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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.