;
16-6 (4) a record of all persons contacted in relation to
16-7 the complaint;
16-8 (5) a summary of the results of the review or
16-9 investigation of the complaint; and
16-10 (6) for complaints for which the department
16-11 [commission] took no action, an explanation of the reason the
16-12 complaint was closed without action.
16-13 (b) For each written complaint that is unrelated to a
16-14 specific workers' compensation claim that the department
16-15 [commission] has authority to resolve, the commissioner [executive
16-16 director] shall provide to the person filing the complaint and the
16-17 person about whom the complaint is made information about the
16-18 department's [commission's] policies and procedures relating to
16-19 complaint investigation and resolution. The commissioner
16-20 [commission], at least quarterly and until final disposition of the
16-21 complaint, shall notify those persons about the status of the
16-22 complaint unless the notice would jeopardize an undercover
16-23 investigation.
16-24 SECTION 2.005. Section 402.024, Labor Code, is amended to
16-25 read as follows:
16-26 Sec. 402.024. PUBLIC PARTICIPATION. (a) The commissioner
16-27 [commission] shall develop and implement policies that provide the
17-1 public with a reasonable opportunity to appear before the
17-2 department [commission] and to speak on issues under the general
17-3 jurisdiction of the department [commission].
17-4 (b) The department [commission] shall comply with federal
17-5 and state laws related to program and facility accessibility.
17-6 (c) In addition to compliance with Subsection (a), the
17-7 commissioner [executive director] shall prepare and maintain a
17-8 written plan that describes how a person who does not speak English
17-9 may be provided reasonable access to the department's
17-10 [commission's] programs and services.
17-11 SECTION 2.006. Section 402.025, Labor Code, is amended to
17-12 read as follows:
17-13 Sec. 402.025. AUDIT. The financial transactions of the
17-14 department [commission] are subject to audit by the state auditor
17-15 in accordance with Chapter 321, Government Code.
17-16 SECTION 2.007. The heading to Subchapter D, Chapter 402,
17-17 Labor Code, is amended to read as follows:
17-18 SUBCHAPTER D. GENERAL POWERS AND DUTIES OF DEPARTMENT
17-19 [COMMISSION]
17-20 SECTION 2.008. Section 402.061, Labor Code, is amended to
17-21 read as follows:
17-22 Sec. 402.061. ADOPTION OF RULES. The commissioner
17-23 [commission] shall adopt rules as necessary for the implementation
17-24 and enforcement of this subtitle.
17-25 SECTION 2.009. Section 402.062, Labor Code, is amended to
17-26 read as follows:
17-27 Sec. 402.062. ACCEPTANCE OF GIFTS, GRANTS, AND DONATIONS.
18-1 (a) The department [commission] may accept gifts, grants, or
18-2 donations as provided by rules adopted by the commissioner
18-3 [commission].
18-4 (b) Notwithstanding Chapter 575, Government Code, the
18-5 department [commission] may accept a grant paid from the Texas
18-6 Workers' Compensation Insurance Fund established under Article
18-7 5.76-3, Insurance Code, to implement specific steps to control and
18-8 lower medical costs in the workers' compensation system and to
18-9 ensure the delivery of quality medical care. The department
18-10 [commission] must publish the name of the grantor and the purpose
18-11 and conditions of the grant in the Texas Register and provide for a
18-12 20-day public comment period before the department [commission] may
18-13 accept the grant. The department [commission] shall acknowledge
18-14 acceptance of the grant at a public meeting. The minutes of the
18-15 public meeting must include the name of the grantor, a description
18-16 of the grant, and a general statement of the purposes for which the
18-17 grant will be used.
18-18 SECTION 2.010. Section 402.064, Labor Code, is amended to
18-19 read as follows:
18-20 Sec. 402.064. FEES. In addition to fees established by this
18-21 subtitle, the commissioner [commission] shall set reasonable fees
18-22 for services provided to persons requesting services from the
18-23 department [commission], including services provided under
18-24 Subchapter E.
18-25 SECTION 2.011. Section 402.065, Labor Code, is amended to
18-26 read as follows:
18-27 Sec. 402.065. EMPLOYMENT OF COUNSEL. The commissioner
19-1 [commission] may employ counsel to represent the department
19-2 [commission] in any legal action the department [commission] is
19-3 authorized to initiate.
19-4 SECTION 2.012. Section 402.066, Labor Code, is amended to
19-5 read as follows:
19-6 Sec. 402.066. RECOMMENDATIONS TO LEGISLATURE. (a) The
19-7 commissioner [commission] shall consider and recommend to the
19-8 legislature changes to this subtitle.
19-9 (b) The commissioner [commission] shall forward the
19-10 recommended changes to the legislature not later than December 1 of
19-11 each even-numbered year.
19-12 SECTION 2.013. Section 402.0665, Labor Code, is amended to
19-13 read as follows:
19-14 Sec. 402.0665. LEGISLATIVE OVERSIGHT. The legislature may
19-15 adopt requirements relating to legislative oversight of the
19-16 department [commission] and the workers' compensation system of
19-17 this state. The department [commission] shall comply with any
19-18 requirements adopted by the legislature under this section.
19-19 SECTION 2.014. Section 402.067, Labor Code, is amended to
19-20 read as follows:
19-21 Sec. 402.067. ADVISORY COMMITTEES. The commissioner
19-22 [commission] may appoint advisory committees as the commissioner
19-23 [it] considers necessary.
19-24 SECTION 2.015. Section 402.068, Labor Code, is amended to
19-25 read as follows:
19-26 Sec. 402.068. DELEGATION OF RIGHTS AND DUTIES. Except as
19-27 expressly provided by this subchapter, the department [commission]
20-1 may not delegate rights and duties imposed on it by this
20-2 subchapter.
20-3 SECTION 2.016. Section 402.069, Labor Code, is amended to
20-4 read as follows:
20-5 Sec. 402.069. QUALIFICATIONS AND STANDARDS OF CONDUCT
20-6 INFORMATION. The commissioner or the commissioner's designee
20-7 [executive director] shall provide to department [members of the
20-8 commission and commission] employees, as often as necessary,
20-9 information regarding their:
20-10 (1) qualifications for office or employment under this
20-11 subtitle; and
20-12 (2) responsibilities under applicable law relating to
20-13 standards of conduct for state officers or employees.
20-14 SECTION 2.017. Section 402.070(a), Labor Code, is amended to
20-15 read as follows:
20-16 (a) The department [commission] shall prepare annually a
20-17 complete and detailed written report accounting for all funds
20-18 received and disbursed by the department [commission] during the
20-19 preceding fiscal year.
20-20 SECTION 2.018. Section 402.071(a), Labor Code, is amended to
20-21 read as follows:
20-22 (a) The commissioner [commission] shall establish
20-23 qualifications for a representative and shall adopt rules
20-24 establishing procedures for authorization of representatives.
20-25 SECTION 2.019. Section 402.072, Labor Code, is amended to
20-26 read as follows:
20-27 Sec. 402.072. SANCTIONS. Only the commissioner [commission]
21-1 may impose:
21-2 (1) a sanction that deprives a person of the right to
21-3 practice before the department [commission] or of the right to
21-4 receive remuneration under this subtitle for a period exceeding 30
21-5 days; or
21-6 (2) another sanction suspending for more than 30 days
21-7 or revoking a license, certification, or permit required for
21-8 practice in the field of workers' compensation.
21-9 SECTION 2.020. Sections 402.073(a) and (c), Labor Code, are
21-10 amended to read as follows:
21-11 (a) The commissioner [commission] and the chief
21-12 administrative law judge of the State Office of Administrative
21-13 Hearings by rule shall adopt a memorandum of understanding
21-14 governing administrative procedure law hearings under this subtitle
21-15 conducted by the State Office of Administrative Hearings in the
21-16 manner provided for a contested case hearing under Chapter 2001,
21-17 Government Code (the administrative procedure law).
21-18 (c) In a case in which a hearing is conducted in conjunction
21-19 with Section 402.072, 407.046, or 408.023, and in other cases under
21-20 this subtitle that are not subject to Subsection (b), the
21-21 administrative law judge who conducts the hearing for the State
21-22 Office of Administrative Hearings shall propose a decision to the
21-23 commissioner [commission] for final consideration and decision by
21-24 the commissioner [commission].
21-25 SECTION 2.021. Section 402.081, Labor Code, is amended to
21-26 read as follows:
21-27 Sec. 402.081. DEPARTMENT [COMMISSION] RECORDS. (a) The
22-1 commissioner [executive director] is the custodian of the
22-2 department's [commission's] records and shall perform the duties of
22-3 a custodian required by law, including providing copies and the
22-4 certification of records.
22-5 (b) The commissioner [executive director] may destroy a
22-6 record maintained by the department [commission] pertaining to an
22-7 injury after the 50th anniversary of the date of the injury to
22-8 which the record refers unless benefits are being paid on the claim
22-9 on that date.
22-10 (c) A record maintained by the department [commission] may
22-11 be preserved in any format permitted by Chapter 441, Government
22-12 Code, and rules adopted by the Texas State Library and Archives
22-13 Commission under that chapter.
22-14 (d) The department [commission] may charge a reasonable fee
22-15 for making available for inspection any of its information that
22-16 contains confidential information that must be redacted before the
22-17 information is made available. However, when a request for
22-18 information is for the inspection of 10 or fewer pages, and a copy
22-19 of the information is not requested, the department [commission]
22-20 may charge only the cost of making a copy of the page from which
22-21 confidential information must be redacted. The fee for access to
22-22 information under Chapter 552, Government Code, shall be in accord
22-23 with the rules of the General Services Commission that prescribe
22-24 the method for computing the charge for copies under that chapter.
22-25 SECTION 2.022. Section 402.082, Labor Code, is amended to
22-26 read as follows:
22-27 Sec. 402.082. INJURY INFORMATION MAINTAINED BY DEPARTMENT
23-1 [COMMISSION]. The department [commission] shall maintain
23-2 information on every compensable injury as to the:
23-3 (1) race, ethnicity, and sex of the claimant;
23-4 (2) classification of the injury;
23-5 (3) amount of wages earned by the claimant before the
23-6 injury; and
23-7 (4) amount of compensation received by the claimant.
23-8 SECTION 2.023. Section 402.083(a), Labor Code, is amended to
23-9 read as follows:
23-10 (a) Information in or derived from a claim file regarding an
23-11 employee is confidential and may not be disclosed by the department
23-12 [commission] except as provided by this subtitle.
23-13 SECTION 2.024. Section 402.084(a), Labor Code, is amended to
23-14 read as follows:
23-15 (a) The department [commission] shall perform and release a
23-16 record check on an employee, including current or prior injury
23-17 information, to the parties listed in Subsection (b) if:
23-18 (1) the claim is:
23-19 (A) open or pending before the department
23-20 [commission];
23-21 (B) on appeal to a court of competent
23-22 jurisdiction; or
23-23 (C) the subject of a subsequent suit in which
23-24 the insurance carrier or the subsequent injury fund is subrogated
23-25 to the rights of the named claimant; and
23-26 (2) the requesting party requests the release on a
23-27 form prescribed by the department [commission] for this purpose and
24-1 provides all required information.
24-2 SECTION 2.025. Section 402.085, Labor Code, is amended to
24-3 read as follows:
24-4 Sec. 402.085. EXCEPTIONS TO CONFIDENTIALITY. (a) The
24-5 department [commission] shall release information on a claim to:
24-6 (1) the Texas Department of Insurance for any
24-7 statutory or regulatory purpose;
24-8 (2) a legislative committee for legislative purposes;
24-9 (3) a state or federal elected official requested in
24-10 writing to provide assistance by a constituent who qualifies to
24-11 obtain injury information under Section 402.084(b), if the request
24-12 for assistance is provided to the department [commission];
24-13 (4) the Research and Oversight Council on Workers'
24-14 Compensation for research purposes; or
24-15 (5) the attorney general or another entity that
24-16 provides child support services under Part D, Title IV, Social
24-17 Security Act (42 U.S.C. Section 651 et seq.), relating to:
24-18 (A) establishing, modifying, or enforcing a
24-19 child support or medical support obligation; or
24-20 (B) locating an absent parent.
24-21 (b) The department [commission] may release information on a
24-22 claim to a governmental agency, political subdivision, or
24-23 regulatory body to use to:
24-24 (1) investigate an allegation of a criminal offense or
24-25 licensing or regulatory violation;
24-26 (2) provide:
24-27 (A) unemployment compensation benefits;
25-1 (B) crime victims compensation benefits;
25-2 (C) vocational rehabilitation services; or
25-3 (D) health care benefits;
25-4 (3) investigate occupational safety or health
25-5 violations;
25-6 (4) verify income on an application for benefits under
25-7 an income-based state or federal assistance program; or
25-8 (5) assess financial resources in an action, including
25-9 an administrative action, to:
25-10 (A) establish, modify, or enforce a child
25-11 support or medical support obligation;
25-12 (B) establish paternity;
25-13 (C) locate an absent parent; or
25-14 (D) cooperate with another state in an action
25-15 authorized under Part D, Title IV, Social Security Act (42 U.S.C.
25-16 Section 651 et seq.), or Chapter 231, Family [76, Human Resources]
25-17 Code.
25-18 SECTION 2.026. Sections 402.088(a), (b), and (d), Labor
25-19 Code, are amended to read as follows:
25-20 (a) On receipt of a valid request made under and complying
25-21 with Section 402.087, the department [commission] shall review its
25-22 records.
25-23 (b) If the department [commission] finds that the applicant
25-24 has made two or more general injury claims in the preceding five
25-25 years, the department [commission] shall release the date and
25-26 description of each injury to the employer.
25-27 (d) If the employer requests information on three or more
26-1 applicants at the same time, the department [commission] may refuse
26-2 to release information until it receives the written authorization
26-3 from each applicant.
26-4 SECTION 2.027. Section 402.089(a), Labor Code, is amended to
26-5 read as follows:
26-6 (a) An employer who receives information by telephone from
26-7 the department [commission] under Section 402.088 and who fails to
26-8 file the necessary authorization in accordance with Section 402.087
26-9 commits a Class C administrative violation.
26-10 SECTION 2.028. Section 402.090, Labor Code, is amended to
26-11 read as follows:
26-12 Sec. 402.090. STATISTICAL INFORMATION. The department
26-13 [commission], the research center, or any other governmental agency
26-14 may prepare and release statistical information if the identity of
26-15 an employee is not explicitly or implicitly disclosed.
26-16 SECTION 2.029. Section 402.091(a), Labor Code, is amended to
26-17 read as follows:
26-18 (a) A person commits an offense if the person knowingly,
26-19 intentionally, or recklessly publishes, discloses, or distributes
26-20 information that is confidential under this subchapter to a person
26-21 not authorized to receive the information directly from the
26-22 department [commission].
26-23 SECTION 2.030. Sections 402.092(a), (b), (d), (e), and (f),
26-24 Labor Code, are amended to read as follows:
26-25 (a) Information maintained in the investigation files of the
26-26 department [commission] is confidential and may not be disclosed
26-27 except:
27-1 (1) in a criminal proceeding;
27-2 (2) in a hearing conducted by the department
27-3 [commission];
27-4 (3) on a judicial determination of good cause; or
27-5 (4) to a governmental agency, political subdivision,
27-6 or regulatory body if the disclosure is necessary or proper for the
27-7 enforcement of the laws of this or another state or of the United
27-8 States.
27-9 (b) Department [Commission] investigation files are not open
27-10 records for purposes of Chapter 552, Government Code.
27-11 (d) For purposes of this section, "investigation file" means
27-12 any information compiled or maintained by the department
27-13 [commission] with respect to a department [commission]
27-14 investigation authorized by law.
27-15 (e) The department [commission], upon request, shall
27-16 disclose the identity of a complainant under this section if the
27-17 department [commission] finds:
27-18 (1) the complaint was groundless or made in bad faith;
27-19 or
27-20 (2) the complaint lacks any basis in fact or evidence;
27-21 or
27-22 (3) the complaint is frivolous; or
27-23 (4) the complaint is done specifically for competitive
27-24 or economic advantage.
27-25 (f) Upon completion of an investigation where the department
27-26 [commission] determines a complaint is groundless, frivolous, made
27-27 in bad faith, or is not supported by evidence or is done
28-1 specifically for competitive or economic advantage the department
28-2 [commission] shall notify the person who was the subject of the
28-3 complaint of its finding and the identity of the complainant.
28-4 ARTICLE 3. GENERAL CONFORMING AMENDMENTS
28-5 SECTION 3.001. Section 91.003(b), Labor Code, is amended to
28-6 read as follows:
28-7 (b) In particular, the Texas Workforce Commission, the Texas
28-8 Department of Insurance, the Texas Department of Workers'
28-9 Compensation [Commission], and the attorney general's office shall
28-10 assist in the implementation of this chapter and shall provide
28-11 information to the department on request.
28-12 SECTION 3.002. Section 401.002, Labor Code, is amended to
28-13 read as follows:
28-14 Sec. 401.002. APPLICATION OF SUNSET ACT. The Texas
28-15 Department of Workers' Compensation [Commission] is subject to
28-16 Chapter 325, Government Code (Texas Sunset Act). Unless continued
28-17 in existence as provided by that chapter, the department
28-18 [commission] is abolished September 1, 2007.
28-19 SECTION 3.003. Section 401.011, Labor Code, is amended by
28-20 amending Subdivisions (8), (15), (37), and (39) and by adding
28-21 Subdivision (45) to read as follows:
28-22 (8) "Commissioner" means the commissioner of workers'
28-23 compensation ["Commission" means the Texas Workers' Compensation
28-24 Commission].
28-25 (15) "Designated doctor" means a doctor appointed by
28-26 mutual agreement of the parties or by the department [commission]
28-27 to recommend a resolution of a dispute as to the medical condition
29-1 of an injured employee.
29-2 (37) "Representative" means a person, including an
29-3 attorney, authorized by the commissioner [commission] to assist or
29-4 represent an employee, a person claiming a death benefit, or an
29-5 insurance carrier in a matter arising under this subtitle that
29-6 relates to the payment of compensation.
29-7 (39) "Sanction" means a penalty or other punitive
29-8 action or remedy imposed by the commissioner [commission] on an
29-9 insurance carrier, representative, employee, employer, or health
29-10 care provider for an act or omission in violation of this subtitle
29-11 or a rule or order of the commissioner [commission].
29-12 (45) "Department" means the Texas Department of
29-13 Workers' Compensation.
29-14 SECTION 3.004. Section 401.021, Labor Code, is amended to
29-15 read as follows:
29-16 Sec. 401.021. APPLICATION OF OTHER ACTS. Except as otherwise
29-17 provided by this subtitle:
29-18 (1) a proceeding, hearing, judicial review, or
29-19 enforcement of a commissioner [commission] order, decision, or rule
29-20 is governed by the following subchapters and sections of Chapter
29-21 2001, Government Code:
29-22 (A) Subchapters A, B, D, E, G, and H, excluding
29-23 Sections 2001.004(3) and 2001.005;
29-24 (B) Sections 2001.051, 2001.052, and 2001.053;
29-25 (C) Sections 2001.056 through 2001.062; and
29-26 (D) Section 2001.141(c);
29-27 (2) a proceeding, hearing, judicial review, or
30-1 enforcement of a commissioner [commission] order, decision, or
30-2 rule is governed by Subchapters A and B, Chapter 2002, Government
30-3 Code, excluding Sections 2002.001(2) and 2002.023;
30-4 (3) Chapter 551, Government Code, applies to a
30-5 proceeding under this subtitle, other than:
30-6 (A) a benefit review conference;
30-7 (B) a contested case hearing;
30-8 (C) an appeals panel proceeding;
30-9 (D) arbitration; or
30-10 (E) another proceeding involving a determination
30-11 on a workers' compensation claim; and
30-12 (4) Chapter 552, Government Code, applies to a record
30-13 of the department [commission] or the research center.
30-14 SECTION 3.005. Section 401.023(b), Labor Code, is amended to
30-15 read as follows:
30-16 (b) The department [commission] shall compute and publish
30-17 the interest and discount rate quarterly, using the auction rate
30-18 quoted on a discount basis for the 52-week treasury bills issued by
30-19 the United States government, as published by the Federal Reserve
30-20 Board on the date nearest to the 15th day preceding the first day
30-21 of the calendar quarter for which the rate is to be effective, plus
30-22 3.5 percent. For this purpose, calendar quarters begin January 1,
30-23 April 1, July 1, and October 1.
30-24 SECTION 3.006. Sections 401.024(b), (c), and (d), Labor Code,
30-25 are amended to read as follows:
30-26 (b) Notwithstanding another provision of this subtitle that
30-27 specifies the form, manner, or procedure for the transmission of
31-1 specified information, the commissioner [commission] by rule may
31-2 permit or require the use of an electronic transmission instead of
31-3 the specified form, manner, or procedure. If the electronic
31-4 transmission of information is not authorized or permitted by
31-5 [commission] rule, the transmission of that information is governed
31-6 by any applicable statute or rule that prescribes the form, manner,
31-7 or procedure for the transmission, including standards adopted by
31-8 the Department of Information Resources.
31-9 (c) The commissioner [commission] may designate and contract
31-10 with a data collection agent to fulfill the data collection
31-11 requirements of this subtitle.
31-12 (d) The commissioner [executive director] may prescribe the
31-13 form, manner, and procedure for transmitting any authorized or
31-14 required electronic transmission, including requirements related to
31-15 security, confidentiality, accuracy, and accountability.
31-16 SECTION 3.007. Subchapter C, Chapter 401, Labor Code, is
31-17 amended by adding Section 401.025 to read as follows:
31-18 Sec. 401.025. REFERENCES TO COMMISSION AND EXECUTIVE
31-19 DIRECTOR. (a) A reference in this code or other law to the Texas
31-20 Workers' Compensation Commission or the executive director of that
31-21 commission means the department or the commissioner as consistent
31-22 with the respective duties of the commissioner and the department
31-23 under this code and other workers' compensation laws of this state.
31-24 (b) A reference in this code or other law to the executive
31-25 director of the Texas Workers' Compensation Commission means the
31-26 commissioner.
31-27 SECTION 3.008. The heading to Section 403.001, Labor Code, is
32-1 amended to read as follows:
32-2 Sec. 403.001. DEPARTMENT [COMMISSION] FUNDS.
32-3 SECTION 3.009. Sections 403.001(a) and (b), Labor Code, are
32-4 amended to read as follows:
32-5 (a) Except as provided by Sections 403.006 and 403.007 or as
32-6 otherwise provided by law, money collected under this subtitle,
32-7 including administrative penalties and advance deposits for
32-8 purchase of services, shall be deposited in the general revenue
32-9 fund of the state treasury to the credit of the department
32-10 [commission].
32-11 (b) The money may be spent as authorized by legislative
32-12 appropriation on warrants issued by the comptroller under
32-13 requisitions made by the department [commission].
32-14 SECTION 3.010. Section 403.003, Labor Code, is amended to
32-15 read as follows:
32-16 Sec. 403.003. RATE OF ASSESSMENT. (a) The commissioner
32-17 [commission] shall set and certify to the comptroller the rate of
32-18 maintenance tax assessment not later than October 31 of each year,
32-19 taking into account:
32-20 (1) any expenditure projected as necessary for the
32-21 department [commission] to:
32-22 (A) administer this subtitle during the fiscal
32-23 year for which the rate of assessment is set; and
32-24 (B) reimburse the general revenue fund as
32-25 provided by Article 4.19, Insurance Code;
32-26 (2) projected employee benefits paid from general
32-27 revenues;
33-1 (3) a surplus or deficit produced by the tax in the
33-2 preceding year;
33-3 (4) revenue recovered from other sources, including
33-4 reappropriated receipts, grants, payments, fees, gifts, and
33-5 penalties recovered under this subtitle; and
33-6 (5) expenditures projected as necessary to support the
33-7 prosecution of workers' compensation insurance fraud.
33-8 (b) In setting the rate of assessment, the commissioner
33-9 [commission] may not consider revenue or expenditures related to:
33-10 (1) the State Office of Risk Management;
33-11 (2) the research and oversight council on workers'
33-12 compensation; or
33-13 (3) any other revenue or expenditure excluded from
33-14 consideration by law.
33-15 SECTION 3.011. Section 403.004, Labor Code, is amended to
33-16 read as follows:
33-17 Sec. 403.004. COLLECTION OF TAX AFTER WITHDRAWAL FROM
33-18 BUSINESS. The insurance commissioner or the commissioner
33-19 [executive director of the commission] immediately shall proceed to
33-20 collect taxes due under this chapter from an insurance carrier that
33-21 withdraws from business in this state, using legal process as
33-22 necessary.
33-23 SECTION 3.012. Section 403.005, Labor Code, is amended to
33-24 read as follows:
33-25 Sec. 403.005. TAX RATE SURPLUS OR DEFICIT. (a) If the tax
33-26 rate set by the commissioner [commission] for a year does not
33-27 produce sufficient revenue to make all expenditures authorized by
34-1 legislative appropriation, the deficit shall be paid from the
34-2 general revenue fund.
34-3 (b) If the tax rate set by the commissioner [commission] for
34-4 a year produces revenue that exceeds the amount required to make
34-5 all expenditures authorized by the legislature, the excess shall be
34-6 deposited in the general revenue fund to the credit of the
34-7 department [commission].
34-8 SECTION 3.013. Section 403.006(c), Labor Code, is amended to
34-9 read as follows:
34-10 (c) The commissioner [executive director] shall appoint an
34-11 administrator for the subsequent injury fund.
34-12 SECTION 3.014. Section 403.007, Labor Code, is amended to
34-13 read as follows:
34-14 Sec. 403.007. FUNDING OF SUBSEQUENT INJURY FUND. (a) If a
34-15 compensable death occurs and no legal beneficiary survives or a
34-16 claim for death benefits is not timely made, the insurance carrier
34-17 shall pay to the department [commission] for deposit to the credit
34-18 of the subsequent injury fund an amount equal to 364 weeks of the
34-19 death benefits otherwise payable.
34-20 (b) The insurance carrier may elect or the commissioner
34-21 [commission] may order that death benefits payable to the fund be
34-22 commuted on written approval of the commissioner [executive
34-23 director]. The commutation may be discounted for present payment
34-24 at the rate established in Section 401.023, compounded annually.
34-25 (c) If a claim for death benefits is not filed with the
34-26 department [commission] by a legal beneficiary on or before the
34-27 first anniversary of the date of the death of the employee, it is
35-1 presumed, for purposes of this section only, that no legal
35-2 beneficiary survived the deceased employee. The presumption does
35-3 not apply against a minor beneficiary or an incompetent beneficiary
35-4 for whom a guardian has not been appointed.
35-5 (d) If the insurance carrier makes payment to the subsequent
35-6 injury fund and it is later determined by a final award of the
35-7 commissioner [commission] or the final judgment of a court of
35-8 competent jurisdiction that a legal beneficiary is entitled to the
35-9 death benefits, the commissioner [commission] shall order the fund
35-10 to reimburse the insurance carrier for the amount overpaid to the
35-11 fund.
35-12 SECTION 3.015. Section 404.002(a), Labor Code, is amended to
35-13 read as follows:
35-14 (a) The Research and Oversight Council on Workers'
35-15 Compensation is an advisory body to the department [commission].
35-16 The council shall be operated in a manner that ensures that its
35-17 research, findings, and conclusions are factual, fair, and
35-18 unbiased.
35-19 SECTION 3.016. Section 404.003(b), Labor Code, is amended to
35-20 read as follows:
35-21 (b) The commissioner [commission] shall set the rate of the
35-22 maintenance tax based on the expenditures authorized and the
35-23 receipts anticipated in legislative appropriations. The tax rate
35-24 for insurance companies may not exceed one-tenth of one percent of
35-25 the correctly reported gross workers' compensation insurance
35-26 premiums. The tax rate for certified self-insurers may not exceed
35-27 one-tenth of one percent of the total tax base of all certified
36-1 self-insurers, as computed under Section 407.103(b).
36-2 SECTION 3.017. Sections 404.004(a) and (d), Labor Code, are
36-3 amended to read as follows:
36-4 (a) The council is governed by a board of directors,
36-5 composed of:
36-6 (1) three senators, appointed by the lieutenant
36-7 governor;
36-8 (2) three members of the house of representatives,
36-9 appointed by the speaker of the house of representatives;
36-10 (3) the commissioner or a person designated by the
36-11 commissioner; and [a member of the commission, appointed by the
36-12 commission, from the members who are wage earners;]
36-13 [(4) a member of the commission, appointed by the
36-14 commission, from the members who are employers of labor; and]
36-15 (4) [(5)] the commissioner of insurance or a person
36-16 designated by that commissioner.
36-17 (d) An officer, employee, or paid consultant of a Texas
36-18 trade association whose members provide services subject to
36-19 regulation by the department [commission] or provide services whose
36-20 fees are subject to regulation by the department [commission] may
36-21 not be an employee of the council who is exempt from the state's
36-22 position classification plan or is compensated at or above the
36-23 amount prescribed by the General Appropriations Act for step 1,
36-24 salary group A17 [17], of the position classification salary
36-25 schedule.
36-26 SECTION 3.018. Section 404.0041, Labor Code, is amended to
36-27 read as follows:
37-1 Sec. 404.0041. EFFECT OF LOBBYING ACTIVITY. A person may
37-2 not act as the general counsel to the board or the council if the
37-3 person is required to register as a lobbyist under Chapter 305,
37-4 Government Code, because of the person's activities for
37-5 compensation on behalf of a profession that is regulated or has
37-6 fees regulated by the department [commission].
37-7 SECTION 3.019. Sections 404.007(a) and (d), Labor Code, are
37-8 amended to read as follows:
37-9 (a) The board shall:
37-10 (1) approve the operating budget of the council;
37-11 (2) adopt rules for the operations of the board and
37-12 the council;
37-13 (3) conduct professional studies and research on all
37-14 matters relevant to the cost, quality, and operational
37-15 effectiveness of the workers' compensation system;
37-16 (4) monitor the cost of income benefits under this
37-17 subtitle, with emphasis on the availability and cost of
37-18 supplemental income benefits;
37-19 (5) monitor the performance and operation of the Texas
37-20 Workers' Compensation Insurance Fund, with emphasis on the insurer
37-21 of last resort program;
37-22 (6) hold regular public hearings and receive testimony
37-23 and reports from:
37-24 (A) the department [commission];
37-25 (B) the Texas Workers' Compensation Insurance
37-26 Fund;
37-27 (C) the Texas Department of Insurance;
38-1 (D) the State Office of Risk Management; and
38-2 (E) any other public or private entity that is
38-3 involved in the workers' compensation system;
38-4 (7) receive information about workers' compensation
38-5 rules and operations of an entity listed in Subdivision (6); and
38-6 (8) review specific recommendations for legislation
38-7 relating to this subtitle [the Texas Workers' Compensation Act]
38-8 formally proposed by an entity listed in Subdivision (6).
38-9 (d) The board may:
38-10 (1) delegate powers to the executive director as it
38-11 considers appropriate, including general guidance on the
38-12 identification of information needs and the conduct of research;
38-13 (2) contract with other persons, including
38-14 institutions of higher education, for conducting economical studies
38-15 of high quality for the council;
38-16 (3) contract with the department [commission] for a
38-17 fiscal, personnel, or other support function;
38-18 (4) appoint expert advisory committees to provide
38-19 technical assistance in conducting research; and
38-20 (5) request reports and other information on workers'
38-21 compensation from an entity listed in Subsection (a)(6). Requests
38-22 made under this subsection shall be reasonable in scope and shall
38-23 take into account the availability of the information requested,
38-24 the preparation time required, and other relevant circumstances.
38-25 SECTION 3.020. Section 404.008(c), Labor Code, is amended to
38-26 read as follows:
38-27 (c) The executive director shall prepare a request for
39-1 legislative appropriations for the operations of the council. If
39-2 the request is approved by the board, the board shall submit the
39-3 request to the department [commission]. The commissioner
39-4 [commission] shall include the request in the department's
39-5 [commission's] legislative appropriations request.
39-6 SECTION 3.021. Section 404.010(a), Labor Code, is amended to
39-7 read as follows:
39-8 (a) As required to fulfill the objectives of the council,
39-9 the council is entitled to access to the files and records of:
39-10 (1) the department [commission];
39-11 (2) the Texas Workforce Commission;
39-12 (3) the Texas Department of Insurance;
39-13 (4) the Texas Department of Human Services;
39-14 (5) the Texas Workers' Compensation Insurance Fund;
39-15 and
39-16 (6) other state agencies.
39-17 SECTION 3.022. The heading to Section 406.004, Labor Code,
39-18 is amended to read as follows:
39-19 Sec. 406.004. EMPLOYER NOTICE TO DEPARTMENT [COMMISSION];
39-20 ADMINISTRATIVE VIOLATION.
39-21 SECTION 3.023. Sections 406.004(a), (b), (c), and (d), Labor
39-22 Code, are amended to read as follows:
39-23 (a) An employer who does not obtain workers' compensation
39-24 insurance coverage shall notify the department [commission] in
39-25 writing, in the time and as prescribed by commissioner [commission]
39-26 rule, that the employer elects not to obtain coverage.
39-27 (b) The commissioner [commission] shall prescribe forms to
40-1 be used for the employer notification and shall require the
40-2 employer to provide reasonable information to the department
40-3 [commission] about the employer's business.
40-4 (c) The department [commission] may contract with the Texas
40-5 Employment Commission or the comptroller for assistance in
40-6 collecting the notification required under this section. Those
40-7 agencies shall cooperate with the department [commission] in
40-8 enforcing this section.
40-9 (d) The employer notification filing required under this
40-10 section shall be filed with the department [commission] in
40-11 accordance with Section 406.009.
40-12 SECTION 3.024. Section 406.005(c), Labor Code, is amended to
40-13 read as follows:
40-14 (c) Each employer shall post a notice of whether the
40-15 employer has workers' compensation insurance coverage at
40-16 conspicuous locations at the employer's place of business as
40-17 necessary to provide reasonable notice to the employees. The
40-18 commissioner [commission] may adopt rules relating to the form and
40-19 content of the notice. The employer shall revise the notice when
40-20 the information contained in the notice is changed.
40-21 SECTION 3.025. Sections 406.006(a), (b), and (c), Labor
40-22 Code, are amended to read as follows:
40-23 (a) An insurance company from which an employer has obtained
40-24 workers' compensation insurance coverage, a certified self-insurer,
40-25 and a political subdivision shall file notice of the coverage and
40-26 claim administration contact information with the department
40-27 [commission] not later than the 10th day after the date on which
41-1 the coverage or claim administration agreement takes effect, unless
41-2 the commissioner [commission] adopts a rule establishing a later
41-3 date for filing. Coverage takes effect on the date on which a
41-4 binder is issued, a later date and time agreed to by the parties,
41-5 on the date provided by the certificate of self-insurance, or on
41-6 the date provided in an interlocal agreement that provides for
41-7 self-insurance. The commissioner [commission] may adopt rules that
41-8 establish the coverage and claim administration contact information
41-9 required under this subsection.
41-10 (b) The notice required under this section shall be filed
41-11 with the department [commission] in accordance with Section
41-12 406.009.
41-13 (c) An insurance company, certified self-insurer, or
41-14 political subdivision commits a violation if the person fails to
41-15 file notice with the department [commission] as provided by this
41-16 section. A violation under this subsection is a Class C
41-17 administrative violation. Each day of noncompliance constitutes a
41-18 separate violation.
41-19 SECTION 3.026. Sections 406.007(a), (b), and (c), Labor
41-20 Code, are amended to read as follows:
41-21 (a) An employer who terminates workers' compensation
41-22 insurance coverage obtained under this subtitle shall file a
41-23 written notice with the department [commission] by certified mail
41-24 not later than the 10th day after the date on which the employer
41-25 notified the insurance carrier to terminate the coverage. The
41-26 notice must include a statement certifying the date that notice was
41-27 provided or will be provided to affected employees under Section
42-1 406.005.
42-2 (b) The notice required under this section shall be filed
42-3 with the department [commission] in accordance with Section
42-4 406.009.
42-5 (c) Termination of coverage takes effect on the later of:
42-6 (1) the 30th day after the date of filing of notice
42-7 with the department [commission] under Subsection (a); or
42-8 (2) the cancellation date of the policy.
42-9 SECTION 3.027. Section 406.008, Labor Code, is amended to
42-10 read as follows:
42-11 Sec. 406.008. CANCELLATION OR NONRENEWAL OF COVERAGE BY
42-12 INSURANCE COMPANY; NOTICE. (a) An insurance company that cancels
42-13 a policy of workers' compensation insurance or that does not renew
42-14 the policy by the anniversary date of the policy shall deliver
42-15 notice of the cancellation or nonrenewal by certified mail or in
42-16 person to the employer and the department [commission] not later
42-17 than:
42-18 (1) the 30th day before the date on which the
42-19 cancellation or nonrenewal takes effect; or
42-20 (2) the 10th day before the date on which the
42-21 cancellation or nonrenewal takes effect if the insurance company
42-22 cancels or does not renew because of:
42-23 (A) fraud in obtaining coverage;
42-24 (B) misrepresentation of the amount of payroll
42-25 for purposes of premium calculation;
42-26 (C) failure to pay a premium when due;
42-27 (D) an increase in the hazard for which the
43-1 employer seeks coverage that results from an act or omission of the
43-2 employer and that would produce an increase in the rate, including
43-3 an increase because of a failure to comply with:
43-4 (i) reasonable recommendations for loss
43-5 control; or
43-6 (ii) recommendations designed to reduce a
43-7 hazard under the employer's control within a reasonable period; or
43-8 (E) a determination made by the commissioner of
43-9 insurance that the continuation of the policy would place the
43-10 insurer in violation of the law or would be hazardous to the
43-11 interest of subscribers, creditors, or the general public.
43-12 (b) The notice required under this section shall be filed
43-13 with the department [commission].
43-14 (c) Failure of the insurance company to give notice as
43-15 required by this section extends the policy until the date on which
43-16 the required notice is provided to the employer and the department
43-17 [commission].
43-18 SECTION 3.028. Sections 406.009(a), (b), (c), and (d), Labor
43-19 Code, are amended to read as follows:
43-20 (a) The department [commission] shall collect and maintain
43-21 the information required under this subchapter and shall monitor
43-22 compliance with the requirements of this subchapter.
43-23 (b) The commissioner [commission] may adopt rules as
43-24 necessary to enforce this subchapter.
43-25 (c) The commissioner [commission] may designate a data
43-26 collection agent, implement an electronic reporting and public
43-27 information access program, and adopt rules as necessary to
44-1 implement the data collection requirements of this subchapter. The
44-2 commissioner [executive director] may establish the form, manner,
44-3 and procedure for the transmission of information to the department
44-4 [commission as authorized by Section 402.042(b)(11)].
44-5 (d) The department [commission] may require an employer or
44-6 insurance carrier subject to this subtitle to identify or confirm
44-7 an employer's coverage status and claim administration contact
44-8 information as necessary to achieve the purposes of this subtitle.
44-9 SECTION 3.029. Section 406.010(c), Labor Code, is amended to
44-10 read as follows:
44-11 (c) The commissioner [commission] by rule shall further
44-12 specify the requirements of this section.
44-13 SECTION 3.030. Section 406.011(a), Labor Code, is amended to
44-14 read as follows:
44-15 (a) The commissioner [commission] by rule may require an
44-16 insurance carrier to designate a representative in Austin to act as
44-17 the insurance carrier's agent before the department [commission] in
44-18 Austin. Notice to the designated agent constitutes notice to the
44-19 insurance carrier.
44-20 SECTION 3.031. Section 406.012, Labor Code, is amended to
44-21 read as follows:
44-22 Sec. 406.012. ENFORCEMENT OF SUBCHAPTER. The commissioner
44-23 [commission] shall enforce the administrative penalties established
44-24 under this subchapter in accordance with Chapter 415.
44-25 SECTION 3.032. Section 406.051(c), Labor Code, is amended to
44-26 read as follows:
44-27 (c) The employer may not transfer:
45-1 (1) the obligation to accept a report of injury under
45-2 Section 409.001;
45-3 (2) the obligation to maintain records of injuries
45-4 under Section 409.006;
45-5 (3) the obligation to report injuries to the insurance
45-6 carrier under Section 409.005;
45-7 (4) liability for a violation of Section 415.006 or
45-8 415.008 or of Chapter 451; or
45-9 (5) the obligation to comply with a commissioner
45-10 [commission] order.
45-11 SECTION 3.033. Section 406.073(b), Labor Code, is amended to
45-12 read as follows:
45-13 (b) The employer shall file the agreement with the
45-14 department [executive director] on request.
45-15 SECTION 3.034. Sections 406.074(a) and (b), Labor Code, are
45-16 amended to read as follows:
45-17 (a) The commissioner [executive director] may enter into an
45-18 agreement with an appropriate agency of another jurisdiction with
45-19 respect to:
45-20 (1) conflicts of jurisdiction;
45-21 (2) assumption of jurisdiction in a case in which the
45-22 contract of employment arises in one state and the injury is
45-23 incurred in another;
45-24 (3) procedures for proceeding against a foreign
45-25 employer who fails to comply with this subtitle; and
45-26 (4) procedures for the appropriate agency to use to
45-27 proceed against an employer of this state who fails to comply with
46-1 the workers' compensation laws of the other jurisdiction.
46-2 (b) An executed agreement that has been adopted as a rule by
46-3 the commissioner [commission] binds all subject employers and
46-4 employees.
46-5 SECTION 3.035. Section 406.093(b), Labor Code, is amended to
46-6 read as follows:
46-7 (b) The commissioner [commission] by rule shall adopt
46-8 procedures relating to the method of payment of benefits to legally
46-9 incompetent employees.
46-10 SECTION 3.036. Section 406.095(b), Labor Code, is amended to
46-11 read as follows:
46-12 (b) The commissioner [commission] by rule shall establish
46-13 the procedures and requirements for an election under this section.
46-14 SECTION 3.037. Sections 406.144(c) and (d), Labor Code, are
46-15 amended to read as follows:
46-16 (c) An agreement under this section shall be filed with the
46-17 department [commission] either by personal delivery or by
46-18 registered or certified mail and is considered filed on receipt by
46-19 the department [commission].
46-20 (d) The hiring contractor shall send a copy of an agreement
46-21 under this section to the hiring contractor's workers' compensation
46-22 insurance carrier on filing of the agreement with the department
46-23 [commission].
46-24 SECTION 3.038. Sections 406.145(a), (b), (c), (d), and (f),
46-25 Labor Code, are amended to read as follows:
46-26 (a) A hiring contractor and an independent subcontractor may
46-27 make a joint agreement declaring that the subcontractor is an
47-1 independent contractor as defined in Section 406.141(2) and that
47-2 the subcontractor is not the employee of the hiring contractor. If
47-3 the joint agreement is signed by both the hiring contractor and the
47-4 subcontractor and filed with the department [commission], the
47-5 subcontractor, as a matter of law, is an independent contractor and
47-6 not an employee, and is not entitled to workers' compensation
47-7 insurance coverage through the hiring contractor unless an
47-8 agreement is entered into under Section 406.144 to provide workers'
47-9 compensation insurance coverage. The commissioner [commission]
47-10 shall prescribe forms for the joint agreement.
47-11 (b) A joint agreement shall be delivered to the department
47-12 [commission] by personal delivery or registered or certified mail
47-13 and is considered filed on receipt by the department [commission].
47-14 (c) The hiring contractor shall send a copy of a joint
47-15 agreement signed under this section to the hiring contractor's
47-16 workers' compensation insurance carrier on filing of the joint
47-17 agreement with the department [commission].
47-18 (d) The department [commission] shall maintain a system for
47-19 accepting and maintaining the joint agreements.
47-20 (f) If a subsequent hiring agreement is made to which the
47-21 joint agreement does not apply, the hiring contractor and
47-22 independent contractor shall notify the department [commission] and
47-23 the hiring contractor's workers' compensation insurance carrier in
47-24 writing.
47-25 SECTION 3.039. Section 406.162(b), Labor Code, is amended to
47-26 read as follows:
47-27 (b) The comptroller shall prepare a consumer price index for
48-1 this state and shall certify the applicable index factor to the
48-2 department [commission] before October 1 of each year. The
48-3 department [commission] shall adjust the gross annual payroll
48-4 requirement under Subsection (a)(2)(B) accordingly.
48-5 SECTION 3.040. Section 407.001(3), Labor Code, is amended to
48-6 read as follows:
48-7 (3) "Impaired employer" means a certified
48-8 self-insurer:
48-9 (A) who has suspended payment of compensation as
48-10 determined by the department [commission];
48-11 (B) who has filed for relief under bankruptcy
48-12 laws;
48-13 (C) against whom bankruptcy proceedings have
48-14 been filed; or
48-15 (D) for whom a receiver has been appointed by a
48-16 court of this state.
48-17 SECTION 3.041. Section 407.021, Labor Code, is amended to
48-18 read as follows:
48-19 Sec. 407.021. DIVISION. The division of self-insurance
48-20 regulation is a division of the department [commission].
48-21 SECTION 3.042. Section 407.022, Labor Code, is amended to
48-22 read as follows:
48-23 Sec. 407.022. DIRECTOR. (a) The commissioner [executive
48-24 director of the commission] shall appoint the director of the
48-25 division.
48-26 (b) The director shall exercise all the rights, powers, and
48-27 duties imposed or conferred on the department [commission] by this
49-1 chapter, other than by Section 407.023.
49-2 SECTION 3.043. Section 407.023, Labor Code, is amended to
49-3 read as follows:
49-4 Sec. 407.023. EXCLUSIVE POWERS AND DUTIES OF COMMISSIONER
49-5 [COMMISSION]. (a) The commissioner [commission, by majority
49-6 vote,] shall:
49-7 (1) approve or deny a recommendation by the director
49-8 concerning the issuance or revocation of a certificate of authority
49-9 to self-insure; and
49-10 (2) certify that a certified self-insurer has
49-11 suspended payment of compensation or has otherwise become an
49-12 impaired employer.
49-13 (b) The commissioner [commission] may not delegate the
49-14 powers and duties imposed by this section.
49-15 SECTION 3.044. Sections 407.041(a), (b), and (c), Labor
49-16 Code, are amended to read as follows:
49-17 (a) An employer who desires to self-insure under this
49-18 chapter must submit an application to the department [commission]
49-19 for a certificate of authority to self-insure.
49-20 (b) The application must be:
49-21 (1) submitted on a form adopted by the commissioner
49-22 [commission]; and
49-23 (2) accompanied by a nonrefundable $1,000 application
49-24 fee.
49-25 (c) Not later than the 60th day after the date on which the
49-26 application is received, the director shall recommend approval or
49-27 denial of the application to the department [commission].
50-1 SECTION 3.045. Section 407.042, Labor Code, is amended to
50-2 read as follows:
50-3 Sec. 407.042. ISSUANCE OF CERTIFICATE. With the approval of
50-4 the Texas Certified Self-Insurer Guaranty Association, [and by
50-5 majority vote,] the commissioner [commission] shall issue a
50-6 certificate of authority to self-insure to an applicant who meets
50-7 the certification requirements under this chapter and pays the
50-8 required fee.
50-9 SECTION 3.046. Section 407.043, Labor Code, is amended to
50-10 read as follows:
50-11 Sec. 407.043. PROCEDURES ON DENIAL OF APPLICATION. (a) If
50-12 the commissioner [commission] determines that an applicant for a
50-13 certificate of authority to self-insure does not meet the
50-14 certification requirements, the commissioner [commission] shall
50-15 notify the applicant in writing of its determination, stating the
50-16 specific reasons for the denial and the conditions to be met before
50-17 approval may be granted.
50-18 (b) The applicant is entitled to a reasonable period, as
50-19 determined by the commissioner [commission], to meet the conditions
50-20 for approval before the application is considered rejected for
50-21 purposes of appeal.
50-22 SECTION 3.047. Section 407.044(a), Labor Code, is amended to
50-23 read as follows:
50-24 (a) A certificate of authority to self-insure is valid for
50-25 one year after the date of issuance and may be renewed under
50-26 procedures prescribed by the commissioner [commission].
50-27 SECTION 3.048. Section 407.045, Labor Code, is amended to
51-1 read as follows:
51-2 Sec. 407.045. WITHDRAWAL FROM SELF-INSURANCE. (a) A
51-3 certified self-insurer may withdraw from self-insurance at any time
51-4 with the approval of the commissioner [commission]. The
51-5 commissioner [commission] shall approve the withdrawal if the
51-6 certified self-insurer shows to the satisfaction of the
51-7 commissioner [commission] that the certified self-insurer has
51-8 established an adequate program to pay all incurred losses,
51-9 including unreported losses, that arise out of accidents or
51-10 occupational diseases first distinctly manifested during the period
51-11 of operation as a certified self-insurer.
51-12 (b) A certified self-insurer who withdraws from
51-13 self-insurance shall surrender to the department [commission] the
51-14 certificate of authority to self-insure.
51-15 SECTION 3.049. Sections 407.046(a), (b), and (d), Labor
51-16 Code, are amended to read as follows:
51-17 (a) The commissioner [commission by majority vote] may
51-18 revoke the certificate of authority to self-insure of a certified
51-19 self-insurer who fails to comply with requirements or conditions
51-20 established by this chapter or a rule adopted by the commissioner
51-21 [commission] under this chapter.
51-22 (b) If the commissioner [commission] believes that a ground
51-23 exists to revoke a certificate of authority to self-insure, the
51-24 commissioner [commission] shall refer the matter to the State
51-25 Office of Administrative Hearings. That office shall hold a
51-26 hearing to determine if the certificate should be revoked. The
51-27 hearing shall be conducted in the manner provided for a contested
52-1 case hearing under Chapter 2001, Government Code (the
52-2 administrative procedure law).
52-3 (d) If the certified self-insurer fails to show cause why
52-4 the certificate should not be revoked, the commissioner
52-5 [commission] immediately shall revoke the certificate.
52-6 SECTION 3.050. Section 407.047(b), Labor Code, is amended to
52-7 read as follows:
52-8 (b) The security required under Sections 407.064 and 407.065
52-9 shall be maintained with the department [commission] or under the
52-10 department's [commission's] control until each claim for workers'
52-11 compensation benefits is paid, is settled, or lapses under this
52-12 subtitle.
52-13 SECTION 3.051. Sections 407.061(a), (c), (e), and (f), Labor
52-14 Code, are amended to read as follows:
52-15 (a) To be eligible for a certificate of authority to
52-16 self-insure, an applicant for an initial or renewal certificate
52-17 must present evidence satisfactory to the commissioner [commission]
52-18 and the association of sufficient financial strength and liquidity,
52-19 under standards adopted by the commissioner [commission], to ensure
52-20 that all workers' compensation obligations incurred by the
52-21 applicant under this chapter are met promptly.
52-22 (c) The applicant must present a plan for claims
52-23 administration that is acceptable to the commissioner [commission]
52-24 and that designates a qualified claims servicing contractor.
52-25 (e) The applicant must provide to the commissioner
52-26 [commission] a copy of each contract entered into with a person
52-27 that provides claims services, underwriting services, or accident
53-1 prevention services if the provider of those services is not an
53-2 employee of the applicant. The contract must be acceptable to the
53-3 commissioner [commission] and must be submitted in a standard form
53-4 adopted by the commissioner [commission], if the commissioner
53-5 [commission] adopts such a form.
53-6 (f) The commissioner [commission] shall adopt rules for the
53-7 requirements for the financial statements required by Subsection
53-8 (b)(2).
53-9 SECTION 3.052. Section 407.062, Labor Code, is amended to
53-10 read as follows:
53-11 Sec. 407.062. FINANCIAL STRENGTH AND LIQUIDITY REQUIREMENTS.
53-12 In assessing the financial strength and liquidity of an applicant,
53-13 the commissioner [commission] shall consider:
53-14 (1) the applicant's organizational structure and
53-15 management background;
53-16 (2) the applicant's profit and loss history;
53-17 (3) the applicant's compensation loss history;
53-18 (4) the source and reliability of the financial
53-19 information submitted by the applicant;
53-20 (5) the number of employees affected by
53-21 self-insurance;
53-22 (6) the applicant's access to excess insurance
53-23 markets;
53-24 (7) financial ratios, indexes, or other financial
53-25 measures that the commissioner [commission] finds appropriate; and
53-26 (8) any other information considered appropriate by
53-27 the commissioner [commission].
54-1 SECTION 3.053. Section 407.063(a), Labor Code, is amended to
54-2 read as follows:
54-3 (a) In addition to meeting the other certification
54-4 requirements imposed under this chapter, an applicant for an
54-5 initial certificate of authority to self-insure must present
54-6 evidence satisfactory to the commissioner [commission] of a total
54-7 unmodified workers' compensation insurance premium in this state in
54-8 the calendar year of application of at least $500,000.
54-9 SECTION 3.054. Section 407.064(b), Labor Code, is amended to
54-10 read as follows:
54-11 (b) If an applicant who has provided a letter of credit as
54-12 all or part of the security required under this section desires to
54-13 cancel the existing letter of credit and substitute a different
54-14 letter of credit or another form of security, the applicant shall
54-15 notify the department [commission] in writing not later than the
54-16 60th day before the effective date of the cancellation of the
54-17 original letter of credit.
54-18 SECTION 3.055. Sections 407.081(a), (b), (c), (d), (f), and
54-19 (g), Labor Code, are amended to read as follows:
54-20 (a) Each certified self-insurer shall file an annual report
54-21 with the department [commission]. The commissioner [commission]
54-22 shall prescribe the form of the report and shall furnish blank
54-23 forms for the preparation of the report to each certified
54-24 self-insurer.
54-25 (b) The report must:
54-26 (1) include payroll information, in the form
54-27 prescribed by this chapter and the department [commission];
55-1 (2) state the number of injuries sustained in the
55-2 three preceding calendar years; and
55-3 (3) indicate separately the amount paid during each
55-4 year for income benefits, medical benefits, death benefits, burial
55-5 benefits, and other proper expenses related to worker injuries.
55-6 (c) Each certified self-insurer shall file with the
55-7 department [commission] as part of the annual report annual
55-8 independent financial statements that reflect the financial
55-9 condition of the self-insurer. The department [commission] shall
55-10 make a financial statement filed under this subsection available
55-11 for public review.
55-12 (d) The department [commission] may require that the report
55-13 include additional financial and statistical information.
55-14 (f) The report must include an estimate of future liability
55-15 for compensation. The estimate must be signed and sworn to by a
55-16 certified casualty actuary every third year, or more frequently if
55-17 required by the commissioner [commission].
55-18 (g) If the commissioner [commission] considers it necessary,
55-19 it may order a certified self-insurer whose financial condition or
55-20 claims record warrants closer supervision to report as provided by
55-21 this section more often than annually.
55-22 SECTION 3.056. Sections 407.082(a), (c), and (d), Labor
55-23 Code, are amended to read as follows:
55-24 (a) Each certified self-insurer shall maintain the books,
55-25 records, and payroll information necessary to compile the annual
55-26 report required under Section 407.081 and any other information
55-27 reasonably required by the commissioner [commission].
56-1 (c) The material maintained by the certified self-insurer
56-2 shall be open to examination by an authorized agent or
56-3 representative of the department [commission] at reasonable times
56-4 to ascertain the correctness of the information.
56-5 (d) The examination may be conducted at any location,
56-6 including the department's [commission's] Austin offices, or, at
56-7 the certified self-insurer's option, in the offices of the
56-8 certified self-insurer. The certified self-insurer shall pay the
56-9 reasonable expenses, including travel expenses, of an inspector who
56-10 conducts an inspection at its offices.
56-11 SECTION 3.057. Section 407.101(b), Labor Code, is amended to
56-12 read as follows:
56-13 (b) The department [commission] shall deposit the
56-14 application fee for a certificate of authority to self-insure in
56-15 the state treasury to the credit of the workers' compensation
56-16 self-insurance fund.
56-17 SECTION 3.058. Section 407.102, Labor Code, is amended to
56-18 read as follows:
56-19 Sec. 407.102. REGULATORY FEE. (a) Each certified
56-20 self-insurer shall pay an annual fee to cover the administrative
56-21 costs incurred by the department [commission] in implementing this
56-22 chapter.
56-23 (b) The department [commission] shall base the fee on the
56-24 total amount of income benefit payments made in the preceding
56-25 calendar year. The department [commission] shall assess each
56-26 certified self-insurer a pro rata share based on the ratio that the
56-27 total amount of income benefit payments made by that certified
57-1 self-insurer bears to the total amount of income benefit payments
57-2 made by all certified self-insurers.
57-3 SECTION 3.059. Sections 407.103(a) and (d), Labor Code, are
57-4 amended to read as follows:
57-5 (a) Each certified self-insurer shall pay a self-insurer
57-6 maintenance tax for the administration of the department
57-7 [commission] and to support the prosecution of workers'
57-8 compensation insurance fraud in this state. Not more than two
57-9 percent of the total tax base of all certified self-insurers, as
57-10 computed under Subsection (b), may be assessed for a maintenance
57-11 tax under this section.
57-12 (d) In setting the rate of maintenance tax assessment for
57-13 insurance companies, the commissioner [commission] may not consider
57-14 revenue or expenditures related to the division.
57-15 SECTION 3.060. Sections 407.104(b), (c), and (e), Labor
57-16 Code, are amended to read as follows:
57-17 (b) The department [commission] shall compute the fee and
57-18 taxes of a certified self-insurer and notify the certified
57-19 self-insurer of the amounts due. The taxes and fees shall be
57-20 remitted to the department [commission].
57-21 (c) The regulatory fee imposed under Section 407.102 shall
57-22 be deposited in the state treasury to the credit of the workers'
57-23 compensation self-insurance fund. The self-insurer maintenance tax
57-24 shall be deposited in the state treasury to the credit of the
57-25 department [commission].
57-26 (e) If the certificate of authority to self-insure of a
57-27 certified self-insurer is terminated, the insurance commissioner or
58-1 the commissioner [executive director of the commission] shall
58-2 proceed immediately to collect taxes due under this subtitle, using
58-3 legal process as necessary.
58-4 SECTION 3.061. Sections 407.122(b) and (c), Labor Code, are
58-5 amended to read as follows:
58-6 (b) The board of directors is composed of the following
58-7 voting members:
58-8 (1) three certified self-insurers;
58-9 (2) the commissioner [one commission member
58-10 representing wage earners;]
58-11 [(3) one commission member representing employers];
58-12 and
58-13 (3) [(4)] the public counsel of the office of public
58-14 insurance counsel.
58-15 (c) The [executive director of the commission and the]
58-16 director of the division of self-insurance regulation serves
58-17 [serve] as a nonvoting member [members] of the board of directors.
58-18 SECTION 3.062. Section 407.123(b), Labor Code, is amended to
58-19 read as follows:
58-20 (b) Rules adopted by the board are subject to the approval
58-21 of the commissioner [commission].
58-22 SECTION 3.063. Sections 407.124(a) and (c), Labor Code, are
58-23 amended to read as follows:
58-24 (a) On determination by the commissioner [commission] that a
58-25 certified self-insurer has become an impaired employer, the
58-26 director shall secure release of the security deposit required by
58-27 this chapter and shall promptly estimate:
59-1 (1) the amount of additional funds needed to
59-2 supplement the security deposit;
59-3 (2) the available assets of the impaired employer for
59-4 the purpose of making payment of all incurred liabilities for
59-5 compensation; and
59-6 (3) the funds maintained by the association for the
59-7 emergency payment of compensation liabilities.
59-8 (c) A certified self-insurer designated as an impaired
59-9 employer is exempt from assessments beginning on the date of the
59-10 designation until the commissioner [commission] determines that the
59-11 employer is no longer impaired.
59-12 SECTION 3.064. Section 407.126(d), Labor Code, is amended to
59-13 read as follows:
59-14 (d) The board of directors shall administer the trust fund
59-15 in accordance with rules adopted by the commissioner [commission].
59-16 SECTION 3.065. Section 407.127(a), Labor Code, is amended to
59-17 read as follows:
59-18 (a) If the commissioner [commission] determines that the
59-19 payment of benefits and claims administration shall be made through
59-20 the association, the association assumes the workers' compensation
59-21 obligations of the impaired employer and shall begin the payment of
59-22 the obligations for which it is liable not later than the 30th day
59-23 after the date of notification by the director.
59-24 SECTION 3.066. Section 407.133(a), Labor Code, is amended to
59-25 read as follows:
59-26 (a) The commissioner [commission, after notice and hearing
59-27 and by majority vote,] may suspend or revoke the certificate of
60-1 authority to self-insure of a certified self-insurer who fails to
60-2 pay an assessment. The association promptly shall report such a
60-3 failure to the director.
60-4 SECTION 3.067. Section 408.003(c), Labor Code, is amended to
60-5 read as follows:
60-6 (c) The employer shall notify the department [commission]
60-7 and the insurance carrier on forms prescribed by the commissioner
60-8 [commission] of the initiation of and amount of payments made under
60-9 this section.
60-10 SECTION 3.068. Sections 408.004(a), (b), (d), (e), and (f),
60-11 Labor Code, are amended to read as follows:
60-12 (a) The commissioner [commission] may require an employee to
60-13 submit to medical examinations to resolve any question about:
60-14 (1) the appropriateness of the health care received by
60-15 the employee;
60-16 (2) the impairment caused by the compensable injury;
60-17 (3) the attainment of maximum medical improvement; or
60-18 (4) similar issues.
60-19 (b) The commissioner [commission] may require an employee to
60-20 submit to a medical examination at the request of the insurance
60-21 carrier, but only after the insurance carrier has attempted and
60-22 failed to receive the permission and concurrence of the employee
60-23 for the examination. Except as otherwise provided by this
60-24 subsection, the insurance carrier is entitled to the examination
60-25 only once in a 180-day period. The commissioner [commission] may
60-26 adopt rules that require an employee to submit to not more than
60-27 three medical examinations in a 180-day period under specified
61-1 circumstances, including to determine whether there has been a
61-2 change in the employee's condition, whether it is necessary to
61-3 change the employee's diagnosis, and whether treatment should be
61-4 extended to another body part or system. The commissioner
61-5 [commission] by rule shall adopt a system for monitoring requests
61-6 made under this subsection by insurance carriers. That system must
61-7 ensure that good cause exists for any additional medical
61-8 examination allowed under this subsection that is not requested by
61-9 the employee. A subsequent examination must be performed by the
61-10 same doctor unless otherwise approved by the commissioner
61-11 [commission].
61-12 (d) An injured employee is entitled to have a doctor of the
61-13 employee's choice present at an examination required by the
61-14 commission at the request of an insurance carrier. The insurance
61-15 carrier shall pay a fee set by the commissioner [commission] to the
61-16 doctor selected by the employee.
61-17 (e) An employee who, without good cause as determined by the
61-18 commissioner [commission], fails or refuses to appear at the time
61-19 scheduled for an examination under Subsection (a) or (b) commits a
61-20 violation. A violation under this subsection is a Class D
61-21 administrative violation. An employee is not entitled to temporary
61-22 income benefits, and an insurance carrier may suspend the payment
61-23 of temporary income benefits, during and for a period in which the
61-24 employee fails to submit to an examination under Subsection (a) or
61-25 (b) unless the commissioner [commission] determines that the
61-26 employee had good cause for the failure to submit to the
61-27 examination. The commissioner [commission] may order temporary
62-1 income benefits to be paid for the period that the commissioner
62-2 [commission] determines the employee had good cause. The
62-3 commissioner [commission] by rule shall ensure that an employee
62-4 receives reasonable notice of an examination and of the insurance
62-5 carrier's basis for suspension of payment, and that the employee is
62-6 provided a reasonable opportunity to reschedule an examination
62-7 missed by the employee for good cause.
62-8 (f) If the report of a doctor selected by an insurance
62-9 carrier indicates that an employee can return to work immediately
62-10 or has reached maximum medical improvement, the insurance carrier
62-11 may suspend or reduce the payment of temporary income benefits on
62-12 the 14th day after the date on which the insurance carrier files a
62-13 notice of suspension with the department [commission] as provided
62-14 by this subsection. The commissioner [commission] shall hold an
62-15 expedited benefit review conference, by personal appearance or by
62-16 telephone, not later than the 10th day after the date on which the
62-17 department [commission] receives the insurance carrier's notice of
62-18 suspension. If a benefit review conference is not held by the 14th
62-19 day after the date on which the department [commission] receives
62-20 the insurance carrier's notice of suspension, an interlocutory
62-21 order, effective from the date of the report certifying maximum
62-22 medical improvement, is automatically entered for the continuation
62-23 of temporary income benefits until a benefit review conference is
62-24 held, and the insurance carrier is eligible for reimbursement for
62-25 any overpayment of benefits as provided by Chapter 410. The
62-26 department [commission] is not required to automatically schedule a
62-27 contested case hearing as required by Section 410.025(b) if a
63-1 benefit review conference is scheduled under this subsection. If a
63-2 benefit review conference is held not later than the 14th day, the
63-3 commissioner [commission] may enter an interlocutory order for the
63-4 continuation of benefits, and the insurance carrier is eligible for
63-5 reimbursement for any overpayments of benefits as provided by
63-6 Chapter 410. The commissioner [commission] shall adopt rules as
63-7 necessary to implement this subsection under which:
63-8 (1) an insurance carrier is required to notify the
63-9 employee and the treating doctor of the suspension of benefits
63-10 under this subsection by certified mail or another verifiable
63-11 delivery method;
63-12 (2) the commissioner [commission] makes a reasonable
63-13 attempt to obtain the treating doctor's opinion before the
63-14 commissioner [commission] makes a determination regarding the entry
63-15 of an interlocutory order; and
63-16 (3) the commissioner [commission] may allow
63-17 abbreviated contested case hearings by personal appearance or
63-18 telephone to consider issues relating to overpayment of benefits
63-19 under this section.
63-20 SECTION 3.069. Section 408.005(e), Labor Code, is amended to
63-21 read as follows:
63-22 (e) The director of the division of hearings shall approve a
63-23 settlement if the director is satisfied that:
63-24 (1) the settlement accurately reflects the agreement
63-25 between the parties;
63-26 (2) the settlement reflects adherence to all
63-27 appropriate provisions of law and the policies of the department
64-1 [commission]; and
64-2 (3) under the law and facts, the settlement is in the
64-3 best interest of the claimant.
64-4 SECTION 3.070. Sections 408.022(a), (b), and (c), Labor
64-5 Code, are amended to read as follows:
64-6 (a) Except in an emergency, the department [commission]
64-7 shall require an employee to receive medical treatment from a
64-8 doctor chosen from a list of doctors approved by the commissioner
64-9 [commission]. A doctor may perform only those procedures that are
64-10 within the scope of the practice for which the doctor is licensed.
64-11 The employee is entitled to the employee's initial choice of a
64-12 doctor from the department's [commission's] list.
64-13 (b) If an employee is dissatisfied with the initial choice
64-14 of a doctor from the department's [commission's] list, the employee
64-15 may notify the department [commission] and request authority to
64-16 select an alternate doctor. The notification must be in writing
64-17 stating the reasons for the change, except notification may be by
64-18 telephone when a medical necessity exists for immediate change.
64-19 (c) The commissioner [commission] shall prescribe criteria
64-20 to be used by the department [commission] in granting the employee
64-21 authority to select an alternate doctor. The criteria may include:
64-22 (1) whether treatment by the current doctor is
64-23 medically inappropriate;
64-24 (2) the professional reputation of the doctor;
64-25 (3) whether the employee is receiving appropriate
64-26 medical care to reach maximum medical improvement; and
64-27 (4) whether a conflict exists between the employee and
65-1 the doctor to the extent that the doctor-patient relationship is
65-2 jeopardized or impaired.
65-3 SECTION 3.071. Section 408.023, Labor Code, is amended to
65-4 read as follows:
65-5 Sec. 408.023. LIST OF APPROVED DOCTORS. (a) Each doctor
65-6 licensed in this state on January 1, 1993, is on the department's
65-7 [commission's] list of approved doctors unless subsequently deleted
65-8 and not reinstated. The name of a doctor shall be placed on the
65-9 list of approved doctors when that doctor becomes licensed in this
65-10 state. A doctor not licensed in this state but licensed in another
65-11 state or jurisdiction who treats employees may apply to the
65-12 department [commission] to be included on the list.
65-13 (b) The commissioner [commission] shall establish criteria
65-14 for deleting a doctor from the list of approved doctors. The
65-15 criteria may include anything the commissioner [commission]
65-16 considers relevant, including:
65-17 (1) sanctions of the doctor by the commissioner
65-18 [commission] for violations of Chapter 413 or Chapter 415;
65-19 (2) sanctions by the Medicare or Medicaid program for:
65-20 (A) substandard medical care;
65-21 (B) overcharging; or
65-22 (C) overutilization of medical services;
65-23 (3) evidence from the department's [commission's]
65-24 medical records that the doctor's charges, fees, diagnoses, or
65-25 treatments are substantially different from those the commissioner
65-26 [commission] finds to be fair and reasonable; and
65-27 (4) suspension of the doctor's license by the
66-1 appropriate licensing authority.
66-2 (c) The department [commission] shall establish procedures
66-3 for a doctor to apply for reinstatement to the list.
66-4 SECTION 3.072. Section 408.024, Labor Code, is amended to
66-5 read as follows:
66-6 Sec. 408.024. NONCOMPLIANCE WITH SELECTION REQUIREMENTS.
66-7 Except as otherwise provided, and after notice and an opportunity
66-8 for hearing, the commissioner [commission] may relieve an insurance
66-9 carrier of liability for health care that is furnished by a health
66-10 care provider or another person selected in a manner inconsistent
66-11 with the requirements of this subchapter.
66-12 SECTION 3.073. Sections 408.025(a), (b), and (d), Labor
66-13 Code, are amended to read as follows:
66-14 (a) The commissioner [commission] by rule shall adopt
66-15 requirements for reports and records that are required to be filed
66-16 with the department [commission] or provided to the injured
66-17 employee, the employee's attorney, or the insurance carrier by a
66-18 health care provider.
66-19 (b) The commissioner [commission] by rule shall adopt
66-20 requirements for reports and records that are to be made available
66-21 by a health care provider to another health care provider to
66-22 prevent unnecessary duplication of tests and examinations.
66-23 (d) On the request of an injured employee, the employee's
66-24 attorney, or the insurance carrier, a health care provider shall
66-25 furnish records relating to treatment or hospitalization for which
66-26 compensation is being sought. The department [commission] may
66-27 regulate the charge for furnishing a report or record, but the
67-1 charge may not be less than the fair and reasonable charge for
67-2 furnishing the report or record. A health care provider may
67-3 disclose to the insurance carrier of an affected employer records
67-4 relating to the diagnosis or treatment of the injured employee
67-5 without the authorization of the injured employee to determine the
67-6 amount of payment or the entitlement to payment.
67-7 SECTION 3.074. Section 408.026, Labor Code, is amended to
67-8 read as follows:
67-9 Sec. 408.026. SPINAL SURGERY SECOND OPINION. (a) Except in
67-10 a medical emergency, an insurance carrier is liable for medical
67-11 costs related to spinal surgery only if:
67-12 (1) before surgery, the employee obtains from a doctor
67-13 approved by the insurance carrier or the commissioner [commission]
67-14 a second opinion that concurs with the treating doctor's
67-15 recommendation;
67-16 (2) the insurance carrier waives the right to an
67-17 examination or fails to request an examination before the 15th day
67-18 after the date of the notification that surgery is recommended; or
67-19 (3) the commissioner [commission] determines that
67-20 extenuating circumstances exist and orders payment for surgery.
67-21 (b) The commissioner [commission] shall adopt rules
67-22 necessary to ensure that an examination required under this section
67-23 is performed without undue delay.
67-24 SECTION 3.075. Section 408.027(d), Labor Code, is amended
67-25 to read as follows:
67-26 (d) If an insurance carrier disputes the amount of payment
67-27 or the health care provider's entitlement to payment, the insurance
68-1 carrier shall send to the department [commission], the health care
68-2 provider, and the injured employee a report that sufficiently
68-3 explains the reasons for the reduction or denial of payment for
68-4 health care services provided to the employee. The insurance
68-5 carrier is entitled to a hearing as provided by Section 413.031(d).
68-6 SECTION 3.076. Section 408.041(c), Labor Code, is amended to
68-7 read as follows:
68-8 (c) If Subsection (a) or (b) cannot reasonably be applied
68-9 because the employee's employment has been irregular or because the
68-10 employee has lost time from work during the 13-week period
68-11 immediately preceding the injury because of illness, weather, or
68-12 another cause beyond the control of the employee, the commissioner
68-13 [commission] may determine the employee's average weekly wage by
68-14 any method that the commissioner [commission] considers fair, just,
68-15 and reasonable to all parties and consistent with the methods
68-16 established under this section.
68-17 SECTION 3.077. Section 408.043(c), Labor Code, is amended to
68-18 read as follows:
68-19 (c) If, for good reason, the commissioner [commission]
68-20 determines that computing the average weekly wage for a seasonal
68-21 employee as provided by this section is impractical, the
68-22 commissioner [commission] shall compute the average weekly wage as
68-23 of the time of the injury in a manner that is fair and just to both
68-24 parties.
68-25 SECTION 3.078. Section 408.045, Labor Code, is amended to
68-26 read as follows:
68-27 Sec. 408.045. NONPECUNIARY WAGES. The commissioner
69-1 [commission] may not include nonpecuniary wages in computing an
69-2 employee's average weekly wage during a period in which the
69-3 employer continues to provide the nonpecuniary wages.
69-4 SECTION 3.079. Section 408.061(f), Labor Code, is amended to
69-5 read as follows:
69-6 (f) The commissioner [commission] shall compute the maximum
69-7 weekly income benefits for each state fiscal year not later than
69-8 September 1 of each year.
69-9 SECTION 3.080. Section 408.062(b), Labor Code, is amended to
69-10 read as follows:
69-11 (b) The commissioner [commission] shall compute the minimum
69-12 weekly income benefit for each state fiscal year not later than
69-13 September 1 of each year.
69-14 SECTION 3.081. Section 408.063(a), Labor Code, is amended to
69-15 read as follows:
69-16 (a) To expedite the payment of income benefits, the
69-17 commissioner [commission] may by rule establish reasonable
69-18 presumptions relating to the wages earned by an employee, including
69-19 the presumption that an employee's last paycheck accurately
69-20 reflects the employee's usual wage.
69-21 SECTION 3.082. Sections 408.081(b) and (c), Labor Code, are
69-22 amended to read as follows:
69-23 (b) Except as otherwise provided by this section or this
69-24 subtitle, income benefits shall be paid weekly as and when they
69-25 accrue without order from the commissioner [commission]. Interest
69-26 on accrued but unpaid benefits shall be paid, without order of the
69-27 commissioner [commission], at the time the accrued benefits are
70-1 paid.
70-2 (c) The commissioner [commission] by rule shall establish
70-3 requirements for agreements under which income benefits may be paid
70-4 monthly. Income benefits may be paid monthly only:
70-5 (1) on the request of the employee and the agreement
70-6 of the employee and the insurance carrier; and
70-7 (2) in compliance with the requirements adopted by the
70-8 commissioner [commission].
70-9 SECTION 3.083. Sections 408.084(a) and (b), Labor Code, are
70-10 amended to read as follows:
70-11 (a) At the request of the insurance carrier, the
70-12 commissioner [commission] may order that impairment income benefits
70-13 and supplemental income benefits be reduced in a proportion equal
70-14 to the proportion of a documented impairment that resulted from
70-15 earlier compensable injuries.
70-16 (b) The commissioner [commission] shall consider the
70-17 cumulative impact of the compensable injuries on the employee's
70-18 overall impairment in determining a reduction under this section.
70-19 SECTION 3.084. Section 408.085, Labor Code, is amended to
70-20 read as follows:
70-21 Sec. 408.085. ADVANCE OF BENEFITS FOR HARDSHIP. (a) If
70-22 there is a likelihood that income benefits will be paid, the
70-23 commissioner [commission] may grant an employee suffering financial
70-24 hardship advances as provided by this subtitle against the amount
70-25 of income benefits to which the employee may be entitled. An
70-26 advance may be ordered before or after the employee attains maximum
70-27 medical improvement. An insurance carrier shall pay the advance
71-1 ordered.
71-2 (b) An employee must apply to the department [commission]
71-3 for an advance on a form prescribed by the commissioner
71-4 [commission]. The application must describe the hardship that is
71-5 the grounds for the advance.
71-6 (c) An advance under this section may not exceed an amount
71-7 equal to four times the maximum weekly benefit for temporary income
71-8 benefits as computed in Section 408.061. The commissioner
71-9 [commission] may not grant more than three advances to a particular
71-10 employee based on the same injury.
71-11 (d) The commissioner [commission] may not grant an advance
71-12 to an employee who is receiving, on the date of the application
71-13 under Subsection (b), at least 90 percent of the employee's net
71-14 preinjury wages under Section 408.003 or 408.129.
71-15 SECTION 3.085. Section 408.086, Labor Code, is amended to
71-16 read as follows:
71-17 Sec. 408.086. DEPARTMENT [COMMISSION] DETERMINATION OF
71-18 EXTENDED UNEMPLOYMENT OR UNDEREMPLOYMENT. (a) During the period
71-19 that impairment income benefits or supplemental income benefits are
71-20 being paid to an employee, the commissioner [commission] shall
71-21 determine at least annually whether any extended unemployment or
71-22 underemployment is a direct result of the employee's impairment.
71-23 (b) To make this determination, the commissioner
71-24 [commission] may require periodic reports from the employee and the
71-25 insurance carrier and, at the insurance carrier's expense, may
71-26 require physical or other examinations, vocational assessments, or
71-27 other tests or diagnoses necessary to perform its duty under this
72-1 section and Subchapter H.
72-2 SECTION 3.086. Section 408.102(b), Labor Code, is amended to
72-3 read as follows:
72-4 (b) The commissioner [commission] by rule shall establish a
72-5 presumption that maximum medical improvement has been reached based
72-6 on a lack of medical improvement in the employee's condition.
72-7 SECTION 3.087. Section 408.103(b), Labor Code, is amended to
72-8 read as follows:
72-9 (b) A temporary income benefit under Subsection (a)(2) may
72-10 not exceed the employee's actual earnings for the previous year.
72-11 It is presumed that the employee's actual earnings for the previous
72-12 year are equal to:
72-13 (1) the sum of the employee's wages as reported in the
72-14 most recent four quarterly wage reports to the Texas Workforce
72-15 [Employment] Commission divided by 52;
72-16 (2) the employee's wages in the single quarter of the
72-17 most recent four quarters in which the employee's earnings were
72-18 highest, divided by 13, if the commissioner [commission] finds that
72-19 the employee's most recent four quarters' earnings reported in the
72-20 Texas Workforce [Employment] Commission wage reports are not
72-21 representative of the employee's usual earnings; or
72-22 (3) the amount the commissioner [commission]
72-23 determines from other credible evidence to be the actual earnings
72-24 for the previous year if the Texas Workforce [Employment]
72-25 Commission does not have a wage report reflecting at least one
72-26 quarter's earnings because the employee worked outside the state
72-27 during the previous year.
73-1 SECTION 3.088. Sections 408.104(a) and (c), Labor Code, are
73-2 amended to read as follows:
73-3 (a) On application by either the employee or the insurance
73-4 carrier, the commissioner [commission] by order may extend the
73-5 104-week period described by Section 401.011(30)(B) if the employee
73-6 has had spinal surgery, or has been approved for spinal surgery
73-7 under Section 408.026 and commissioner [commission] rules, within
73-8 12 weeks before the expiration of the 104-week period. If an order
73-9 is issued under this section, the order shall extend the statutory
73-10 period for maximum medical improvement to a date certain, based on
73-11 medical evidence presented to the commissioner [commission].
73-12 (c) The commissioner [commission] shall adopt rules to
73-13 implement this section, including rules establishing procedures for
73-14 requesting and disputing an extension.
73-15 SECTION 3.089. Sections 408.122(b) and (c), Labor Code, are
73-16 amended to read as follows:
73-17 (b) To be eligible to serve as a designated doctor, a doctor
73-18 must meet specific qualifications, including training in the
73-19 determination of impairment ratings. The commissioner [executive
73-20 director] shall develop qualification standards and administrative
73-21 policies to implement this subsection, and [the commission] may
73-22 adopt rules as necessary. To the extent possible, a designated
73-23 doctor must be in the same discipline and licensed by the same
73-24 board of examiners as the employee's doctor of choice.
73-25 (c) If a dispute exists as to whether the employee has
73-26 reached maximum medical improvement, the commissioner [commission]
73-27 shall direct the employee to be examined by a designated doctor
74-1 chosen by mutual agreement of the parties. If the parties are
74-2 unable to agree on a designated doctor, the commissioner
74-3 [commission] shall direct the employee to be examined by a
74-4 designated doctor chosen by the department [commission]. The
74-5 designated doctor shall report to the department [commission]. The
74-6 report of the designated doctor has presumptive weight, and the
74-7 department [commission] shall base its determination of whether the
74-8 employee has reached maximum medical improvement on the report
74-9 unless the great weight of the other medical evidence is to the
74-10 contrary.
74-11 SECTION 3.090. Sections 408.123(b) and (c), Labor Code, are
74-12 amended to read as follows:
74-13 (b) A certifying doctor shall issue a written report
74-14 certifying that maximum medical improvement has been reached,
74-15 stating the employee's impairment rating, and providing any other
74-16 information required by the commissioner [commission] to:
74-17 (1) the department [commission];
74-18 (2) the employee; and
74-19 (3) the insurance carrier.
74-20 (c) If an employee is not certified as having reached
74-21 maximum medical improvement before the expiration of 102 weeks
74-22 after the date income benefits begin to accrue, the department
74-23 [commission] shall notify the treating doctor of the requirements
74-24 of this subchapter.
74-25 SECTION 3.091. Section 408.124, Labor Code, is amended to
74-26 read as follows:
74-27 Sec. 408.124. IMPAIRMENT RATING GUIDELINES. (a) An award
75-1 of an impairment income benefit, whether by the commissioner
75-2 [commission] or a court, shall be made on an impairment rating
75-3 determined using the impairment rating guidelines described in this
75-4 section.
75-5 (b) For determining the existence and degree of an
75-6 employee's impairment, the commissioner [commission] shall use
75-7 "Guides to the Evaluation of Permanent Impairment," third edition,
75-8 second printing, dated February 1989, published by the American
75-9 Medical Association.
75-10 (c) Notwithstanding Subsection (b), the commissioner
75-11 [commission] by rule may adopt the fourth edition of the "Guides to
75-12 the Evaluation of Permanent Impairment," published by the American
75-13 Medical Association, for determining the existence and degree of an
75-14 employee's impairment.
75-15 SECTION 3.092. Sections 408.125(a), (b), (c), (d), (e), and
75-16 (f), Labor Code, are amended to read as follows:
75-17 (a) If an impairment rating is disputed, the commissioner
75-18 [commission] shall direct the employee to be examined by a
75-19 designated doctor chosen by mutual agreement of the parties.
75-20 (b) If the parties are unable to agree on a designated
75-21 doctor, the commissioner [commission] shall direct the employee to
75-22 be examined by a designated doctor chosen by the department
75-23 [commission].
75-24 (c) The designated doctor shall report in writing to the
75-25 department [commission].
75-26 (d) If the designated doctor is chosen by the parties, the
75-27 department [commission] shall adopt the impairment rating made by
76-1 the designated doctor.
76-2 (e) If the designated doctor is chosen by the department
76-3 [commission], the report of the designated doctor shall have
76-4 presumptive weight, and the commissioner [commission] shall base
76-5 the impairment rating on that report unless the great weight of the
76-6 other medical evidence is to the contrary. If the great weight of
76-7 the medical evidence contradicts the impairment rating contained in
76-8 the report of the designated doctor chosen by the department
76-9 [commission], the commissioner [commission] shall adopt the
76-10 impairment rating of one of the other doctors.
76-11 (f) To avoid undue influence on a person selected as a
76-12 designated doctor under this section, only the injured employee or
76-13 an appropriate member of the staff of the department [commission]
76-14 may communicate with the designated doctor about the case regarding
76-15 the injured employee's medical condition or history before the
76-16 examination of the injured employee by the designated doctor. After
76-17 that examination is completed, communication with the designated
76-18 doctor regarding the injured employee's medical condition or
76-19 history may be made only through appropriate department
76-20 [commission] staff members. The designated doctor may initiate
76-21 communication with any doctor who has previously treated or
76-22 examined the injured employee for the work-related injury.
76-23 SECTION 3.093. Section 408.127(c), Labor Code, is amended to
76-24 read as follows:
76-25 (c) The commissioner [commission] shall adopt rules and
76-26 forms to ensure the full reporting and the accuracy of reductions
76-27 and reimbursements made under this section.
77-1 SECTION 3.094. Sections 408.129(a), (b), and (d), Labor
77-2 Code, are amended to read as follows:
77-3 (a) On approval by the commissioner [commission] of a
77-4 written request received from an employee, an insurance carrier
77-5 shall accelerate the payment of impairment income benefits to the
77-6 employee. The accelerated payment may not exceed a rate of payment
77-7 equal to that of the employee's net preinjury wage.
77-8 (b) The commissioner [commission] shall approve the request
77-9 and order the acceleration of the benefits if the commissioner
77-10 [commission] determines that the acceleration is:
77-11 (1) required to relieve hardship; and
77-12 (2) in the overall best interest of the employee.
77-13 (d) The commissioner [commission] may prescribe forms
77-14 necessary to implement this section.
77-15 SECTION 3.095. Section 408.141, Labor Code, is amended to
77-16 read as follows:
77-17 Sec. 408.141. AWARD OF SUPPLEMENTAL INCOME BENEFITS. An
77-18 award of a supplemental income benefit, whether by the commissioner
77-19 [commission] or a court, shall be made in accordance with this
77-20 subchapter.
77-21 SECTION 3.096. Sections 408.143(a) and (b), Labor Code, are
77-22 amended to read as follows:
77-23 (a) After the commissioner's [commission's] initial
77-24 determination of supplemental income benefits, the employee must
77-25 file a statement with the insurance carrier stating:
77-26 (1) that the employee has earned less than 80 percent
77-27 of the employee's average weekly wage as a direct result of the
78-1 employee's impairment;
78-2 (2) the amount of wages the employee earned in the
78-3 filing period provided by Subsection (b); and
78-4 (3) that the employee has in good faith sought
78-5 employment commensurate with the employee's ability to work.
78-6 (b) The statement required under this section must be filed
78-7 quarterly on a form and in the manner provided by the commissioner
78-8 [commission]. The commissioner [commission] may modify the filing
78-9 period as appropriate to an individual case.
78-10 SECTION 3.097. Section 408.147(c), Labor Code, is amended to
78-11 read as follows:
78-12 (c) If an insurance carrier disputes the commissioner's [a
78-13 commission] determination that an employee is entitled to
78-14 supplemental income benefits or the amount of supplemental income
78-15 benefits due and the employee prevails on any disputed issue, the
78-16 insurance carrier is liable for reasonable and necessary attorney's
78-17 fees incurred by the employee as a result of the insurance
78-18 carrier's dispute and for supplemental income benefits accrued but
78-19 not paid and interest on that amount, according to Section 408.064.
78-20 Attorney's fees awarded under this subsection are not subject to
78-21 Sections 408.221(b), (e), and (h).
78-22 SECTION 3.098. Section 408.148, Labor Code, is amended to
78-23 read as follows:
78-24 Sec. 408.148. EMPLOYEE DISCHARGE AFTER TERMINATION. The
78-25 commissioner [commission] may reinstate supplemental income
78-26 benefits to an employee who is discharged within 12 months of the
78-27 date of losing entitlement to supplemental income benefits under
79-1 Section 408.146(c) if the commissioner [commission] finds that the
79-2 employee was discharged at that time with the intent to deprive the
79-3 employee of supplemental income benefits.
79-4 SECTION 3.099. Section 408.149, Labor Code, is amended to
79-5 read as follows:
79-6 Sec. 408.149. STATUS REVIEW; BENEFIT REVIEW CONFERENCE. (a)
79-7 Not more than once in each period of 12 calendar months, an
79-8 employee and an insurance carrier each may request the commissioner
79-9 [commission] to review the status of the employee and determine
79-10 whether the employee's unemployment or underemployment is a direct
79-11 result of impairment from the compensable injury.
79-12 (b) Either party may request a benefit review conference to
79-13 contest a determination of the commissioner [commission] at any
79-14 time, subject only to the limits placed on the insurance carrier by
79-15 Section 408.147.
79-16 SECTION 3.100. Section 408.150(a), Labor Code, is amended to
79-17 read as follows:
79-18 (a) The department [commission] shall refer an employee to
79-19 the Texas Rehabilitation Commission with a recommendation for
79-20 appropriate services if the department [commission] determines that
79-21 an employee entitled to supplemental income benefits could be
79-22 materially assisted by vocational rehabilitation or training in
79-23 returning to employment or returning to employment more nearly
79-24 approximating the employee's preinjury employment. The department
79-25 [commission] shall also notify insurance carriers of the need for
79-26 vocational rehabilitation or training services. The insurance
79-27 carrier may provide services through a private provider of
80-1 vocational rehabilitation services under Section 409.012.
80-2 SECTION 3.101. Sections 408.151(b) and (c), Labor Code, are
80-3 amended to read as follows:
80-4 (b) If a dispute exists as to whether the employee's medical
80-5 condition has improved sufficiently to allow the employee to return
80-6 to work, the commissioner [commission] shall direct the employee to
80-7 be examined by a designated doctor chosen by the department
80-8 [commission]. The designated doctor shall report to the department
80-9 [commission]. The report of the designated doctor has presumptive
80-10 weight, and the commission shall base its determination of whether
80-11 the employee's medical condition has improved sufficiently to allow
80-12 the employee to return to work on that report unless the great
80-13 weight of the other medical evidence is to the contrary.
80-14 (c) The commissioner [commission] may require an employee to
80-15 whom Subsection (a) applies to submit to a medical examination
80-16 under Section 408.004 only to determine whether the employee's
80-17 medical condition is a direct result of impairment from a
80-18 compensable injury.
80-19 SECTION 3.102. Section 408.161(d), Labor Code, is amended to
80-20 read as follows:
80-21 (d) An insurance carrier may pay lifetime income benefits
80-22 through an annuity if the annuity agreement meets the terms and
80-23 conditions for annuity agreements adopted by the commissioner
80-24 [commission] by rule. The establishment of an annuity under this
80-25 subsection does not relieve the insurance carrier of the liability
80-26 under this title for ensuring that the lifetime income benefits are
80-27 paid.
81-1 SECTION 3.103. Sections 408.181(c) and (d), Labor Code, are
81-2 amended to read as follows:
81-3 (c) The commissioner [commission] by rule shall establish
81-4 requirements for agreements under which death benefits may be paid
81-5 monthly. Death benefits may be paid monthly only:
81-6 (1) on the request of the legal beneficiary and the
81-7 agreement of the legal beneficiary and the insurance carrier; and
81-8 (2) in compliance with the requirements adopted by the
81-9 commissioner [commission].
81-10 (d) An insurance carrier may pay death benefits through an
81-11 annuity if the annuity agreement meets the terms and conditions for
81-12 annuity agreements adopted by the commissioner [commission] by
81-13 rule. The establishment of an annuity under this subsection does
81-14 not relieve the insurance carrier of the liability under this title
81-15 for ensuring that the death benefits are paid.
81-16 SECTION 3.104. Section 408.182(f), Labor Code, is amended to
81-17 read as follows:
81-18 (f) In this section:
81-19 (1) "Eligible child" means a child of a deceased
81-20 employee if the child is:
81-21 (A) a minor;
81-22 (B) enrolled as a full-time student in an
81-23 accredited educational institution and is less than 25 years of
81-24 age; or
81-25 (C) a dependent of the deceased employee at the
81-26 time of the employee's death.
81-27 (2) "Eligible grandchild" means a grandchild of a
82-1 deceased employee who is a dependent of the deceased employee and
82-2 whose parent is not an eligible child.
82-3 (3) "Eligible spouse" means the surviving spouse of a
82-4 deceased employee unless the spouse abandoned the employee for
82-5 longer than the year immediately preceding the death without good
82-6 cause, as determined by the department [commission].
82-7 SECTION 3.105. Section 408.183(b), Labor Code, is amended to
82-8 read as follows:
82-9 (b) An eligible spouse is entitled to receive death benefits
82-10 for life or until remarriage. On remarriage, the eligible spouse
82-11 is entitled to receive 104 weeks of death benefits, commuted as
82-12 provided by commissioner [commission] rule.
82-13 SECTION 3.106. Section 408.187(c), Labor Code, is amended to
82-14 read as follows:
82-15 (c) The commissioner [commission] shall require the
82-16 insurance carrier to pay the costs of a procedure ordered under
82-17 this section.
82-18 SECTION 3.107. Section 408.202, Labor Code, is amended to
82-19 read as follows:
82-20 Sec. 408.202. ASSIGNABILITY OF BENEFITS. Benefits are not
82-21 assignable, except a legal beneficiary may, with the commissioner's
82-22 [commission] approval, assign the right to death benefits.
82-23 SECTION 3.108. Sections 408.221(a)-(f), Labor Code, are
82-24 amended to read as follows:
82-25 (a) An attorney's fee, including a contingency fee, for
82-26 representing a claimant before the department [commission] or court
82-27 under this subtitle must be approved by the commissioner
83-1 [commission] or court.
83-2 (b) Except as otherwise provided, an attorney's fee under
83-3 this section is based on the attorney's time and expenses according
83-4 to written evidence presented to the commissioner [commission] or
83-5 court. Except as provided by Section 408.147(c), the attorney's
83-6 fee shall be paid from the claimant's recovery.
83-7 (c) In approving an attorney's fee under this section, the
83-8 commissioner [commission] or court shall consider:
83-9 (1) the time and labor required;
83-10 (2) the novelty and difficulty of the questions
83-11 involved;
83-12 (3) the skill required to perform the legal services
83-13 properly;
83-14 (4) the fee customarily charged in the locality for
83-15 similar legal services;
83-16 (5) the amount involved in the controversy;
83-17 (6) the benefits to the claimant that the attorney is
83-18 responsible for securing; and
83-19 (7) the experience and ability of the attorney
83-20 performing the services.
83-21 (d) The commissioner [commission] by rule or the court may
83-22 provide for the commutation of an attorney's fee, except that the
83-23 attorney's fee shall be paid in periodic payments in a claim
83-24 involving death benefits if the only dispute is as to the proper
83-25 beneficiary or beneficiaries.
83-26 (e) The commissioner [commission] by rule shall provide
83-27 guidelines for maximum attorney's fees for specific services in
84-1 accordance with this section.
84-2 (f) An attorney's fee may not be allowed in a case involving
84-3 a fatal injury or lifetime income benefit if the insurance carrier
84-4 admits liability on all issues and tenders payment of maximum
84-5 benefits in writing under this subtitle while the claim is pending
84-6 before the commissioner [commission].
84-7 SECTION 3.109. Section 408.222, Labor Code, is amended to
84-8 read as follows:
84-9 Sec. 408.222. ATTORNEY'S FEES PAID TO DEFENSE COUNSEL. (a)
84-10 The amount of an attorney's fee for defending an insurance carrier
84-11 in a workers' compensation action brought under this subtitle must
84-12 be approved by the commissioner [commission] or court and
84-13 determined by the commissioner [commission] or court to be
84-14 reasonable and necessary.
84-15 (b) In determining whether a fee is reasonable under this
84-16 section, the commissioner [commission] or court shall consider
84-17 issues analogous to those listed under Section 408.221(c). The
84-18 defense counsel shall present written evidence to the commissioner
84-19 [commission] or court relating to:
84-20 (1) the time spent and expenses incurred in defending
84-21 the case; and
84-22 (2) other evidence considered necessary by the
84-23 commissioner [commission] or court in making a determination under
84-24 this section.
84-25 SECTION 3.110. Section 409.002, Labor Code, is amended to
84-26 read as follows:
84-27 Sec. 409.002. FAILURE TO FILE NOTICE OF INJURY. Failure to
85-1 notify an employer as required by Section 409.001(a) relieves the
85-2 employer and the employer's insurance carrier of liability under
85-3 this subtitle unless:
85-4 (1) the employer, a person eligible to receive notice
85-5 under Section 409.001(b), or the employer's insurance carrier has
85-6 actual knowledge of the employee's injury;
85-7 (2) the commissioner [commission] determines that good
85-8 cause exists for failure to provide notice in a timely manner; or
85-9 (3) the employer or the employer's insurance carrier
85-10 does not contest the claim.
85-11 SECTION 3.111. Section 409.003, Labor Code, is amended to
85-12 read as follows:
85-13 Sec. 409.003. CLAIM FOR COMPENSATION. An employee or a
85-14 person acting on the employee's behalf shall file with the
85-15 department [commission] a claim for compensation for an injury not
85-16 later than one year after the date on which:
85-17 (1) the injury occurred; or
85-18 (2) if the injury is an occupational disease, the
85-19 employee knew or should have known that the disease was related to
85-20 the employee's employment.
85-21 SECTION 3.112. Section 409.004, Labor Code, is amended to
85-22 read as follows:
85-23 Sec. 409.004. FAILURE TO FILE CLAIM FOR COMPENSATION.
85-24 Failure to file a claim for compensation with the department
85-25 [commission] as required under Section 409.003 relieves the
85-26 employer and the employer's insurance carrier of liability under
85-27 this subtitle unless:
86-1 (1) good cause exists for failure to file a claim in a
86-2 timely manner; or
86-3 (2) the employer or the employer's insurance carrier
86-4 does not contest the claim.
86-5 SECTION 3.113. Sections 409.005(d), (e), (f), (h), and (i),
86-6 Labor Code, are amended to read as follows:
86-7 (d) The insurance carrier shall file the report of the
86-8 injury on behalf of the policyholder. Except as provided by
86-9 Subsection (e), the insurance carrier must electronically file the
86-10 report with the department [commission] not later than the seventh
86-11 day after the date on which the carrier receives the report from
86-12 the employer.
86-13 (e) The commissioner [executive director] may waive the
86-14 electronic filing requirement under Subsection (d) and allow an
86-15 insurance carrier to mail or deliver the report to the department
86-16 [commission] not later than the seventh day after the date on which
86-17 the carrier receives the report from the employer.
86-18 (f) A report required under this section may not be
86-19 considered to be an admission by or evidence against an employer or
86-20 an insurance carrier in a proceeding before the department
86-21 [commission] or a court in which the facts set out in the report
86-22 are contradicted by the employer or insurance carrier.
86-23 (h) The commissioner [commission] may adopt rules relating
86-24 to:
86-25 (1) the information that must be contained in a report
86-26 required under this section, including the summary of rights and
86-27 responsibilities required under Subsection (g); and
87-1 (2) the development and implementation of an
87-2 electronic filing system for injury reports under this section.
87-3 (i) An employer and insurance carrier shall file subsequent
87-4 reports as required by commissioner [commission] rule.
87-5 SECTION 3.114. Sections 409.006(b) and (c), Labor Code, are
87-6 amended to read as follows:
87-7 (b) The record shall be available to the department
87-8 [commission] at reasonable times and under conditions prescribed by
87-9 the commissioner [commission].
87-10 (c) The commissioner [commission] may adopt rules relating
87-11 to the information that must be contained in an employer record
87-12 under this section.
87-13 SECTION 3.115. Section 409.007(a), Labor Code, is amended to
87-14 read as follows:
87-15 (a) A person must file a claim for death benefits with the
87-16 department [commission] not later than the first anniversary of the
87-17 date of the employee's death.
87-18 SECTION 3.116. Section 409.009, Labor Code, is amended to
87-19 read as follows:
87-20 Sec. 409.009. SUBCLAIMS. A person may file a written claim
87-21 with the department [commission] as a subclaimant if the person
87-22 has:
87-23 (1) provided compensation, including health care
87-24 provided by a health care insurer, directly or indirectly, to or
87-25 for an employee or legal beneficiary; and
87-26 (2) sought and been refused reimbursement from the
87-27 insurance carrier.
88-1 SECTION 3.117. Section 409.010, Labor Code, is amended to
88-2 read as follows:
88-3 Sec. 409.010. INFORMATION PROVIDED TO EMPLOYEE OR LEGAL
88-4 BENEFICIARY. Immediately on receiving notice of an injury or death
88-5 from any person, the department [commission] shall mail to the
88-6 employee or legal beneficiary a clear and concise description of:
88-7 (1) the services provided by the department
88-8 [commission], including the services of the ombudsman program;
88-9 (2) the department's [commission's] procedures; and
88-10 (3) the person's rights and responsibilities under
88-11 this subtitle.
88-12 SECTION 3.118. Sections 409.011(a) and (c), Labor Code, are
88-13 amended to read as follows:
88-14 (a) Immediately on receiving notice of an injury or death
88-15 from any person, the department [commission] shall mail to the
88-16 employer a description of:
88-17 (1) the services provided by the department
88-18 [commission];
88-19 (2) the department's [commission's] procedures; and
88-20 (3) the employer's rights and responsibilities under
88-21 this subtitle.
88-22 (c) The department [commission] is not required to provide
88-23 the information to an employer more than once during a calendar
88-24 year.
88-25 SECTION 3.119. Section 409.012, Labor Code, is amended to
88-26 read as follows:
88-27 Sec. 409.012. VOCATIONAL REHABILITATION INFORMATION. (a)
89-1 The commissioner [commission] shall analyze each report of injury
89-2 received from an employer under this chapter to determine whether
89-3 the injured employee would be assisted by vocational
89-4 rehabilitation.
89-5 (b) If the commissioner [commission] determines that an
89-6 injured employee would be assisted by vocational rehabilitation,
89-7 the department [commission] shall notify the injured employee in
89-8 writing of the services and facilities available through the Texas
89-9 Rehabilitation Commission and private providers of vocational
89-10 rehabilitation. The department [commission] shall notify the Texas
89-11 Rehabilitation Commission and the affected insurance carrier that
89-12 the injured employee has been identified as one who could be
89-13 assisted by vocational rehabilitation.
89-14 (c) The department [commission] shall cooperate with the
89-15 Texas Rehabilitation Commission and private providers of vocational
89-16 rehabilitation in the provision of services and facilities to
89-17 employees by the Texas Rehabilitation Commission.
89-18 (d) A private provider of vocational rehabilitation services
89-19 may register with the department [commission].
89-20 (e) The commissioner [commission] by rule may require that a
89-21 private provider of vocational rehabilitation services maintain
89-22 certain credentials and qualifications in order to provide services
89-23 in connection with a workers' compensation insurance claim.
89-24 SECTION 3.120. Section 409.013, Labor Code, is amended to
89-25 read as follows:
89-26 Sec. 409.013. PLAIN LANGUAGE INFORMATION; NOTIFICATION OF
89-27 INJURED WORKER. (a) The department [commission] shall develop
90-1 information for public dissemination about the benefit process and
90-2 the compensation procedures established under this chapter. The
90-3 information must be written in plain language and must be available
90-4 in English and Spanish.
90-5 (b) On receipt of a report under Section 409.005, the
90-6 department [commission] shall contact the affected employee by mail
90-7 or by telephone and shall provide the information required under
90-8 Subsection (a) to that employee, together with any other
90-9 information that may be prepared by the department [commission] for
90-10 public dissemination that relates to the employee's situation, such
90-11 as information relating to back injuries or occupational diseases.
90-12 SECTION 3.121. Sections 409.021(a) and (b), Labor Code, are
90-13 amended to read as follows:
90-14 (a) An insurance carrier shall initiate compensation under
90-15 this subtitle promptly. Not later than the seventh day after the
90-16 date on which an insurance carrier receives written notice of an
90-17 injury, the insurance carrier shall:
90-18 (1) begin the payment of benefits as required by this
90-19 subtitle; or
90-20 (2) notify the department [commission] and the
90-21 employee in writing of its refusal to pay and advise the employee
90-22 of:
90-23 (A) the right to request a benefit review
90-24 conference; and
90-25 (B) the means to obtain additional information
90-26 from the department [commission].
90-27 (b) An insurance carrier shall notify the department
91-1 [commission] in writing of the initiation of income or death
91-2 benefit payments in the manner prescribed by commissioner
91-3 [commission] rules.
91-4 SECTION 3.122. Section 409.022(c), Labor Code, is amended to
91-5 read as follows:
91-6 (c) An insurance carrier commits a violation if the
91-7 insurance carrier does not have reasonable grounds for a refusal to
91-8 pay benefits, as determined by the commissioner [commission]. A
91-9 violation under this subsection is a Class B administrative
91-10 violation.
91-11 SECTION 3.123. Section 409.023(a), Labor Code, is amended to
91-12 read as follows:
91-13 (a) An insurance carrier shall continue to pay benefits
91-14 promptly as and when the benefits accrue without a final decision,
91-15 order, or other action of the commissioner [commission], except as
91-16 otherwise provided.
91-17 SECTION 3.124. Section 409.0231(b), Labor Code, is amended to
91-18 read as follows:
91-19 (b) The commissioner [commission] shall adopt rules in
91-20 consultation with the Texas Department of Information Resources as
91-21 necessary to implement this section, including rules prescribing a
91-22 period of benefits that is of sufficient duration to allow payment
91-23 by electronic funds transfer.
91-24 SECTION 3.125. Section 409.024, Labor Code, is amended to
91-25 read as follows:
91-26 Sec. 409.024. TERMINATION OR REDUCTION OF BENEFITS; NOTICE;
91-27 ADMINISTRATIVE VIOLATION. (a) An insurance carrier shall file with
92-1 the department [commission] a notice of termination or reduction of
92-2 benefits, including the reasons for the termination or reduction,
92-3 not later than the 10th day after the date on which benefits are
92-4 terminated or reduced.
92-5 (b) An insurance carrier commits a violation if the
92-6 insurance carrier does not have reasonable grounds to terminate or
92-7 reduce benefits, as determined by the commissioner [commission]. A
92-8 violation under this subsection is a Class B administrative
92-9 violation.
92-10 SECTION 3.126. Section 409.041(a), Labor Code, is amended to
92-11 read as follows:
92-12 (a) The department [commission] shall maintain an ombudsman
92-13 program as provided by this subchapter to assist injured workers
92-14 and persons claiming death benefits in obtaining benefits under
92-15 this subtitle.
92-16 SECTION 3.127. Sections 409.042(a) and (c), Labor Code, are
92-17 amended to read as follows:
92-18 (a) At least one specially qualified employee in each
92-19 department [commission] office shall be designated an ombudsman who
92-20 shall perform the duties under this section as the person's primary
92-21 responsibility.
92-22 (c) The commissioner [commission] by rule shall adopt
92-23 training guidelines and continuing education requirements for
92-24 ombudsmen. Training provided under this subsection must:
92-25 (1) include education regarding this subtitle, rules
92-26 adopted under this subtitle, and appeals panel decisions, with
92-27 emphasis on benefits and the dispute resolution process; and
93-1 (2) require an ombudsman undergoing training to be
93-2 observed and monitored by an experienced ombudsman during daily
93-3 activities conducted under this subchapter.
93-4 SECTION 3.128. Section 409.043(a), Labor Code, is amended to
93-5 read as follows:
93-6 (a) Each employer shall notify its employees of the
93-7 ombudsman program in a manner prescribed by the commissioner
93-8 [commission].
93-9 SECTION 3.129. Section 409.044, Labor Code, is amended to
93-10 read as follows:
93-11 Sec. 409.044. PUBLIC INFORMATION. The department
93-12 [commission] shall widely disseminate information about the
93-13 ombudsman program.
93-14 SECTION 3.130. Section 410.002, Labor Code, is amended to
93-15 read as follows:
93-16 Sec. 410.002. LAW GOVERNING LIABILITY PROCEEDINGS. A
93-17 proceeding before the department [commission] to determine the
93-18 liability of an insurance carrier for compensation for an injury or
93-19 death under this subtitle is governed by this chapter.
93-20 SECTION 3.131. Section 410.004, Labor Code, is amended to
93-21 read as follows:
93-22 Sec. 410.004. DIVISION OF HEARINGS. The division shall
93-23 conduct benefit review conferences, contested case hearings,
93-24 arbitration, and appeals within the department [commission] related
93-25 to workers' compensation claims.
93-26 SECTION 3.132. Section 410.005(a), Labor Code, is amended to
93-27 read as follows:
94-1 (a) Unless the commissioner [commission] determines that
94-2 good cause exists for the selection of a different location, a
94-3 benefit review conference or a contested case hearing may not be
94-4 conducted at a site more than 75 miles from the claimant's
94-5 residence at the time of the injury.
94-6 SECTION 3.133. Section 410.021, Labor Code, is amended to
94-7 read as follows:
94-8 Sec. 410.021. PURPOSE. A benefit review conference is a
94-9 nonadversarial, informal dispute resolution proceeding designed to:
94-10 (1) explain, orally and in writing, the rights of the
94-11 respective parties to a workers' compensation claim and the
94-12 procedures necessary to protect those rights;
94-13 (2) discuss the facts of the claim, review available
94-14 information in order to evaluate the claim, and delineate the
94-15 disputed issues; and
94-16 (3) mediate and resolve disputed issues by agreement
94-17 of the parties in accordance with this subtitle and the policies of
94-18 the department [commission].
94-19 SECTION 3.134. Sections 410.022(b) and (c), Labor Code, are
94-20 amended to read as follows:
94-21 (b) A benefit review officer must:
94-22 (1) be an employee of the department [commission]; and
94-23 (2) be trained in the principles and procedures of
94-24 dispute mediation.
94-25 (c) The department [commission] shall institute and maintain
94-26 an education and training program for benefit review officers and
94-27 shall consult or contract with the Federal Mediation and
95-1 Conciliation Service or other appropriate organizations for this
95-2 purpose.
95-3 SECTION 3.135. Section 410.023, Labor Code, is amended to
95-4 read as follows:
95-5 Sec. 410.023. REQUEST FOR BENEFIT REVIEW CONFERENCE. On
95-6 receipt of a request from a party or on its own motion, the
95-7 department [commission] may direct the parties to a disputed
95-8 workers' compensation claim to meet in a benefit review conference
95-9 to attempt to reach agreement on disputed issues involved in the
95-10 claim.
95-11 SECTION 3.136. Section 410.024, Labor Code, is amended to
95-12 read as follows:
95-13 Sec. 410.024. BENEFIT REVIEW CONFERENCE AS PREREQUISITE TO
95-14 FURTHER PROCEEDINGS ON CERTAIN CLAIMS. (a) Except as otherwise
95-15 provided by law or commissioner [commission] rule, the parties to a
95-16 disputed compensation claim are not entitled to a contested case
95-17 hearing or arbitration on the claim unless a benefit review
95-18 conference is conducted as provided by this subchapter.
95-19 (b) The commissioner [commission] by rule shall adopt
95-20 guidelines relating to claims that do not require a benefit review
95-21 conference and may proceed directly to a contested case hearing or
95-22 arbitration.
95-23 SECTION 3.137. Section 410.025, Labor Code, is amended to
95-24 read as follows:
95-25 Sec. 410.025. SCHEDULING OF BENEFIT REVIEW CONFERENCE;
95-26 NOTICE. (a) The commissioner [commission] by rule shall prescribe
95-27 the time within which a benefit review conference must be
96-1 scheduled.
96-2 (b) At the time a benefit review conference is scheduled,
96-3 the department [commission] shall schedule a contested case hearing
96-4 to be held not later than the 60th day after the date of the
96-5 benefit review conference if the disputed issues are not resolved
96-6 at the benefit review conference.
96-7 (c) The department [commission] shall send written notice of
96-8 the benefit review conference to the parties to the claim and the
96-9 employer.
96-10 (d) The commissioner [commission] by rule shall provide for
96-11 expedited proceedings in cases in which compensability or liability
96-12 for essential medical treatment is in dispute.
96-13 SECTION 3.138. Section 410.026(a), Labor Code, is amended to
96-14 read as follows:
96-15 (a) A benefit review officer shall:
96-16 (1) mediate disputes between the parties and assist in
96-17 the adjustment of the claim consistent with this subtitle and the
96-18 policies of the department [commission];
96-19 (2) thoroughly inform all parties of their rights and
96-20 responsibilities under this subtitle, especially in a case in which
96-21 the employee is not represented by an attorney or other
96-22 representative; and
96-23 (3) ensure that all documents and information relating
96-24 to the employee's wages, medical condition, and any other
96-25 information pertinent to the resolution of disputed issues are
96-26 contained in the claim file at the conference, especially in a case
96-27 in which the employee is not represented by an attorney or other
97-1 representative.
97-2 SECTION 3.139. Section 410.027(a), Labor Code, is amended to
97-3 read as follows:
97-4 (a) The commissioner [commission] shall adopt rules for
97-5 conducting benefit review conferences.
97-6 SECTION 3.140. Section 410.030, Labor Code, is amended to
97-7 read as follows:
97-8 Sec. 410.030. BINDING EFFECT OF AGREEMENT. (a) An agreement
97-9 signed in accordance with Section 410.029 is binding on the
97-10 insurance carrier through the conclusion of all matters relating to
97-11 the claim, unless the department [commission] or a court, on a
97-12 finding of fraud, newly discovered evidence, or other good and
97-13 sufficient cause, relieves the insurance carrier of the effect of
97-14 the agreement.
97-15 (b) The agreement is binding on the claimant, if represented
97-16 by an attorney, to the same extent as on the insurance carrier. If
97-17 the claimant is not represented by an attorney, the agreement is
97-18 binding on the claimant through the conclusion of all matters
97-19 relating to the claim while the claim is pending before the
97-20 department [commission], unless the commissioner [commission] for
97-21 good cause relieves the claimant of the effect of the agreement.
97-22 SECTION 3.141. Section 410.034(b), Labor Code, is amended to
97-23 read as follows:
97-24 (b) The commissioner [commission] by rule shall prescribe
97-25 the times within which the agreement and report must be filed.
97-26 SECTION 3.142. Section 410.102, Labor Code, is amended to
97-27 read as follows:
98-1 Sec. 410.102. ARBITRATORS; QUALIFICATIONS. (a) An
98-2 arbitrator must be an employee of the department [commission],
98-3 except that the department [commission] may contract with qualified
98-4 arbitrators on a determination of special need.
98-5 (b) An arbitrator must:
98-6 (1) be a member of the National Academy of
98-7 Arbitrators;
98-8 (2) be on an approved list of the American Arbitration
98-9 Association or Federal Mediation and Conciliation Service; or
98-10 (3) meet qualifications established by the
98-11 commissioner [commission] by rule [and be approved by an
98-12 affirmative vote of at least two commission members representing
98-13 employers of labor and at least two commission members representing
98-14 wage earners].
98-15 (c) The department [commission] shall require that each
98-16 arbitrator have appropriate training in the workers' compensation
98-17 laws of this state. The commissioner [commission] shall establish
98-18 procedures to carry out this subsection.
98-19 SECTION 3.143. Section 410.103, Labor Code, is amended to
98-20 read as follows:
98-21 Sec. 410.103. DUTIES OF ARBITRATOR. An arbitrator shall:
98-22 (1) protect the interests of all parties;
98-23 (2) ensure that all relevant evidence has been
98-24 disclosed to the arbitrator and to all parties; and
98-25 (3) render an award consistent with this subtitle and
98-26 the policies of the department [commission].
98-27 SECTION 3.144. Sections 410.104(b) and (c), Labor Code, are
99-1 amended to read as follows:
99-2 (b) To elect arbitration, the parties must file the election
99-3 with the department [commission] not later than the 20th day after
99-4 the last day of the benefit review conference. The commissioner
99-5 [commission] shall prescribe a form for that purpose.
99-6 (c) An election to engage in arbitration under this
99-7 subchapter is irrevocable and binding on all parties for the
99-8 resolution of all disputes arising out of the claims that are under
99-9 the jurisdiction of the department [commission].
99-10 SECTION 3.145. Section 410.105, Labor Code, is amended to
99-11 read as follows:
99-12 Sec. 410.105. LISTS OF ARBITRATORS. (a) The department
99-13 [commission] shall establish regional lists of arbitrators who meet
99-14 the qualifications prescribed under Sections 410.102(a) and (b).
99-15 Each regional list shall be initially prepared in a random name
99-16 order, and subsequent additions to a list shall be added
99-17 chronologically.
99-18 (b) The commissioner [commission] shall review the lists of
99-19 arbitrators annually and determine if each arbitrator is fair and
99-20 impartial and makes awards that are consistent with and in
99-21 accordance with this subtitle and the rules of the commissioner
99-22 [commission. The commission shall remove an arbitrator if after
99-23 review the arbitrator does not receive an affirmative vote of at
99-24 least two commission members representing employers of labor and at
99-25 least two commission members representing wage earners].
99-26 (c) The department's [commission's] lists are confidential
99-27 and are not subject to disclosure under Chapter 552, Government
100-1 Code. The lists may not be revealed by any department [commission]
100-2 employee to any person who is not a commission employee. The lists
100-3 are exempt from discovery in civil litigation unless the party
100-4 seeking the discovery establishes reasonable cause to believe that
100-5 a violation of the requirements of this section or Section 410.106,
100-6 410.107, 410.108, or 410.109(b) occurred and that the violation is
100-7 relevant to the issues in dispute.
100-8 SECTION 3.146. Section 410.106, Labor Code, is amended to
100-9 read as follows:
100-10 Sec. 410.106. SELECTION OF ARBITRATOR. The department
100-11 [commission] shall assign the arbitrator for a particular case by
100-12 selecting the next name after the previous case's selection in
100-13 consecutive order. The department [commission] may not change the
100-14 order of names once the order is established under this subchapter,
100-15 except that once each arbitrator on the list has been assigned to a
100-16 case, the names shall be randomly reordered.
100-17 SECTION 3.147. Section 410.107(a), Labor Code, is amended to
100-18 read as follows:
100-19 (a) The department [commission] shall assign an arbitrator
100-20 to a pending case not later than the 30th day after the date on
100-21 which the election for arbitration is filed with the department
100-22 [commission].
100-23 SECTION 3.148. Section 410.108(a), Labor Code, is amended to
100-24 read as follows:
100-25 (a) Each party is entitled, in its sole discretion, to one
100-26 rejection of the arbitrator in each case. If a party rejects the
100-27 arbitrator, the department [commission] shall assign another
101-1 arbitrator as provided by Section 410.106.
101-2 SECTION 3.149. Section 410.109, Labor Code, is amended to
101-3 read as follows:
101-4 Sec. 410.109. SCHEDULING OF ARBITRATION. (a) The arbitrator
101-5 shall schedule arbitration to be held not later than the 30th day
101-6 after the date of the arbitrator's assignment and shall notify the
101-7 parties and the department [commission] of the scheduled date.
101-8 (b) If an arbitrator is unable to schedule arbitration in
101-9 accordance with Subsection (a), the department [commission] shall
101-10 appoint the next arbitrator on the applicable list. Each party is
101-11 entitled to reject the arbitrator appointed under this subsection
101-12 in the manner provided under Section 410.108.
101-13 SECTION 3.150. Section 410.111, Labor Code, is amended to
101-14 read as follows:
101-15 Sec. 410.111. RULES. The commissioner [commission] shall
101-16 adopt rules for arbitration consistent with generally recognized
101-17 arbitration principles and procedures.
101-18 SECTION 3.151. Section 410.114(b), Labor Code, is amended to
101-19 read as follows:
101-20 (b) The department [commission] shall make an electronic
101-21 recording of the proceeding.
101-22 SECTION 3.152. Section 410.118(d), Labor Code, is amended to
101-23 read as follows:
101-24 (d) The arbitrator shall file a copy of the award as part of
101-25 the permanent claim file at the department [commission] and shall
101-26 notify the parties in writing of the decision.
101-27 SECTION 3.153. Section 410.119(b), Labor Code, is amended to
102-1 read as follows:
102-2 (b) An arbitrator's award is a final order of the department
102-3 [commission].
102-4 SECTION 3.154. Sections 410.121(a) and (b), Labor Code, are
102-5 amended to read as follows:
102-6 (a) On application of an aggrieved party, a court of
102-7 competent jurisdiction shall vacate an arbitrator's award on a
102-8 finding that:
102-9 (1) the award was procured by corruption, fraud, or
102-10 misrepresentation;
102-11 (2) the decision of the arbitrator was arbitrary and
102-12 capricious; or
102-13 (3) the award was outside the jurisdiction of the
102-14 department [commission].
102-15 (b) If an award is vacated, the case shall be remanded to
102-16 the department [commission] for another arbitration proceeding.
102-17 SECTION 3.155. Section 410.151(b), Labor Code, is amended to
102-18 read as follows:
102-19 (b) An issue that was not raised at a benefit review
102-20 conference or that was resolved at a benefit review conference may
102-21 not be considered unless:
102-22 (1) the parties consent; or
102-23 (2) if the issue was not raised, the commissioner
102-24 [commission] determines that good cause existed for not raising the
102-25 issue at the conference.
102-26 SECTION 3.156. Section 410.153, Labor Code, is amended to
102-27 read as follows:
103-1 Sec. 410.153. APPLICATION OF ADMINISTRATIVE PROCEDURE ACT.
103-2 Chapter 2001, Government Code, applies to a contested case hearing
103-3 to the extent that the commissioner [commission] finds appropriate,
103-4 except that the following do not apply:
103-5 (1) Section 2001.054;
103-6 (2) Sections 2001.061 and 2001.062;
103-7 (3) Section 2001.202; and
103-8 (4) Subchapters F, G, I, and Z, except for Section
103-9 2001.141(c).
103-10 SECTION 3.157. Section 410.154, Labor Code, is amended to
103-11 read as follows:
103-12 Sec. 410.154. SCHEDULING OF HEARING. The department
103-13 [commission] shall schedule a contested case hearing in accordance
103-14 with Section 410.024 or 410.025(b).
103-15 SECTION 3.158. Section 410.155, Labor Code, is amended to
103-16 read as follows:
103-17 Sec. 410.155. CONTINUANCE. (a) A written request by a party
103-18 for a continuance of a contested case hearing to another date must
103-19 be directed to the commissioner [commission].
103-20 (b) The commissioner [commission] may grant a continuance
103-21 only if the commissioner [commission] determines that there is good
103-22 cause for the continuance.
103-23 SECTION 3.159. Section 410.157, Labor Code, is amended to
103-24 read as follows:
103-25 Sec. 410.157. RULES. The commissioner [commission] shall
103-26 adopt rules governing procedures under which contested case
103-27 hearings are conducted.
104-1 SECTION 3.160. Section 410.158(a), Labor Code, is amended to
104-2 read as follows:
104-3 (a) Except as provided by Section 410.162, discovery is
104-4 limited to:
104-5 (1) depositions on written questions to any health
104-6 care provider;
104-7 (2) depositions of other witnesses as permitted by the
104-8 hearing officer for good cause shown; and
104-9 (3) interrogatories as prescribed by the commissioner
104-10 [commission].
104-11 SECTION 3.161. Section 410.159, Labor Code, is amended to
104-12 read as follows:
104-13 Sec. 410.159. STANDARD INTERROGATORIES. (a) The
104-14 commissioner [commission] by rule shall prescribe standard form
104-15 sets of interrogatories to elicit information from claimants and
104-16 insurance carriers.
104-17 (b) Standard interrogatories shall be answered by each party
104-18 and served on the opposing party within the time prescribed by
104-19 commissioner [commission] rule, unless the parties agree otherwise.
104-20 SECTION 3.162. Section 410.160, Labor Code, is amended to
104-21 read as follows:
104-22 Sec. 410.160. EXCHANGE OF INFORMATION. Within the time
104-23 prescribed by commissioner [commission] rule, the parties shall
104-24 exchange:
104-25 (1) all medical reports and reports of expert
104-26 witnesses who will be called to testify at the hearing;
104-27 (2) all medical records;
105-1 (3) any witness statements;
105-2 (4) the identity and location of any witness known to
105-3 the parties to have knowledge of relevant facts; and
105-4 (5) all photographs or other documents that a party
105-5 intends to offer into evidence at the hearing.
105-6 SECTION 3.163. Section 410.161, Labor Code, is amended to
105-7 read as follows:
105-8 Sec. 410.161. FAILURE TO DISCLOSE INFORMATION. A party who
105-9 fails to disclose information known to the party or documents that
105-10 are in the party's possession, custody, or control at the time
105-11 disclosure is required by Sections 410.158-410.160 may not
105-12 introduce the evidence at any subsequent proceeding before the
105-13 department [commission] or in court on the claim unless good cause
105-14 is shown for not having disclosed the information or documents
105-15 under those sections.
105-16 SECTION 3.164. Sections 410.168(d) and (e), Labor Code, are
105-17 amended to read as follows:
105-18 (d) On a form that the commissioner [commission] by rule
105-19 prescribes, the hearing officer shall issue a separate written
105-20 decision regarding attorney's fees and any matter related to
105-21 attorney's fees. The decision regarding attorney's fees and the
105-22 form may not be made known to a jury in a judicial review of an
105-23 award, including an appeal.
105-24 (e) The commissioner [commission] by rule shall prescribe
105-25 the times within which the hearing officer must file the decisions
105-26 with the division.
105-27 SECTION 3.165. Section 410.203(d), Labor Code, is amended to
106-1 read as follows:
106-2 (d) A hearing on remand shall be accelerated and the
106-3 commissioner [commission] shall adopt rules to give priority to the
106-4 hearing over other proceedings.
106-5 SECTION 3.166. Section 410.204(b), Labor Code, is amended to
106-6 read as follows:
106-7 (b) A copy of the decision of the appeals panel shall be
106-8 sent to each party not later than the seventh day after the date
106-9 the decision is filed with the department [commission].
106-10 SECTION 3.167. Section 410.206, Labor Code, is amended to
106-11 read as follows:
106-12 Sec. 410.206. CLERICAL ERROR. The commissioner [executive
106-13 director] may revise a decision in a contested case hearing on a
106-14 finding of clerical error.
106-15 SECTION 3.168. Section 410.207, Labor Code, is amended to
106-16 read as follows:
106-17 Sec. 410.207. CONTINUATION OF COMMISSION JURISDICTION.
106-18 During judicial review of an appeals panel decision on any disputed
106-19 issue relating to a workers' compensation claim, the department
106-20 [commission] retains jurisdiction of all other issues related to
106-21 the claim.
106-22 SECTION 3.169. Sections 410.208(a) and (c), Labor Code, are
106-23 amended to read as follows:
106-24 (a) If an insurance carrier refuses or fails to comply with
106-25 a final order or decision of the commissioner [commission], the
106-26 claimant may bring suit in the county of the claimant's residence
106-27 or the county in which the injury occurred to enforce the award as
107-1 a final and binding order of the commissioner [commission].
107-2 (c) A person commits a violation if the person fails or
107-3 refuses to comply with a commissioner's [commission] order or
107-4 decision within 20 days after the date the order or decision
107-5 becomes final. A violation under this subsection is a Class A
107-6 administrative violation.
107-7 SECTION 3.170. Section 410.209, Labor Code, is amended to
107-8 read as follows:
107-9 Sec. 410.209. REIMBURSEMENT FOR OVERPAYMENT. The subsequent
107-10 injury fund shall reimburse an insurance carrier for any
107-11 overpayments of benefits made under an interlocutory order or
107-12 decision if that order or decision is reversed or modified by final
107-13 arbitration, order, or decision of the commissioner [commission] or
107-14 a court. The commissioner [commission] shall adopt rules to
107-15 provide for a periodic reimbursement schedule, providing for
107-16 reimbursement at least annually.
107-17 SECTION 3.171. Section 410.253, Labor Code, is amended to
107-18 read as follows:
107-19 Sec. 410.253. SERVICE. A copy of the petition shall be
107-20 simultaneously filed with the court and the department [commission]
107-21 and served on any opposing party.
107-22 SECTION 3.172. Section 410.254, Labor Code, is amended to
107-23 read as follows:
107-24 Sec. 410.254. [COMMISSION] INTERVENTION. On timely motion
107-25 initiated by the commissioner [executive director], the department
107-26 [commission] shall be permitted to intervene in any judicial
107-27 proceeding under this subchapter or Subchapter G.
108-1 SECTION 3.173. The heading to Section 410.258, Labor Code, is
108-2 amended to read as follows:
108-3 Sec. 410.258. NOTIFICATION OF DEPARTMENT [COMMISSION] OF
108-4 PROPOSED JUDGMENTS AND SETTLEMENTS; RIGHT TO INTERVENE.
108-5 SECTION 3.174. Sections 410.258(a), (b), (c), (d), and (e),
108-6 Labor Code, are amended to read as follows:
108-7 (a) The party who initiated a proceeding under this
108-8 subchapter or Subchapter G must file any proposed judgment or
108-9 settlement made by the parties to the proceeding, including a
108-10 proposed default judgment, with the commissioner [executive
108-11 director of the commission] not later than the 30th day before the
108-12 date on which the court is scheduled to enter the judgment or
108-13 approve the settlement. The proposed judgment or settlement must
108-14 be mailed to the department [executive director] by certified mail,
108-15 return receipt requested.
108-16 (b) The department [commission] may intervene in a
108-17 proceeding under Subsection (a) not later than the 30th day after
108-18 the date of receipt of the proposed judgment or settlement.
108-19 (c) The commissioner [commission] shall review the proposed
108-20 judgment or settlement to determine compliance with all appropriate
108-21 provisions of the law. If the commissioner [commission] determines
108-22 that the proposal is not in compliance with the law, the department
108-23 [commission] may intervene as a matter of right in the proceeding
108-24 not later than the 30th day after the date of receipt of the
108-25 proposed judgment or settlement. The court may limit the extent of
108-26 the department's [commission's] intervention to providing the
108-27 information described by Subsection (e).
109-1 (d) If the department [commission] does not intervene before
109-2 the 31st day after the date of receipt of the proposed judgment or
109-3 settlement, the court shall enter the judgment or approve the
109-4 settlement if the court determines that the proposed judgment or
109-5 settlement is in compliance with all appropriate provisions of the
109-6 law.
109-7 (e) If the department [commission] intervenes in the
109-8 proceeding, the commissioner [commission] shall inform the court of
109-9 each reason the commissioner [commission] believes the proposed
109-10 judgment or settlement is not in compliance with the law. The
109-11 court shall give full consideration to the information provided by
109-12 the commissioner [commission] before entering a judgment or
109-13 approving a settlement.
109-14 SECTION 3.175. Section 410.301(a), Labor Code, is amended to
109-15 read as follows:
109-16 (a) Judicial review of a final decision of a department
109-17 [commission] appeals panel regarding compensability or eligibility
109-18 for or the amount of income or death benefits shall be conducted as
109-19 provided by this subchapter.
109-20 SECTION 3.176. Section 410.302, Labor Code, is amended to
109-21 read as follows:
109-22 Sec. 410.302. LIMITATION OF ISSUES. A trial under this
109-23 subchapter is limited to issues decided by the department
109-24 [commission] appeals panel and on which judicial review is sought.
109-25 The pleadings must specifically set forth the determinations of the
109-26 appeals panel by which the party is aggrieved.
109-27 SECTION 3.177. Section 410.304, Labor Code, is amended to
110-1 read as follows:
110-2 Sec. 410.304. CONSIDERATION OF APPEALS PANEL DECISION. (a)
110-3 In a jury trial, the court, before submitting the case to the jury,
110-4 shall inform the jury in the court's instructions, charge, or
110-5 questions to the jury of the department [commission] appeals panel
110-6 decision on each disputed issue described by Section 410.301(a)
110-7 that is submitted to the jury.
110-8 (b) In a trial to the court without a jury, the court in
110-9 rendering its judgment on an issue described by Section 410.301(a)
110-10 shall consider the decision of the department [commission] appeals
110-11 panel.
110-12 SECTION 3.178. Sections 410.306(b) and (c), Labor Code, are
110-13 amended to read as follows:
110-14 (b) The department [commission] on payment of a reasonable
110-15 fee shall make available to the parties a certified copy of the
110-16 department's [commission's] record. All facts and evidence the
110-17 record contains are admissible to the extent allowed under the
110-18 Texas Rules of Civil Evidence.
110-19 (c) Except as provided by Section 410.307, evidence of
110-20 extent of impairment shall be limited to that presented to the
110-21 department [commission]. The court or jury, in its determination
110-22 of the extent of impairment, shall adopt one of the impairment
110-23 ratings under Subchapter G, Chapter 408.
110-24 SECTION 3.179. Sections 410.307(a) and (d), Labor Code, are
110-25 amended to read as follows:
110-26 (a) Evidence of the extent of impairment is not limited to
110-27 that presented to the department [commission] if the court, after a
111-1 hearing, finds that there is a substantial change of condition.
111-2 The court's finding of a substantial change of condition may be
111-3 based only on:
111-4 (1) medical evidence from the same doctor or doctors
111-5 whose testimony or opinion was presented to the department
111-6 [commission];
111-7 (2) evidence that has come to the party's knowledge
111-8 since the contested case hearing;
111-9 (3) evidence that could not have been discovered
111-10 earlier with due diligence by the party; and
111-11 (4) evidence that would probably produce a different
111-12 result if it is admitted into evidence at the trial.
111-13 (d) If the court finds a substantial change of condition
111-14 under this section, new medical evidence of the extent of
111-15 impairment must be from and is limited to the same doctor or
111-16 doctors who made impairment ratings before the department
111-17 [commission] under Section 408.123.
111-18 SECTION 3.180. Section 410.308(a), Labor Code, is amended to
111-19 read as follows:
111-20 (a) The department [commission] or the Texas Department of
111-21 Insurance shall furnish any interested party in the claim with a
111-22 certified copy of the notice of the employer securing compensation
111-23 with the insurance carrier, filed with the department [commission].
111-24 SECTION 3.181. Section 411.001(1), Labor Code, is amended to
111-25 read as follows:
111-26 (1) "Division" means the division of workers' health
111-27 and safety of the department [commission].
112-1 SECTION 3.182. Section 411.013, Labor Code, is amended to
112-2 read as follows:
112-3 Sec. 411.013. FEDERAL CONTRACTS AND PROGRAMS. With the
112-4 approval of the commissioner [commission], the division may:
112-5 (1) enter into contracts with the federal government
112-6 to perform occupational safety projects; and
112-7 (2) apply for federal funds through any federal
112-8 program relating to occupational safety.
112-9 SECTION 3.183. Section 411.032, Labor Code, is amended to
112-10 read as follows:
112-11 Sec. 411.032. EMPLOYER INJURY AND OCCUPATIONAL DISEASE
112-12 REPORT; ADMINISTRATIVE VIOLATION. (a) An employer shall file with
112-13 the department [commission] a report of each:
112-14 (1) on-the-job injury that results in the employee's
112-15 absence from work for more than one day; and
112-16 (2) occupational disease of which the employer has
112-17 knowledge.
112-18 (b) The commissioner [commission] shall adopt rules and
112-19 prescribe the form and manner of reports filed under this section.
112-20 (c) An employer commits an administrative violation if the
112-21 employer fails to report to the department [commission] as required
112-22 under Subsection (a) unless good cause exists, as determined by the
112-23 commissioner [commission], for the failure. A violation under this
112-24 subsection is a Class D administrative violation.
112-25 SECTION 3.184. Section 411.035, Labor Code, is amended to
112-26 read as follows:
112-27 Sec. 411.035. USE OF INJURY REPORT. A report made under
113-1 Section 411.032 may not be considered to be an admission by or
113-2 evidence against an employer or an insurance carrier in a
113-3 proceeding before the department [commission] or a court in which
113-4 the facts set out in the report are contradicted by the employer or
113-5 insurance carrier.
113-6 SECTION 3.185. Section 411.0415, Labor Code, is amended to
113-7 read as follows:
113-8 Sec. 411.0415. EXEMPTION FOR CERTAIN EMPLOYERS; HEARING.
113-9 (a) The commissioner [executive director] may exclude from
113-10 identification as a hazardous employer an employer who presents
113-11 evidence satisfactory to the commissioner [commission] that the
113-12 injury frequencies of the employer substantially exceed those that
113-13 may reasonably be expected in that employer's business or industry
113-14 only because of a fatality that:
113-15 (1) occurred because of factors beyond the employer's
113-16 control; or
113-17 (2) was outside the course and scope of the deceased
113-18 individual's employment.
113-19 (b) The commissioner [commission] by rule shall analyze and
113-20 list fatalities that may not be related to the work environment,
113-21 including:
113-22 (1) heart attacks;
113-23 (2) common diseases of life;
113-24 (3) homicides;
113-25 (4) suicides;
113-26 (5) vehicle accidents involving a third party;
113-27 (6) common carrier accidents; and
114-1 (7) natural events.
114-2 (c) If the commissioner [commission] determines that the
114-3 case history of the employee's fatality indicates that the employer
114-4 or the work environment was a proximate cause of the fatality, the
114-5 commissioner [commission] may request a hearing under Section
114-6 411.049. If the hearing establishes that a proximate cause of the
114-7 fatality was a factor or factors within the employer's control and
114-8 was within the course and scope of the employment, the commissioner
114-9 [commission] may identify the employer for the hazardous employer
114-10 program if that fatality causes the employer to be designated as a
114-11 hazardous employer.
114-12 SECTION 3.186. Section 411.042(b), Labor Code, is amended to
114-13 read as follows:
114-14 (b) The commissioner [commission] by rule shall require a
114-15 minimum interval of at least six months before a subsequent audit
114-16 to identify an employer who was previously identified as a
114-17 hazardous employer.
114-18 SECTION 3.187. Section 411.043(b), Labor Code, is amended to
114-19 read as follows:
114-20 (b) The safety consultant shall file a written report with
114-21 the department [commission] and the employer setting out any
114-22 hazardous conditions or practices identified by the safety
114-23 consultation.
114-24 SECTION 3.188. Section 411.045(a), Labor Code, is amended to
114-25 read as follows:
114-26 (a) Not earlier than six months or later than nine months
114-27 after the formulation of an accident prevention plan under Section
115-1 411.043, the division shall conduct a follow-up inspection of the
115-2 employer's premises. The department [commission] may require the
115-3 participation of the safety consultant who performed the initial
115-4 consultation and formulated the safety plan.
115-5 SECTION 3.189. Section 411.048, Labor Code, is amended to
115-6 read as follows:
115-7 Sec. 411.048. COSTS CHARGED TO EMPLOYER. (a) The department
115-8 [commission] shall charge an employer that is a political
115-9 subdivision for reimbursement of the reasonable cost of services
115-10 provided by the division, including a reasonable allocation of the
115-11 department's [commission's] administrative costs, in formulating
115-12 and monitoring the implementation of a plan under Section 411.043
115-13 or 411.047, investigating an accident under Section 411.044, or in
115-14 conducting a follow-up inspection under Section 411.045.
115-15 (b) The department [commission] shall charge a private
115-16 employer for reimbursement of the reasonable cost of services
115-17 provided by the division, including a reasonable allocation of the
115-18 department's [commission's] administrative costs, in providing
115-19 safety and health services under this program at the request of the
115-20 private employer. This subsection does not apply to services
115-21 provided to the employer under Section 411.018.
115-22 SECTION 3.190. Section 411.049(a), Labor Code, is amended to
115-23 read as follows:
115-24 (a) An employer may request a hearing to contest findings
115-25 made by the department [commission] under this subchapter.
115-26 SECTION 3.191. Section 411.050, Labor Code, is amended to
115-27 read as follows:
116-1 Sec. 411.050. ADMISSIBILITY OF IDENTIFICATION AS HAZARDOUS
116-2 EMPLOYER. The identification of an employer as a hazardous employer
116-3 under this subchapter is not admissible in any judicial proceeding
116-4 unless:
116-5 (1) the department [commission] has determined that
116-6 the employer is not in compliance with this subchapter; and
116-7 (2) that determination has not been reversed or
116-8 superseded at the time of the event giving rise to the judicial
116-9 proceeding.
116-10 SECTION 3.192. Section 411.062, Labor Code, is amended to
116-11 read as follows:
116-12 Sec. 411.062. FIELD SAFETY REPRESENTATIVE; QUALIFICATIONS.
116-13 (a) The commissioner [commission] by rule shall establish
116-14 qualifications for field safety representatives. The rules must
116-15 include education and experience requirements for those
116-16 representatives.
116-17 (b) Each field safety representative must meet the
116-18 qualifications established by the commissioner [commission].
116-19 SECTION 3.193. Section 411.064(c), Labor Code, is amended to
116-20 read as follows:
116-21 (c) The insurance company shall reimburse the department
116-22 [commission] for the reasonable cost of the reinspection, including
116-23 a reasonable allocation of the department's [commission's]
116-24 administrative costs incurred in conducting the inspections.
116-25 SECTION 3.194. Section 411.065(b), Labor Code, is amended to
116-26 read as follows:
116-27 (b) The information must include:
117-1 (1) the amount of money spent by the insurance company
117-2 on accident prevention services;
117-3 (2) the number and qualifications of field safety
117-4 representatives employed by the insurance company;
117-5 (3) the number of site inspections performed;
117-6 (4) accident prevention services for which the
117-7 insurance company contracts;
117-8 (5) a breakdown of the premium size of the risks to
117-9 which services were provided;
117-10 (6) evidence of the effectiveness of and
117-11 accomplishments in accident prevention; and
117-12 (7) any additional information required by the
117-13 department [commission].
117-14 SECTION 3.195. The heading to Section 411.067, Labor Code, is
117-15 amended to read as follows:
117-16 Sec. 411.067. DEPARTMENT [COMMISSION] PERSONNEL.
117-17 SECTION 3.196. Section 411.067(a), Labor Code, is amended to
117-18 read as follows:
117-19 (a) The department [commission] shall employ the personnel
117-20 necessary to enforce this subchapter, including at least 10 safety
117-21 inspectors to perform inspections at a job site and at an insurance
117-22 company to determine the adequacy of the accident prevention
117-23 services provided by the insurance company.
117-24 SECTION 3.197. Section 411.081(b), Labor Code, is amended to
117-25 read as follows:
117-26 (b) Each employer shall notify its employees of this service
117-27 in a manner prescribed by the department [commission].
118-1 SECTION 3.198. Section 411.092, Labor Code, is amended to
118-2 read as follows:
118-3 Sec. 411.092. ENFORCEMENT; RULES. The commissioner
118-4 [commission] shall enforce Section 411.091 and may adopt rules for
118-5 that purpose.
118-6 SECTION 3.199. Section 411.104(b), Labor Code, is amended to
118-7 read as follows:
118-8 (b) In addition to the duties specified in this chapter, the
118-9 division shall perform other duties as required by the department
118-10 [commission].
118-11 SECTION 3.200. Section 411.105, Labor Code, is amended to
118-12 read as follows:
118-13 Sec. 411.105. CONFIDENTIAL INFORMATION; PENALTY. (a) The
118-14 department [commission] and its employees may not disclose at a
118-15 public hearing or otherwise information relating to secret
118-16 processes, methods of manufacture, or products.
118-17 (b) The commissioner [A member] or an employee of the
118-18 department [commission] commits an offense if the commissioner
118-19 [member] or employee wilfully discloses or conspires to disclose
118-20 information made confidential under this section. An offense under
118-21 this subsection is a misdemeanor punishable by a fine not to exceed
118-22 $1,000 and by forfeiture of the person's appointment as
118-23 commissioner [a member] or as an employee of the department
118-24 [commission].
118-25 SECTION 3.201. Section 411.106, Labor Code, is amended to
118-26 read as follows:
118-27 Sec. 411.106. SAFETY CLASSIFICATION. (a) To establish a
119-1 safety classification for employers, the department [commission]
119-2 shall:
119-3 (1) obtain medical and compensation cost information
119-4 regularly compiled by the Texas Department of Insurance in
119-5 performing that agency's rate-making duties and functions regarding
119-6 employer liability and workers' compensation insurance; and
119-7 (2) collect and compile information relating to:
119-8 (A) the frequency rate of accidents;
119-9 (B) the existence and implementation of private
119-10 safety programs;
119-11 (C) the number of work-hour losses because of
119-12 injuries; and
119-13 (D) other facts showing accident experience.
119-14 (b) From the information obtained under Subsection (a), the
119-15 department [commission] shall classify employers as appropriate to
119-16 implement this subchapter.
119-17 SECTION 3.202. Section 411.107, Labor Code, is amended to
119-18 read as follows:
119-19 Sec. 411.107. ELIMINATION OF SAFETY IMPEDIMENTS. The
119-20 department [commission] may endeavor to eliminate an impediment to
119-21 occupational or industrial safety that is reported to the
119-22 department [commission] by an affected employer. In attempting to
119-23 eliminate an impediment the department [commission] may advise and
119-24 consult with an employer, or a representative of an employer, who
119-25 is directly involved.
119-26 SECTION 3.203. Section 411.108, Labor Code, is amended to
119-27 read as follows:
120-1 Sec. 411.108. ACCIDENT REPORTS. The department [commission]
120-2 may require an employer and any other appropriate person to report
120-3 accidents, personal injuries, fatalities, or other statistics and
120-4 information relating to accidents on forms prescribed by and
120-5 covering periods designated by the department [commission].
120-6 SECTION 3.204. Sections 412.041(f), (g), and (j), Labor Code,
120-7 are amended to read as follows:
120-8 (f) In administering and enforcing Chapter 501, the director
120-9 shall act in the capacity of employer and insurer. (effective for
120-10 dates of injury before September 1, 1995.)
120-11 (1) The director shall act as an adversary before the
120-12 department [commission] and courts and present the legal defenses
120-13 and positions of the state as an employer and insurer.
120-14 (2) For the purposes of this subsection and Chapter
120-15 501, the director is entitled to the legal counsel of the attorney
120-16 general.
120-17 (3) The director is subject to the rules, orders, and
120-18 decisions of the commissioner [commission] in the same manner as a
120-19 private employer, insurer, or association.
120-20 (g) In administering and enforcing Chapter 501, the director
120-21 shall act in the capacity of insurer. (effective for dates of
120-22 injury on or after September 1, 1995.)
120-23 (1) The director shall act as an adversary before the
120-24 department [commission] and courts and present the legal defenses
120-25 and positions of the state as an insurer.
120-26 (2) For purposes of this subsection and Chapter 501,
120-27 the director is entitled to legal counsel of the attorney general.
121-1 (3) The director is subject to the rules, orders, and
121-2 decisions of the commissioner [commission] in the same manner as an
121-3 insurer or association.
121-4 (j) The director shall furnish copies of all rules to the
121-5 commissioner [commission] and to the administrative heads of all
121-6 state agencies affected by this chapter and Chapter 501.
121-7 SECTION 3.205. Section 413.001, Labor Code, is amended to
121-8 read as follows:
121-9 Sec. 413.001. DEFINITION. In this chapter, "division" means
121-10 the division of medical review of the department [commission].
121-11 SECTION 3.206. Section 413.002, Labor Code, is amended to
121-12 read as follows:
121-13 Sec. 413.002. DIVISION OF MEDICAL REVIEW. (a) The
121-14 department [commission] shall maintain a division of medical review
121-15 to ensure compliance with the rules and to implement this chapter
121-16 under the policies adopted by the department [commission].
121-17 (b) The division shall monitor health care providers,
121-18 insurance carriers, and workers' compensation claimants who receive
121-19 medical services to ensure the compliance of those persons with
121-20 rules adopted by the commissioner [commission] relating to health
121-21 care, including medical policies and fee guidelines.
121-22 (c) In monitoring health care providers who serve as
121-23 designated doctors under Chapter 408, the division shall evaluate
121-24 the compliance of those providers with this subtitle and with rules
121-25 adopted by the commissioner [commission] relating to medical
121-26 policies, fee guidelines, and impairment ratings.
121-27 SECTION 3.207. Section 413.003, Labor Code, is amended to
122-1 read as follows:
122-2 Sec. 413.003. AUTHORITY TO CONTRACT. The department
122-3 [commission] may contract with a private or public entity to
122-4 perform a duty or function of the division.
122-5 SECTION 3.208. Section 413.004, Labor Code, is amended to
122-6 read as follows:
122-7 Sec. 413.004. COORDINATION WITH PROVIDERS. The division
122-8 shall coordinate its activities with health care providers as
122-9 necessary to perform its duties under this chapter. The
122-10 coordination may include:
122-11 (1) conducting educational seminars on department
122-12 [commission] rules and procedures; or
122-13 (2) providing information to and requesting assistance
122-14 from professional peer review organizations.
122-15 SECTION 3.209. Sections 413.005(a), (b), and (d), Labor Code,
122-16 are amended to read as follows:
122-17 (a) The medical advisory committee advises the division in
122-18 developing and administering the medical policies, fee guidelines,
122-19 and utilization guidelines established under Section 413.011. The
122-20 committee shall advise the department [commission] or professional
122-21 organization in the review and revision of medical policies and fee
122-22 guidelines required under Section 413.012.
122-23 (b) The medical advisory committee is composed of members
122-24 appointed by the commissioner [commission] as follows:
122-25 (1) a representative of a public health care facility;
122-26 (2) a representative of a private health care
122-27 facility;
123-1 (3) a doctor of medicine;
123-2 (4) a doctor of osteopathic medicine;
123-3 (5) a chiropractor;
123-4 (6) a dentist;
123-5 (7) a physical therapist;
123-6 (8) a pharmacist;
123-7 (9) a podiatrist;
123-8 (10) an occupational therapist;
123-9 (11) a medical equipment supplier;
123-10 (12) a registered nurse;
123-11 (13) a representative of employers;
123-12 (14) a representative of employees;
123-13 (15) a representative of an insurance carrier; and
123-14 (16) two representatives of the general public.
123-15 (d) The commissioner [commission] shall designate the
123-16 presiding officer of the medical advisory committee.
123-17 SECTION 3.210. Section 413.006, Labor Code, is amended to
123-18 read as follows:
123-19 Sec. 413.006. ADVISORY COMMITTEES. The commissioner
123-20 [commission] may appoint advisory committees in addition to the
123-21 medical advisory committee as it considers necessary.
123-22 SECTION 3.211. Sections 413.007(a) and (c), Labor Code, are
123-23 amended to read as follows:
123-24 (a) The division shall maintain a statewide data base of
123-25 medical charges, actual payments, and treatment protocols that may
123-26 be used by:
123-27 (1) the department [commission] in adopting the
124-1 medical policies and fee guidelines; and
124-2 (2) the division in administering the medical
124-3 policies, fee guidelines, or rules.
124-4 (c) The division shall ensure that the data base is
124-5 available for public access for a reasonable fee established by the
124-6 department [commission]. The identities of injured workers and
124-7 beneficiaries may not be disclosed.
124-8 SECTION 3.212. Sections 413.008(a) and (b), Labor Code, are
124-9 amended to read as follows:
124-10 (a) On request from the department [commission] for specific
124-11 information, an insurance carrier shall provide to the division any
124-12 information in its possession, custody, or control that reasonably
124-13 relates to the department's [commission's] duties under this
124-14 subtitle and to health care:
124-15 (1) treatment;
124-16 (2) services;
124-17 (3) fees; and
124-18 (4) charges.
124-19 (b) The department [commission] shall keep confidential
124-20 information that is confidential by law.
124-21 SECTION 3.213. Section 413.011, Labor Code, is amended to
124-22 read as follows:
124-23 Sec. 413.011. GUIDELINES AND MEDICAL POLICIES. (a) The
124-24 commissioner [commission] by rule shall establish medical policies
124-25 and guidelines relating to:
124-26 (1) fees charged or paid for medical services for
124-27 employees who suffer compensable injuries, including guidelines
125-1 relating to payment of fees for specific medical treatments or
125-2 services;
125-3 (2) use of medical services by employees who suffer
125-4 compensable injuries; and
125-5 (3) fees charged or paid for providing expert
125-6 testimony relating to an issue arising under this subtitle.
125-7 (b) Guidelines for medical services fees must be fair and
125-8 reasonable and designed to ensure the quality of medical care and
125-9 to achieve effective medical cost control. The guidelines may not
125-10 provide for payment of a fee in excess of the fee charged for
125-11 similar treatment of an injured individual of an equivalent
125-12 standard of living and paid by that individual or by someone acting
125-13 on that individual's behalf. The commissioner [commission] shall
125-14 consider the increased security of payment afforded by this
125-15 subtitle in establishing the fee guidelines.
125-16 (c) Medical policies adopted by the commissioner
125-17 [commission] must be consistent with Sections 413.013, 413.020,
125-18 413.052, and 413.053.
125-19 (d) The commissioner [commission] by rule shall establish
125-20 medical policies relating to necessary treatments for injuries.
125-21 Medical policies shall be designed to ensure the quality of medical
125-22 care and to achieve effective medical cost control.
125-23 SECTION 3.214. Section 413.013, Labor Code, is amended to
125-24 read as follows:
125-25 Sec. 413.013. PROGRAMS. The commissioner [commission] by
125-26 rule shall establish:
125-27 (1) a program for prospective, concurrent, and
126-1 retrospective review and resolution of a dispute regarding health
126-2 care treatments and services;
126-3 (2) a program for the systematic monitoring of the
126-4 necessity of treatments administered and fees charged and paid for
126-5 medical treatments or services, including the authorization of
126-6 prospective, concurrent, or retrospective review under the medical
126-7 policies of the department [commission] to ensure that the medical
126-8 policies or guidelines are not exceeded;
126-9 (3) a program to detect practices and patterns by
126-10 insurance carriers in unreasonably denying authorization of payment
126-11 for medical services requested or performed if authorization is
126-12 required by the medical policies of the department [commission];
126-13 and
126-14 (4) a program to increase the intensity of review for
126-15 compliance with the medical policies or fee guidelines for any
126-16 health care provider that has established a practice or pattern in
126-17 charges and treatments inconsistent with the medical policies and
126-18 fee guidelines.
126-19 SECTION 3.215. Section 413.014, Labor Code, is amended to
126-20 read as follows:
126-21 Sec. 413.014. PREAUTHORIZATION. (a) The commissioner
126-22 [commission] by rule shall specify which health care treatments and
126-23 services require express preauthorization by the insurance carrier.
126-24 Treatments and services for a medical emergency do not require
126-25 express preauthorization.
126-26 (b) The insurance carrier is not liable for those specified
126-27 treatments and services unless preauthorization is sought by the
127-1 claimant or health care provider and either obtained from the
127-2 insurance carrier or ordered by the commissioner [commission].
127-3 SECTION 3.216. Section 413.015(b), Labor Code, is amended to
127-4 read as follows:
127-5 (b) The commissioner [commission] shall provide by rule for
127-6 the review and audit of the payment by insurance carriers of
127-7 charges for medical services provided under this subtitle to ensure
127-8 compliance of health care providers and insurance carriers with the
127-9 medical policies and fee guidelines adopted by the commissioner
127-10 [commission].
127-11 SECTION 3.217. Section 413.016(b), Labor Code, is amended to
127-12 read as follows:
127-13 (b) If the division determines that an insurance carrier has
127-14 paid medical charges that are inconsistent with the medical
127-15 policies or fee guidelines adopted by the commissioner
127-16 [commission], the division shall refer the insurance carrier
127-17 alleged to have violated this subtitle to the division of
127-18 compliance and practices. If the insurance carrier reduced a
127-19 charge of a health care provider that was within the guidelines,
127-20 the insurance carrier shall be directed to submit the difference to
127-21 the provider unless the reduction is in accordance with an
127-22 agreement between the health care provider and the insurance
127-23 carrier.
127-24 SECTION 3.218. Section 413.017, Labor Code, is amended to
127-25 read as follows:
127-26 Sec. 413.017. PRESUMPTION OF REASONABLENESS. The following
127-27 medical services are presumed reasonable:
128-1 (1) medical services consistent with the medical
128-2 policies and fee guidelines adopted by the commissioner
128-3 [commission]; and
128-4 (2) medical services that are provided subject to
128-5 prospective, concurrent, or retrospective review as required by the
128-6 medical policies of the department [commission] and that are
128-7 authorized by an insurance carrier.
128-8 SECTION 3.219. Sections 413.018(a), (c), (d), and (e), Labor
128-9 Code, are amended to read as follows:
128-10 (a) The commissioner [commission] by rule shall provide for
128-11 the periodic review of medical care provided in claims in which
128-12 guidelines for expected or average return to work time frames are
128-13 exceeded.
128-14 (c) The department [commission] shall implement a program to
128-15 encourage employers and treating doctors to discuss the
128-16 availability of modified duty to encourage the safe and more timely
128-17 return to work of injured employees. The department [commission]
128-18 may require a treating or examining doctor, on the request of the
128-19 employer, insurance carrier, or department [commission], to provide
128-20 a functional capacity evaluation of an injured employee and to
128-21 determine the employee's ability to engage in physical activities
128-22 found in the workplace or in activities that are required in a
128-23 modified duty setting.
128-24 (d) The department [commission] shall provide through the
128-25 department's [commission's] health and safety information and
128-26 medical review outreach programs information to employers regarding
128-27 effective return to work programs. This section does not require
129-1 an employer to provide modified duty or an employee to accept a
129-2 modified duty assignment. An employee who does not accept an
129-3 employer's offer of modified duty determined by the department
129-4 [commission] to be a bona fide job offer is subject to Section
129-5 408.103(e).
129-6 (e) The commissioner [commission] may adopt rules and forms
129-7 as necessary to implement this section.
129-8 SECTION 3.220. Section 413.020, Labor Code, is amended to
129-9 read as follows:
129-10 Sec. 413.020. DEPARTMENT [COMMISSION] CHARGES. The
129-11 commissioner [commission] by rule shall establish procedures to
129-12 enable the department [commission] to charge:
129-13 (1) an insurance carrier a reasonable fee for access
129-14 to or evaluation of health care treatment, fees, or charges under
129-15 this subtitle; and
129-16 (2) a health care provider who exceeds a fee or
129-17 utilization guideline established under this subtitle or an
129-18 insurance carrier who unreasonably disputes charges that are
129-19 consistent with a fee or utilization guideline established under
129-20 this subtitle a reasonable fee for review of health care treatment,
129-21 fees, or charges under this subtitle.
129-22 SECTION 3.221. Sections 413.031(a) and (c), Labor Code, are
129-23 amended to read as follows:
129-24 (a) A party, including a health care provider, is entitled
129-25 to a review of a medical service provided or for which
129-26 authorization of payment is sought if a health care provider is:
129-27 (1) denied payment or paid a reduced amount for the
130-1 medical service rendered;
130-2 (2) denied authorization for the payment for the
130-3 service requested or performed if authorization is required by the
130-4 medical policies of the department [commission]; or
130-5 (3) ordered by the division to refund a payment
130-6 received for a medical service rendered.
130-7 (c) A review of a medical service under this section shall
130-8 be provided by a health care provider professional review
130-9 organization if requested by the health care practitioner or if
130-10 ordered by the commissioner [commission].
130-11 SECTION 3.222. Section 413.041, Labor Code, is amended to
130-12 read as follows:
130-13 Sec. 413.041. DISCLOSURE. A health care provider who refers
130-14 a workers' compensation claimant to another health care provider in
130-15 which the referring provider has more than a five percent financial
130-16 interest shall file an annual disclosure statement with the
130-17 department [commission] as provided by commissioner [commission]
130-18 rules and shall disclose the interest to the insurance carrier at
130-19 the time of the referral. The referring provider shall specify the
130-20 degree of the financial interest and shall provide other
130-21 information as required by commissioner [commission] rules.
130-22 SECTION 3.223. Section 413.044, Labor Code, is amended to
130-23 read as follows:
130-24 Sec. 413.044. SANCTIONS ON DESIGNATED DOCTOR. In addition to
130-25 or in lieu of an administrative penalty under Section 415.021 or a
130-26 sanction imposed under Section 415.023, the commissioner
130-27 [commission] may impose sanctions against a person who serves as a
131-1 designated doctor under Chapter 408 who, after an evaluation
131-2 conducted under Section 413.002(c), is determined by the division
131-3 to be out of compliance with this subtitle or with rules adopted by
131-4 the commissioner [commission] relating to medical policies, fee
131-5 guidelines, and impairment ratings.
131-6 SECTION 3.224. Section 413.051, Labor Code, is amended to
131-7 read as follows:
131-8 Sec. 413.051. CONTRACTS WITH REVIEW ORGANIZATIONS AND HEALTH
131-9 CARE PROVIDERS. (a) The department [commission] may contract with
131-10 a health care provider professional review organization or other
131-11 entity to develop, maintain, or review medical policies or fee
131-12 guidelines or to review compliance with the medical policies or fee
131-13 guidelines.
131-14 (b) For purposes of review or resolution of a dispute as to
131-15 compliance with the medical policies or fee guidelines, the
131-16 department [commission] may contract only with a health care
131-17 provider professional review organization that includes in the
131-18 review process health care practitioners who are licensed in the
131-19 category under review and are of the same field or specialty as the
131-20 category under review.
131-21 (c) The department [commission] may contract with a health
131-22 care provider for medical consultant services, including:
131-23 (1) independent medical examinations;
131-24 (2) medical case reviews; or
131-25 (3) establishment of medical policies and fee
131-26 guidelines.
131-27 SECTION 3.225. Section 413.052, Labor Code, is amended to
132-1 read as follows:
132-2 Sec. 413.052. PRODUCTION OF DOCUMENTS. The commissioner
132-3 [commission] by rule shall establish procedures to enable the
132-4 commission to compel the production of documents.
132-5 SECTION 3.226. Section 413.053, Labor Code, is amended to
132-6 read as follows:
132-7 Sec. 413.053. STANDARDS OF REPORTING AND BILLING. The
132-8 commissioner [commission] by rule shall establish standards of
132-9 reporting and billing governing both form and content.
132-10 SECTION 3.227. Section 413.054(a), Labor Code, is amended to
132-11 read as follows:
132-12 (a) A person who performs services for the department
132-13 [commission] as a designated doctor, an independent medical
132-14 examiner, a doctor performing a medical case review, or a member of
132-15 a peer review panel has the same immunity from liability as the
132-16 commissioner [a commission member] under Section 402.012 [402.010].
132-17 SECTION 3.228. Sections 413.055(a) and (b), Labor Code, are
132-18 amended to read as follows:
132-19 (a) The department [executive director], as provided by
132-20 commissioner [commission] rule, may enter an interlocutory order
132-21 for the payment of all or part of medical benefits. The order may
132-22 address accrued benefits, future benefits, or both accrued benefits
132-23 and future benefits.
132-24 (b) The subsequent injury fund shall reimburse an insurance
132-25 carrier for any overpayments of benefits made under an order
132-26 entered under Subsection (a) if the order is reversed or modified
132-27 by final arbitration, order, or decision of the commissioner
133-1 [commission] or a court. The commissioner [commission] shall adopt
133-2 rules to provide for a periodic reimbursement schedule, providing
133-3 for reimbursement at least annually.
133-4 SECTION 3.229. Section 414.002(a), Labor Code, is amended to
133-5 read as follows:
133-6 (a) The division shall monitor for compliance with
133-7 commissioner [commission] rules, this subtitle, and other laws
133-8 relating to workers' compensation the conduct of persons subject to
133-9 this subtitle, other than persons monitored by the division of
133-10 medical review. Persons to be monitored include:
133-11 (1) persons claiming benefits under this subtitle;
133-12 (2) employers;
133-13 (3) insurance carriers; and
133-14 (4) attorneys and other representatives of parties.
133-15 SECTION 3.230. Section 414.003, Labor Code, is amended to
133-16 read as follows:
133-17 Sec. 414.003. COMPILATION AND USE OF INFORMATION. (a) The
133-18 division shall compile and maintain statistical and other
133-19 information as necessary to detect practices or patterns of conduct
133-20 by persons subject to monitoring under this chapter that:
133-21 (1) violate this subtitle or commissioner [commission]
133-22 rules; or
133-23 (2) otherwise adversely affect the workers'
133-24 compensation system of this state.
133-25 (b) The department [commission] shall use the information
133-26 compiled under this section to impose appropriate penalties and
133-27 other sanctions under Chapters 415 and 416.
134-1 SECTION 3.231. Section 414.005, Labor Code, is amended to
134-2 read as follows:
134-3 Sec. 414.005. INVESTIGATION UNIT. The division shall
134-4 maintain an investigation unit to conduct investigations relating
134-5 to alleged violations of this subtitle or commissioner [commission]
134-6 rules, with particular emphasis on violations of Chapters 415 and
134-7 416.
134-8 SECTION 3.232. Section 415.001, Labor Code, is amended to
134-9 read as follows:
134-10 Sec. 415.001. ADMINISTRATIVE VIOLATION BY REPRESENTATIVE OF
134-11 EMPLOYEE OR LEGAL BENEFICIARY. A representative of an employee or
134-12 legal beneficiary commits an administrative violation if the person
134-13 wilfully or intentionally:
134-14 (1) fails without good cause to attend a dispute
134-15 resolution proceeding within the department [commission];
134-16 (2) attends a dispute resolution proceeding within the
134-17 department [commission] without complete authority or fails to
134-18 exercise authority to effectuate an agreement or settlement;
134-19 (3) commits an act of barratry under Section 38.12,
134-20 Penal Code;
134-21 (4) withholds from the employee's or legal
134-22 beneficiary's weekly benefits or from advances amounts not
134-23 authorized to be withheld by the department [commission];
134-24 (5) enters into a settlement or agreement without the
134-25 knowledge, consent, and signature of the employee or legal
134-26 beneficiary;
134-27 (6) takes a fee or withholds expenses in excess of the
135-1 amounts authorized by the department [commission];
135-2 (7) refuses or fails to make prompt delivery to the
135-3 employee or legal beneficiary of funds belonging to the employee or
135-4 legal beneficiary as a result of a settlement, agreement, order, or
135-5 award;
135-6 (8) violates the Texas Disciplinary Rules of
135-7 Professional Conduct of the State Bar of Texas;
135-8 (9) misrepresents the provisions of this subtitle to
135-9 an employee, an employer, a health care provider, or a legal
135-10 beneficiary;
135-11 (10) violates a commissioner [commission] rule; or
135-12 (11) fails to comply with this subtitle.
135-13 SECTION 3.233. Section 415.002, Labor Code, is amended to
135-14 read as follows:
135-15 Sec. 415.002. ADMINISTRATIVE VIOLATION BY AN INSURANCE
135-16 CARRIER. (a) An insurance carrier or its representative commits an
135-17 administrative violation if that person wilfully or intentionally:
135-18 (1) misrepresents a provision of this subtitle to an
135-19 employee, an employer, a health care provider, or a legal
135-20 beneficiary;
135-21 (2) terminates or reduces benefits without
135-22 substantiating evidence that the action is reasonable and
135-23 authorized by law;
135-24 (3) instructs an employer not to file a document
135-25 required to be filed with the department [commission];
135-26 (4) instructs or encourages an employer to violate a
135-27 claimant's right to medical benefits under this subtitle;
136-1 (5) fails to tender promptly full death benefits if a
136-2 legitimate dispute does not exist as to the liability of the
136-3 insurance carrier;
136-4 (6) allows an employer, other than a self-insured
136-5 employer, to dictate the methods by which and the terms on which a
136-6 claim is handled and settled;
136-7 (7) fails to confirm medical benefits coverage to a
136-8 person or facility providing medical treatment to a claimant if a
136-9 legitimate dispute does not exist as to the liability of the
136-10 insurance carrier;
136-11 (8) fails, without good cause, to attend a dispute
136-12 resolution proceeding within the department [commission];
136-13 (9) attends a dispute resolution proceeding within the
136-14 department [commission] without complete authority or fails to
136-15 exercise authority to effectuate agreement or settlement;
136-16 (10) adjusts a workers' compensation claim in a manner
136-17 contrary to license requirements for an insurance adjuster,
136-18 including the requirements of Chapter 407, Acts of the 63rd
136-19 Legislature, Regular Session, 1973 (Article 21.07-4, Vernon's Texas
136-20 Insurance Code), or the rules of the Texas Department [State Board]
136-21 of Insurance;
136-22 (11) fails to process claims promptly in a reasonable
136-23 and prudent manner;
136-24 (12) fails to initiate or reinstate benefits when due
136-25 if a legitimate dispute does not exist as to the liability of the
136-26 insurance carrier;
136-27 (13) misrepresents the reason for not paying benefits
137-1 or terminating or reducing the payment of benefits;
137-2 (14) dates documents to misrepresent the actual date
137-3 of the initiation of benefits;
137-4 (15) makes a notation on a draft or other instrument
137-5 indicating that the draft or instrument represents a final
137-6 settlement of a claim if the claim is still open and pending before
137-7 the department [commission];
137-8 (16) fails or refuses to pay benefits from week to
137-9 week as and when due directly to the person entitled to the
137-10 benefits;
137-11 (17) fails to pay an order awarding benefits;
137-12 (18) controverts a claim if the evidence clearly
137-13 indicates liability;
137-14 (19) unreasonably disputes the reasonableness and
137-15 necessity of health care;
137-16 (20) violates a commissioner [commission] rule; or
137-17 (21) fails to comply with a provision of this
137-18 subtitle.
137-19 (b) An insurance carrier or its representative does not
137-20 commit an administrative violation under Subsection (a)(6) by
137-21 allowing an employer to:
137-22 (1) freely discuss a claim;
137-23 (2) assist in the investigation and evaluation of a
137-24 claim; or
137-25 (3) attend a proceeding of the department [commission]
137-26 and participate at the proceeding in accordance with this subtitle.
137-27 SECTION 3.234. Section 415.003, Labor Code, is amended to
138-1 read as follows:
138-2 Sec. 415.003. ADMINISTRATIVE VIOLATION BY HEALTH CARE
138-3 PROVIDER. A health care provider commits an administrative
138-4 violation if the person wilfully or intentionally:
138-5 (1) submits a charge for health care that was not
138-6 furnished;
138-7 (2) administers improper, unreasonable, or medically
138-8 unnecessary treatment or services;
138-9 (3) makes an unnecessary referral;
138-10 (4) violates the department's [commission's] fee and
138-11 treatment guidelines;
138-12 (5) violates a commissioner [commission] rule; or
138-13 (6) fails to comply with a provision of this subtitle.
138-14 SECTION 3.235. Sections 415.0035(a) and (b), Labor Code, are
138-15 amended to read as follows:
138-16 (a) An insurance carrier or its representative commits an
138-17 administrative violation if that person:
138-18 (1) fails to submit to the department [commission] a
138-19 settlement or agreement of the parties;
138-20 (2) fails to timely notify the department [commission]
138-21 of the termination or reduction of benefits and the reason for that
138-22 action; or
138-23 (3) denies preauthorization in a manner that is not in
138-24 accordance with rules adopted by the commissioner [commission]
138-25 under Section 413.014.
138-26 (b) A health care provider commits an administrative
138-27 violation if that person:
139-1 (1) fails or refuses to timely file required reports
139-2 or records; or
139-3 (2) fails to file with the department [commission] the
139-4 annual disclosure statement required by Section 413.041.
139-5 SECTION 3.236. Section 415.007(a), Labor Code, is amended to
139-6 read as follows:
139-7 (a) An attorney who represents a claimant before the
139-8 department [commission] may not lend money to the claimant during
139-9 the pendency of the workers' compensation claim.
139-10 SECTION 3.237. Section 415.008(e), Labor Code, is amended to
139-11 read as follows:
139-12 (e) If an administrative violation proceeding is pending
139-13 under this section against an employee or person claiming death
139-14 benefits, the department [commission] may not take final action on
139-15 the person's benefits.
139-16 SECTION 3.238. Section 415.010(a), Labor Code, is amended to
139-17 read as follows:
139-18 (a) A party to an agreement approved by the department
139-19 [commission] commits a violation if the person knowingly breaches a
139-20 provision of the agreement.
139-21 SECTION 3.239. Sections 415.021(a), (b), and (c), Labor
139-22 Code, are amended to read as follows:
139-23 (a) The commissioner [commission] may assess an
139-24 administrative penalty against a person who commits an
139-25 administrative violation.
139-26 (b) The commissioner [commission] may assess an
139-27 administrative penalty not to exceed $10,000 and may enter a cease
140-1 and desist order against a person who:
140-2 (1) commits repeated administrative violations;
140-3 (2) allows, as a business practice, the commission of
140-4 repeated administrative violations; or
140-5 (3) violates an order or decision of the commissioner
140-6 [commission].
140-7 (c) In assessing an administrative penalty, the commissioner
140-8 [commission] shall consider:
140-9 (1) the seriousness of the violation, including the
140-10 nature, circumstances, consequences, extent, and gravity of the
140-11 prohibited act;
140-12 (2) the history and extent of previous administrative
140-13 violations;
140-14 (3) the demonstrated good faith of the violator,
140-15 including actions taken to rectify the consequences of the
140-16 prohibited act;
140-17 (4) the economic benefit resulting from the prohibited
140-18 act;
140-19 (5) the penalty necessary to deter future violations;
140-20 and
140-21 (6) other matters that justice may require.
140-22 SECTION 3.240. Section 415.023(b), Labor Code, is amended to
140-23 read as follows:
140-24 (b) The commissioner [commission] may adopt rules providing
140-25 for:
140-26 (1) a reduction or denial of fees;
140-27 (2) public or private reprimand by the commission;
141-1 (3) suspension from practice before the commission; or
141-2 (4) restriction, suspension, or revocation of the
141-3 right to receive reimbursement under this subtitle.
141-4 SECTION 3.241. Section 415.024, Labor Code, is amended to
141-5 read as follows:
141-6 Sec. 415.024. BREACH OF SETTLEMENT AGREEMENT; ADMINISTRATIVE
141-7 VIOLATION. A material and substantial breach of a settlement
141-8 agreement that establishes a compliance plan is a Class A
141-9 administrative violation. In determining the amount of the
141-10 penalty, the commissioner [commission] shall consider the total
141-11 volume of claims handled by the insurance carrier.
141-12 SECTION 3.242. Section 415.032(b), Labor Code, is amended to
141-13 read as follows:
141-14 (b) Not later than the 20th day after the date on which
141-15 notice is received, the charged party shall:
141-16 (1) remit the amount of the penalty to the department
141-17 [commission]; or
141-18 (2) submit to the department [commission] a written
141-19 request for a hearing.
141-20 SECTION 3.243. Section 415.033, Labor Code, is amended to
141-21 read as follows:
141-22 Sec. 415.033. FAILURE TO RESPOND. If, without good cause, a
141-23 charged party fails to respond as required under Section 415.032,
141-24 the penalty is due and the department [commission] shall initiate
141-25 enforcement proceedings.
141-26 SECTION 3.244. Section 415.034(a), Labor Code, is amended to
141-27 read as follows:
142-1 (a) On the request of the charged party or the commissioner
142-2 [executive director], the State Office of Administrative Hearings
142-3 shall set a hearing. The hearing shall be conducted in the manner
142-4 provided for a contested case under Chapter 2001, Government Code
142-5 (the administrative procedure law).
142-6 SECTION 3.245. Sections 415.035(b) and (d), Labor Code, are
142-7 amended to read as follows:
142-8 (b) If an administrative penalty is assessed, the person
142-9 charged shall:
142-10 (1) forward the amount of the penalty to the
142-11 commissioner [executive director] for deposit in an escrow account;
142-12 or
142-13 (2) post with the commissioner [executive director] a
142-14 bond for the amount of the penalty, effective until all judicial
142-15 review of the determination is final.
142-16 (d) If the court determines that the penalty should not have
142-17 been assessed or reduces the amount of the penalty, the
142-18 commissioner [executive director] shall:
142-19 (1) remit the appropriate amount, plus accrued
142-20 interest, if the administrative penalty was paid; or
142-21 (2) release the bond.
142-22 SECTION 3.246. Section 416.001, Labor Code, is amended to
142-23 read as follows:
142-24 Sec. 416.001. CERTAIN CAUSES OF ACTION PRECLUDED. An action
142-25 taken by an insurance carrier under an order of the commissioner
142-26 [commission] or recommendations of a benefit review officer under
142-27 Section 410.031, 410.032, or 410.033 may not be the basis of a
143-1 cause of action against the insurance carrier for a breach of the
143-2 duty of good faith and fair dealing.
143-3 SECTION 3.247. Sections 417.001(c) and (d), Labor Code, are
143-4 amended to read as follows:
143-5 (c) If a claimant receives benefits from the subsequent
143-6 injury fund, the department [commission] is:
143-7 (1) considered to be the insurance carrier under this
143-8 section for purposes of those benefits;
143-9 (2) subrogated to the rights of the claimant; and
143-10 (3) entitled to reimbursement in the same manner as
143-11 the insurance carrier.
143-12 (d) The department [commission] shall remit money recovered
143-13 under this section to the comptroller for deposit to the credit of
143-14 the subsequent injury fund.
143-15 SECTION 3.248. Section 417.003(b), Labor Code, is amended to
143-16 read as follows:
143-17 (b) An attorney who represents the claimant and is also to
143-18 represent the subrogated insurance carrier shall make a full
143-19 written disclosure to the claimant before employment as an attorney
143-20 by the insurance carrier. The claimant must acknowledge the
143-21 disclosure and consent to the representation. A signed copy of the
143-22 disclosure shall be furnished to all concerned parties and made a
143-23 part of the department [commission] file. A copy of the disclosure
143-24 with the claimant's consent shall be filed with the claimant's
143-25 pleading before a judgment is entered and approved by the court.
143-26 The claimant's attorney may not receive a fee under this section to
143-27 which the attorney is otherwise entitled under an agreement with
144-1 the insurance carrier unless the attorney complies with the
144-2 requirements of this subsection.
144-3 SECTION 3.249. Section 501.001, Labor Code, is amended to
144-4 read as follows:
144-5 Sec. 501.001. DEFINITIONS. In this chapter:
144-6 (1) ["Commission" means the Texas Workers'
144-7 Compensation Commission.]
144-8 [(2)] "Compensable injury" has the meaning assigned to
144-9 that term under Subtitle A.
144-10 (2) "Department" means the Texas Department of
144-11 Workers' Compensation.
144-12 (3) "Director" means the director of the State Office
144-13 of Risk Management.
144-14 (4) "Office" means the State Office of Risk
144-15 Management.
144-16 (5) "Employee" means a person who is:
144-17 (A) in the service of the state pursuant to an
144-18 election, appointment, or express oral or written contract of hire;
144-19 (B) paid from state funds but whose duties
144-20 require that the person work and frequently receive supervision in
144-21 a political subdivision of the state;
144-22 (C) a peace officer employed by a political
144-23 subdivision, while the peace officer is exercising authority
144-24 granted under Article 14.03(c), Code of Criminal Procedure; or
144-25 (D) a member of the state military forces, as
144-26 defined by Section 431.001, Government Code, who is engaged in
144-27 authorized training or duty.
145-1 (6) "State agency" includes a department, board,
145-2 commission, or institution of this state.
145-3 (7) "Board" means the risk management board.
145-4 SECTION 3.250. Section 501.026(d), Labor Code, is amended to
145-5 read as follows:
145-6 (d) A person entitled to benefits under this section may
145-7 receive the benefits only if the person seeks medical attention
145-8 from a doctor for the injury not later than 48 hours after the
145-9 occurrence of the injury or after the date the person knew or
145-10 should have known the injury occurred. The person shall comply
145-11 with the requirements of Section 409.001 by providing notice of the
145-12 injury to the department [commission] or the state agency with
145-13 which the officer or employee under Subsection (b) is associated.
145-14 SECTION 3.251. Section 501.050(a), Labor Code, is amended to
145-15 read as follows:
145-16 (a) In each case appealed from the department [commission]
145-17 to a county or district court:
145-18 (1) the clerk of the court shall mail to the
145-19 department [commission]:
145-20 (A) not later than the 20th day after the date
145-21 the case is filed, a notice containing the style, number, and date
145-22 of filing of the case; and
145-23 (B) not later than the 20th day after the date
145-24 the judgment is rendered, a certified copy of the judgment; and
145-25 (2) the attorney preparing the judgment shall file the
145-26 original and a copy of the judgment with the clerk.
145-27 SECTION 3.252. Section 502.001(1), Labor Code, is amended to
146-1 read as follows:
146-2 (1) "Department" means the Texas Department of
146-3 Workers' Compensation ["Commission" means the Texas Workers'
146-4 Compensation Commission].
146-5 SECTION 3.253. The heading to Section 502.063, Labor Code, is
146-6 amended to read as follows:
146-7 Sec. 502.063. CERTIFIED COPIES OF DEPARTMENT [COMMISSION]
146-8 DOCUMENTS.
146-9 SECTION 3.254. Sections 502.063(a) and (c), Labor Code, are
146-10 amended to read as follows:
146-11 (a) The department [commission] shall furnish a certified
146-12 copy of an order, award, decision, or paper on file in the
146-13 department's [commission's] office to a person entitled to the copy
146-14 on written request and payment of the fee for the copy. The fee is
146-15 the same as that charged for similar services by the secretary of
146-16 state's office.
146-17 (c) A fee or salary may not be paid to an [a member or]
146-18 employee of the department [commission] for making a copy under
146-19 Subsection (a) that exceeds the fee charged for the copy.
146-20 SECTION 3.255. Section 502.065(a), Labor Code, is amended to
146-21 read as follows:
146-22 (a) In addition to a report of an injury filed with the
146-23 department [commission] under Section 409.005(a), an institution
146-24 shall file a supplemental report that contains:
146-25 (1) the name, age, sex, and occupation of the injured
146-26 employee;
146-27 (2) the character of work in which the employee was
147-1 engaged at the time of the injury;
147-2 (3) the place, date, and hour of the injury; and
147-3 (4) the nature and cause of the injury.
147-4 SECTION 3.256. Sections 502.066(a) and (e), Labor Code, are
147-5 amended to read as follows:
147-6 (a) The department [commission] may require an employee who
147-7 claims to have been injured to submit to an examination by the
147-8 department [commission] or a person acting under the department's
147-9 [commission's] authority at a reasonable time and place in this
147-10 state.
147-11 (e) The institution shall pay the fee set by the department
147-12 [commission] of a physician or chiropractor selected by the
147-13 employee under Subsection (b) or (d).
147-14 SECTION 3.257. Section 502.067(a), Labor Code, is amended to
147-15 read as follows:
147-16 (a) The commissioner [commission] may order or direct the
147-17 institution to reduce or suspend the compensation of an injured
147-18 employee who:
147-19 (1) persists in insanitary or injurious practices that
147-20 tend to imperil or retard the employee's recovery; or
147-21 (2) refuses to submit to medical, surgical,
147-22 chiropractic, or other remedial treatment recognized by the state
147-23 that is reasonably essential to promote the employee's recovery.
147-24 SECTION 3.258. Section 502.068, Labor Code, is amended to
147-25 read as follows:
147-26 Sec. 502.068. POSTPONEMENT OF HEARING. If an injured
147-27 employee is receiving benefits under this chapter and the
148-1 institution is providing hospitalization, medical treatment, or
148-2 chiropractic care to the employee, the department [commission] may
148-3 postpone the hearing on the employee's claim. An appeal may not be
148-4 taken from a department [commission] order under this section.
148-5 SECTION 3.259. Section 502.069(a), Labor Code, is amended to
148-6 read as follows:
148-7 (a) In each case appealed from the department [commission]
148-8 to a county or district court:
148-9 (1) the clerk of the court shall mail to the
148-10 department [commission]:
148-11 (A) not later than the 20th day after the date
148-12 the case is filed, a notice containing the style, number, and date
148-13 of filing of the case; and
148-14 (B) not later than the 20th day after the date
148-15 the judgment is rendered, a certified copy of the judgment; and
148-16 (2) the attorney preparing the judgment shall file the
148-17 original and a copy of the judgment with the clerk.
148-18 SECTION 3.260. Section 503.001(1), Labor Code, is amended to
148-19 read as follows:
148-20 (1) "Department" means the Texas Department of
148-21 Workers' Compensation ["Commission" means the Texas Workers'
148-22 Compensation Commission].
148-23 SECTION 3.261. The heading to Section 503.063, Labor Code, is
148-24 amended to read as follows:
148-25 Sec. 503.063. CERTIFIED COPIES OF DEPARTMENT [COMMISSION]
148-26 DOCUMENTS.
148-27 SECTION 3.262. Sections 503.063(a) and (c), Labor Code, are
149-1 amended to read as follows:
149-2 (a) The department [commission] shall furnish a certified
149-3 copy of an order, award, decision, or paper on file in the
149-4 department's [commission's] office to a person entitled to the copy
149-5 on written request and payment of the fee for the copy. The fee is
149-6 the same as that charged for similar services by the secretary of
149-7 state's office.
149-8 (c) A fee or salary may not be paid to an [a member or]
149-9 employee of the department [commission] for making a copy under
149-10 Subsection (a) that exceeds the fee charged for the copy.
149-11 SECTION 3.263. Section 503.065(a), Labor Code, is amended to
149-12 read as follows:
149-13 (a) In addition to a report of an injury filed with the
149-14 department [commission] under Section 409.005(a), an institution
149-15 shall file a supplemental report that contains:
149-16 (1) the name, age, sex, and occupation of the injured
149-17 employee;
149-18 (2) the character of work in which the employee was
149-19 engaged at the time of the injury;
149-20 (3) the place, date, and hour of the injury; and
149-21 (4) the nature and cause of the injury.
149-22 SECTION 3.264. Sections 503.066(a) and (e), Labor Code, are
149-23 amended to read as follows:
149-24 (a) The department [commission] may require an employee who
149-25 claims to have been injured to submit to an examination by the
149-26 department [commission] or a person acting under the department's
149-27 [commission's] authority at a reasonable time and place in this
150-1 state.
150-2 (e) The institution shall pay the fee, as set by the
150-3 department [commission], of a physician selected by the employee
150-4 under Subsection (b) or (d).
150-5 SECTION 3.265. Section 503.067(a), Labor Code, is amended to
150-6 read as follows:
150-7 (a) The commissioner [commission] may order or direct the
150-8 institution to reduce or suspend the compensation of an injured
150-9 employee who:
150-10 (1) persists in insanitary or injurious practices that
150-11 tend to imperil or retard the employee's recovery; or
150-12 (2) refuses to submit to medical, surgical, or other
150-13 remedial treatment recognized by the state that is reasonably
150-14 essential to promote the employee's recovery.
150-15 SECTION 3.266. Section 503.068, Labor Code, is amended to
150-16 read as follows:
150-17 Sec. 503.068. POSTPONEMENT OF HEARING. If an injured
150-18 employee is receiving benefits under this chapter and the
150-19 institution is providing hospitalization or medical treatment to
150-20 the employee, the department [commission] may postpone the hearing
150-21 on the employee's claim. An appeal may not be taken from a
150-22 commissioner [commission] order under this section.
150-23 SECTION 3.267. Section 503.069(a), Labor Code, is amended to
150-24 read as follows:
150-25 (a) In each case appealed from the department [commission]
150-26 to a county or district court:
150-27 (1) the clerk of the court shall mail to the
151-1 department [commission]:
151-2 (A) not later than the 20th day after the date
151-3 the case is filed, a notice containing the style, number, and date
151-4 of filing of the case; and
151-5 (B) not later than the 20th day after the date
151-6 the judgment is rendered, a certified copy of the judgment; and
151-7 (2) the attorney preparing the judgment shall file the
151-8 original and a copy of the judgment with the clerk.
151-9 SECTION 3.268. Section 503.070(a), Labor Code, is amended to
151-10 read as follows:
151-11 (a) A party who does not consent to abide by the final
151-12 decision of the commissioner [commission] shall file notice with
151-13 the department [commission] as required by Section 410.253 and
151-14 bring suit in the county in which the injury occurred to set aside
151-15 the final decision of the commissioner [commission].
151-16 SECTION 3.269. Section 504.001(1), Labor Code, is amended to
151-17 read as follows:
151-18 (1) "Department" means the Texas Department of
151-19 Workers' Compensation ["Commission" means the Texas Workers'
151-20 Compensation Commission].
151-21 SECTION 3.270. The heading to Section 504.018, Labor Code, is
151-22 amended to read as follows:
151-23 Sec. 504.018. NOTICE TO DEPARTMENT [COMMISSION] AND
151-24 EMPLOYEES; EFFECT ON COMMON-LAW OR STATUTORY LIABILITY.
151-25 SECTION 3.271. Section 504.018(a), Labor Code, is amended to
151-26 read as follows:
151-27 (a) A political subdivision shall notify the department
152-1 [commission] of the method by which its employees will receive
152-2 benefits, the approximate number of employees covered, and the
152-3 estimated amount of payroll.
152-4 SECTION 3.272. The heading to Section 505.053, Labor Code, is
152-5 amended to read as follows:
152-6 Sec. 505.053. CERTIFIED COPIES OF TEXAS DEPARTMENT OF
152-7 WORKERS' COMPENSATION [COMMISSION] DOCUMENTS.
152-8 SECTION 3.273. Sections 505.053(a) and (c), Labor Code, are
152-9 amended to read as follows:
152-10 (a) The Texas Department of Workers' Compensation
152-11 [commission] shall furnish a certified copy of an order, award,
152-12 decision, or paper on file in that department's [the commission's]
152-13 office to a person entitled to the copy on written request and
152-14 payment of the fee for the copy. The fee shall be the same as that
152-15 charged for similar services by the secretary of state's office.
152-16 (c) A fee or salary may not be paid to a person in the Texas
152-17 Department of Workers' Compensation [commission] for making the
152-18 copies that exceeds the fee charged for the copies.
152-19 SECTION 3.274. Section 505.054(d), Labor Code, is amended to
152-20 read as follows:
152-21 (d) A physician designated under Subsection (c) who conducts
152-22 an examination shall file with the department a complete transcript
152-23 of the examination on a form furnished by the department. The
152-24 department shall maintain all reports under this subsection as part
152-25 of the department's permanent records. A report under this
152-26 subsection is admissible in evidence before the Texas Department of
152-27 Workers' Compensation [commission] and in an appeal from a final
153-1 award or ruling of that department [the commission] in which the
153-2 individual named in the examination is a claimant for compensation
153-3 under this chapter. A report under this subsection that is
153-4 admitted is prima facie evidence of the facts stated in the report.
153-5 SECTION 3.275. Section 505.055, Labor Code, is amended to
153-6 read as follows:
153-7 Sec. 505.055. REPORTS OF INJURIES. (a) A report of an
153-8 injury filed with the Texas Department of Workers' Compensation
153-9 [commission] under Section 409.005, in addition to the information
153-10 required by commissioner of workers' compensation [commission]
153-11 rules, must contain:
153-12 (1) the name, age, sex, and occupation of the injured
153-13 employee;
153-14 (2) the character of work in which the employee was
153-15 engaged at the time of the injury;
153-16 (3) the place, date, and hour of the injury; and
153-17 (4) the nature and cause of the injury.
153-18 (b) In addition to subsequent reports of an injury filed
153-19 with the Texas Department of Workers' Compensation [commission]
153-20 under Section 409.005(i) [409.005(e)], the department shall file a
153-21 subsequent report on a form obtained for that purpose:
153-22 (1) on the termination of incapacity of the injured
153-23 employee; or
153-24 (2) if the incapacity extends beyond 60 days.
153-25 SECTION 3.276. Sections 505.056(a) and (d), Labor Code, are
153-26 amended to read as follows:
153-27 (a) The Texas Department of Workers' Compensation
154-1 [commission] may require an employee who claims to have been
154-2 injured to submit to an examination by that department [the
154-3 commission] or a person acting under the [commission's] authority
154-4 of that department at a reasonable time and place in this state.
154-5 (d) On the request of an employee or the department, the
154-6 employee or the department is entitled to have a physician selected
154-7 by the employee or the department present to participate in an
154-8 examination under Subsection (a) or Section 408.004. The employee
154-9 is entitled to have a physician selected by the employee present to
154-10 participate in an examination under Subsection (c). The department
154-11 shall pay the fee set by the Texas Department of Workers'
154-12 Compensation [commission] of a physician selected by the employee
154-13 under this subsection.
154-14 SECTION 3.277. Section 505.057(a), Labor Code, is amended to
154-15 read as follows:
154-16 (a) The Texas Department of Workers' Compensation
154-17 [commission] may order or direct the department to reduce or
154-18 suspend the compensation of an injured employee if the employee:
154-19 (1) persists in insanitary or injurious practices that
154-20 tend to imperil or retard the employee's recovery; or
154-21 (2) refuses to submit to medical, surgical, or other
154-22 remedial treatment recognized by the state that is reasonably
154-23 essential to promote the employee's recovery.
154-24 SECTION 3.278. Section 505.058, Labor Code, is amended to
154-25 read as follows:
154-26 Sec. 505.058. POSTPONEMENT OF HEARING. If an injured
154-27 employee is receiving benefits under this chapter and the
155-1 department is providing hospitalization or medical treatment to the
155-2 employee, the Texas Department of Workers' Compensation
155-3 [commission] may postpone the hearing of the employee's claim. An
155-4 appeal may not be taken from an [a commission] order of the
155-5 commissioner of workers' compensation under this section.
155-6 SECTION 3.279. Section 505.059(a), Labor Code, is amended to
155-7 read as follows:
155-8 (a) In each case appealed from the Texas Department of
155-9 Workers' Compensation [commission] to a county or district court:
155-10 (1) the clerk of the court shall mail to the Texas
155-11 Department of Workers' Compensation [commission]:
155-12 (A) not later than the 20th day after the date
155-13 the case is filed, a notice containing the style, number, and date
155-14 of filing of the case; and
155-15 (B) not later than the 20th day after the date
155-16 the judgment is rendered, a certified copy of the judgment; and
155-17 (2) the attorney preparing the judgment shall file the
155-18 original and a copy of the judgment with the clerk.
155-19 ARTICLE 4. REPEALER
155-20 SECTION 4.001. The following laws are repealed:
155-21 (1) Section 402.063, Labor Code; and
155-22 (2) Section 505.001(1), Labor Code.
155-23 ARTICLE 5. TRANSITION PROVISIONS; EFFECTIVE DATE
155-24 SECTION 5.001. The change in designation of the Texas
155-25 Workers' Compensation Commission to the Texas Department of
155-26 Workers' Compensation does not affect or impair any act done or
155-27 taken, any rule, standard, or rate adopted, any order or
156-1 certificate issued, or any form approved by the Texas Workers'
156-2 Compensation Commission as a state agency, or any penalty assessed
156-3 by the Texas Workers' Compensation Commission as a state agency
156-4 before the change in designation made by this Act.
156-5 SECTION 5.002. (a) The Texas Workers' Compensation
156-6 Commission is abolished on the effective date of this Act. The
156-7 term of a person who is serving on the Texas Workers' Compensation
156-8 Commission on the effective date of this Act expires the date the
156-9 commissioner of workers' compensation is appointed.
156-10 (b) A person who is serving as a member or as executive
156-11 director of the Texas Workers' Compensation Commission on August
156-12 31, 2001, is not eligible for appointment as commissioner under
156-13 Section 402.004, Labor Code, as added by this Act.
156-14 SECTION 5.003. All appropriations made by the legislature for
156-15 the use and benefit of the Texas Workers' Compensation Commission
156-16 are available for the use and benefit of the Texas Department of
156-17 Workers' Compensation.
156-18 SECTION 5.004. The governor shall appoint the commissioner of
156-19 workers' compensation not later than December 31, 2001.
156-20 SECTION 5.005. This Act takes effect September 1, 2001.