This website will be unavailable from Friday, April 26, 2024 at 6:00 p.m. through Monday, April 29, 2024 at 7:00 a.m. due to data center maintenance.
H.B. No. 2199
AN ACT
relating to the right of an insurance carrier to contest the
compensability of an injury in a workers' compensation case;
providing an administrative violation.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 409.021, Labor Code, is amended by
amending Subsections (a) and (e) and adding Subsections (a-1),
(a-2), and (f) to read as follows:
(a) An insurance carrier shall initiate compensation under
this subtitle promptly. Not later than the 15th [seventh] day after
the date on which an insurance carrier receives written notice of an
injury, the insurance carrier shall:
(1) begin the payment of benefits as required by this
subtitle; or
(2) notify the commission and the employee in writing
of its refusal to pay and advise the employee of:
(A) the right to request a benefit review
conference; and
(B) the means to obtain additional information
from the commission.
(a-1) An insurance carrier that fails to comply with
Subsection (a) does not waive the carrier's right to contest the
compensability of the injury as provided by Subsection (c) but
commits an administrative violation subject to Subsection (e).
(a-2) An insurance carrier is not required to comply with
Subsection (a) if the insurance carrier has accepted the claim as a
compensable injury and income or death benefits have not yet
accrued but will be paid by the insurance carrier when the benefits
accrue and are due.
(e) An insurance carrier commits a violation if the
insurance carrier does not initiate payments or file a notice of
refusal as required by this section. A violation under this
subsection shall be assessed at $500 if the carrier initiates
compensation or files a notice of refusal within five working days
of the date required by Subsection (a), $1,500 if the carrier
initiates compensation or files a notice of refusal more than five
and less than 16 working days of the date required by Subsection
(a), $2,500 if the carrier initiates compensation or files a notice
of refusal more than 15 and less than 31 working days of the date
required by Subsection (a), or $5,000 if the carrier initiates
compensation or files a notice of refusal more than 30 days after
the date required by Subsection (a). The administrative penalties
are not cumulative. [is a Class B administrative violation. Each
day of noncompliance constitutes a separate violation.]
(f) For purposes of this section:
(1) a certified self-insurer receives notice on the
date the qualified claims servicing contractor designated by the
certified self-insurer under Section 407.061(c) receives notice;
and
(2) a political subdivision that self-insures under
Section 504.011, either individually or through an interlocal
agreement with other political subdivisions, receives notice on the
date the intergovernmental risk pool or other entity responsible
for administering the claim for the political subdivision receives
notice.
SECTION 2. This Act takes effect September 1, 2003, and
applies only to a claim for workers' compensation benefits based on
a compensable injury that occurs on or after that date. A claim
based on a compensable injury that occurs before the effective date
of this Act is governed by the law in effect on the date the
compensable injury occurred, and the former law is continued in
effect for that purpose.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2199 was passed by the House on May
10, 2003, by a non-record vote.
______________________________
Chief Clerk of the House
I certify that H.B. No. 2199 was passed by the Senate on May
28, 2003, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor