78R14065 KSD-D
By: Solomons H.B. No. 2199
Substitute the following for H.B. No. 2199:
By: Bohac C.S.H.B. No. 2199
A BILL TO BE ENTITLED
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 the maximum amount permitted for
[is] a Class B administrative violation. Each day of noncompliance
constitutes a separate violation. In addition to the assessment
for the insurance carrier's initial violation under this
subsection, the insurance carrier is liable for and shall pay to the
employee, without order from the commission, a penalty of $500 for
the carrier's initial 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.