By:  Solomons                                                     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 to read as follows: (a) An insurance carrier shall initiate compensation under this subtitle promptly. Not later than the [seventh] fifteenth 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. (b) An insurance carrier who fails to comply with the provisions of Subsection (a) does not waive the carrier's right to contest the compensability of the injury as described in Subsection (d), but commits an administrative violation as described in Subsection (f). [(b)] (c) An insurance carrier shall notify the commission in writing of the initiation of income or death benefit payments in the manner prescribed by commission rules. [(c)] (d) If an insurance carrier does not contest the compensability of an injury on or before the 60th day after the date on which the insurance carrier is notified of the injury, the insurance carrier waives its right to contest compensability. The initiation of payments by an insurance carrier does not affect the right of the insurance carrier to continue to investigate or deny the compensability of an injury during the 60-day period. [(d)] (e) An insurance carrier may reopen the issue of the compensability of an injury if there is a finding of evidence that could not reasonably have been discovered earlier. [(e)] (f) 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 level for a [is a] Class B administrative violation. Each day of noncompliance constitutes a separate violation. (g) For the 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 on effect on the date the compensable injury occurred, and the former law is continued in effect for that purpose.