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A BILL TO BE ENTITLED
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AN ACT
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relating to workers' compensation claims for certain medical |
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benefits, death benefits, and burial benefits. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 413.031, Labor Code, is amended by |
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amending Subsection (k) and adding Subsections (k-1) and (k-2) to |
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read as follows: |
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(k) A [Except as provided by Subsection (l), a] party to a |
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medical dispute, other than a medical dispute regarding spinal |
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surgery subject to Subsection (l) and a dispute subject to Section |
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413.0311, that remains unresolved after a review of the medical |
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service under this section is entitled to a hearing. A hearing |
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under this subsection shall be conducted by the State Office of |
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Administrative Hearings not later than the 60th day after the date |
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on which the party notifies the division of the request for a |
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hearing. The hearing shall be conducted in the manner provided for |
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a contested case under Chapter 2001, Government Code. |
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(k-1) A party who has exhausted all administrative remedies |
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under Subsection (k) and who is aggrieved by a final decision of the |
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State Office of Administrative Hearings may seek judicial review of |
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the decision. Judicial review under this subsection shall be |
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conducted in the manner provided for judicial review of a contested |
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case under Subchapter G, Chapter 2001, Government Code. |
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(k-2) The division and the department are not considered to |
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be parties to the medical dispute for purposes of Subsections (k) |
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and (k-1) [this subsection.
Judicial review under this subsection
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shall be conducted in the manner provided for judicial review of
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contested cases under Subchapter G, Chapter 2001, Government Code]. |
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SECTION 2. Subchapter C, Chapter 413, Labor Code, is |
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amended by adding Section 413.0311 to read as follows: |
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Sec. 413.0311. REVIEW OF CERTAIN MEDICAL DISPUTES; |
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CONTESTED CASE HEARING. (a) This section applies only to the |
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following medical disputes that remain unresolved after any |
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applicable review under Sections 413.031(b) through (i): |
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(1) a medical fee dispute in which the amount of |
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reimbursement sought by the requestor in its request for medical |
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dispute resolution does not exceed $2,000; |
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(2) an appeal of an independent review organization |
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decision regarding determination of the retrospective medical |
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necessity for a health care service for which the amount billed does |
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not exceed $3,000; and |
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(3) an appeal of an independent review organization |
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decision regarding determination of the concurrent or prospective |
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medical necessity for a health care service. |
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(b) A party to a medical dispute described by Subsection (a) |
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is entitled to a contested case hearing. A contested case hearing |
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under this section shall be conducted by a hearings officer in the |
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manner provided for contested case hearings under Subchapter D, |
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Chapter 410. Notwithstanding Section 410.024, a benefit review |
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conference is not a prerequisite to a contested case hearing under |
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this section. |
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(c) The decision of a hearings officer under this section is |
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final in the absence of a timely appeal by a party for judicial |
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review under Subsection (d). |
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(d) A party who has exhausted all administrative remedies |
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under Section 413.031 and this section and who is aggrieved by a |
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final decision of the hearings officer under Subsection (c) may |
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seek judicial review of the decision. Judicial review under this |
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subsection shall be conducted in the manner provided for judicial |
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review of a contested case under Subchapter G, Chapter 2001, |
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Government Code. |
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(e) The division and the department are not considered to be |
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parties to the medical dispute for purposes of this section. |
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SECTION 3. Section 402.073(b), Labor Code, is amended to |
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read as follows: |
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(b) In a case in which a hearing is conducted by the State |
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Office of Administrative Hearings under Section 413.031, 413.055, |
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or 415.034, the administrative law judge who conducts the hearing |
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for the State Office of Administrative Hearings shall enter the |
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final decision in the case after completion of the hearing. |
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SECTION 4. Section 408.182, Labor Code, is amended by |
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adding Subsections (d-1) and (d-2) to read as follows: |
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(d-1) If there is no eligible spouse, no eligible child, and |
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no eligible grandchild, and there are no surviving dependents of |
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the deceased employee who are parents, siblings, or grandparents of |
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the deceased, the death benefits shall be paid in equal shares to |
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surviving eligible parents of the deceased. A payment of death |
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benefits made under this subsection may not exceed one payment per |
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household. |
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(d-2) Except as otherwise provided by this subsection, to |
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be eligible to receive death benefits under Subsection (d-1), an |
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eligible parent must file with the division a claim for those |
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benefits not later than the first anniversary of the date of the |
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injured employee's death from the compensable injury. The |
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commissioner may extend the time for filing a claim under this |
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subsection only if the eligible parent submits proof satisfactory |
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to the commissioner of a compelling reason for the delay. |
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SECTION 5. Section 408.182(f), Labor Code, is amended by |
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adding Subdivision (4) to read as follows: |
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(4) "Eligible parent" means the mother or the father |
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of a deceased employee, including an adoptive parent or a |
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stepparent, who receives burial benefits under Section 408.186. |
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The term does not include a parent whose parental rights have been |
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terminated. |
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SECTION 6. Section 408.183, Labor Code, is amended by |
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adding Subsection (f-1) to read as follows: |
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(f-1) An eligible parent who is not a surviving dependent of |
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the deceased employee is entitled to receive death benefits until |
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the earlier of: |
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(1) the date the eligible parent dies; or |
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(2) the date of the expiration of 104 weeks of death |
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benefit payments. |
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SECTION 7. The change in law made by this Act applies to |
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workers' compensation medical disputes described by Section |
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413.031, Labor Code, as amended by this Act and Section 413.0311, |
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Labor Code, as added by this Act: |
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(1) that are pending for adjudication by the division |
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of workers' compensation of the Texas Department of Insurance on or |
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after the effective date of this Act; |
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(2) that may be remanded to the division of workers' |
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compensation of the Texas Department of Insurance on or after the |
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effective date of this Act; or |
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(3) that may arise on or after the effective date of |
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this Act. |
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SECTION 8. Chapter 408, Labor Code, as amended by this Act, |
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applies only to a claim for workers' compensation benefits based on |
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a compensable injury that occurs on or after the effective date of |
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this Act. A claim based on a compensable injury that occurs before |
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that date is governed by the law in effect on the date that the |
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compensable injury occurred, and the former law is continued in |
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effect for that purpose. |
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SECTION 9. This Act takes effect September 1, 2007. |
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