1-1 By: Fraser S.B. No. 1395
1-2 (In the Senate - Filed March 8, 2001; March 13, 2001, read
1-3 first time and referred to Committee on Business and Commerce;
1-4 April 17, 2001, reported favorably by the following vote: Yeas 4,
1-5 Nays 1; April 17, 2001, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to the right of an insurance carrier to contest the
1-9 compensability of an injury in a workers' compensation case.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Section 409.021, Labor Code, is amended to read
1-12 as follows:
1-13 Sec. 409.021. INITIATION OF BENEFITS; INSURANCE CARRIER'S
1-14 REFUSAL; ADMINISTRATIVE VIOLATION. (a) An insurance carrier shall
1-15 initiate compensation under this subtitle promptly. Not later than
1-16 the seventh day after the date on which an insurance carrier
1-17 receives written notice of an injury, the insurance carrier shall:
1-18 (1) begin the payment of benefits as required by this
1-19 subtitle; or
1-20 (2) notify the commission and the employee in writing
1-21 of its refusal to pay and advise the employee of:
1-22 (A) the right to request a benefit review
1-23 conference; and
1-24 (B) the means to obtain additional information
1-25 from the commission.
1-26 (b) An insurance carrier who fails to begin the payment of
1-27 benefits or file a notice of refusal on or before the seventh day
1-28 after the date on which the insurance carrier is notified of the
1-29 injury does not waive the carrier's right to contest the
1-30 compensability of the injury but commits an administrative
1-31 violation subject to Subsection (f).
1-32 (c) An insurance carrier shall notify the commission in
1-33 writing of the initiation of income or death benefit payments in
1-34 the manner prescribed by commission rules.
1-35 (d) [(c)] If an insurance carrier does not contest the
1-36 compensability of an injury on or before the 60th day after the
1-37 date on which the insurance carrier is notified of the injury, the
1-38 insurance carrier waives its right to contest compensability. The
1-39 initiation of payments by an insurance carrier does not affect the
1-40 right of the insurance carrier to continue to investigate or deny
1-41 the compensability of an injury during the 60-day period.
1-42 (e) [(d)] An insurance carrier may reopen the issue of the
1-43 compensability of an injury if there is a finding of evidence that
1-44 could not reasonably have been discovered earlier.
1-45 (f) [(e)] An insurance carrier commits a violation if the
1-46 insurance carrier does not initiate payments or file a notice of
1-47 refusal as required by this section. A violation under this
1-48 subsection is a Class B administrative violation. Each day of
1-49 noncompliance constitutes a separate violation.
1-50 SECTION 2. This Act takes effect September 1, 2001, and
1-51 applies only to a claim for workers' compensation benefits based on
1-52 a compensable injury that occurs on or after that date. A claim
1-53 based on a compensable injury that occurs before the effective date
1-54 of this Act is governed by the law in effect on the date the
1-55 compensable injury occurred, and the former law is continued in
1-56 effect for that purpose.
1-57 * * * * *