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.