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A BILL TO BE ENTITLED
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AN ACT
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relating to workers' compensation subclaims. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 409.009, Labor Code, is amended to read |
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as follows: |
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Sec. 409.009. SUBCLAIMS. (a) A person may file a written |
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claim with the division as a subclaimant if the person has: |
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(1) provided compensation, including health care |
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provided by a health care insurer, directly or indirectly, to or for |
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an employee or legal beneficiary; and |
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(2) sought and been refused reimbursement from the |
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insurance carrier. |
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(b) Health care benefits provided by a health care insurer |
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under this section are considered accrued medical benefits provided |
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to a claimant for purposes of Section 410.168(a)(3). A hearing |
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officer may award the health care insurer, as a subclaimant, all or |
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part of the subclaim and may order the insurance carrier to pay the |
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subclaim as part of a dispute adjudication process under Chapter |
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410. |
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(c) A subclaimant is not required to seek reimbursement from |
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a health care provider or the subclaimant's insured. |
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(d) It is not a defense to a subclaimant's request for |
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reimbursement in a contested case hearing under Chapter 410 or an |
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arbitration proceeding that: |
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(1) the subclaimant: |
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(A) has not sought reimbursement from a health |
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care provider or the subclaimant's insured; or |
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(B) did not seek preauthorization under Section |
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413.014 or rules adopted under that section; or |
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(2) the health care provider did not bill the workers' |
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compensation insurance carrier before the first anniversary of the |
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date the services paid for by the subclaimant were provided. |
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SECTION 2. Section 410.104, Labor Code, is amended by |
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adding Subsection (b-1) to read as follows: |
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(b-1) Notwithstanding Subsections (a) and (b), in a dispute |
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that does not involve compensability, extent of injury, or |
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eligibility for or the amount of income or death benefits, a |
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subclaimant and the insurance carrier shall arbitrate the dispute. |
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The arbitration may proceed under this subchapter or Chapter 171, |
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Civil Practice and Remedies Code. If the arbitration proceeding is |
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conducted under this subchapter, a benefit review conference under |
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Subchapter B is not a prerequisite. The commissioner shall |
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prescribe any necessary form for that purpose. |
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SECTION 3. Section 171.002(a), Civil Practice and Remedies |
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Code, is amended to read as follows: |
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(a) This chapter does not apply to: |
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(1) a collective bargaining agreement between an |
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employer and a labor union; |
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(2) an agreement for the acquisition by one or more |
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individuals of property, services, money, or credit in which the |
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total consideration to be furnished by the individual is not more |
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than $50,000, except as provided by Subsection (b); |
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(3) a claim for personal injury, except as provided by |
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Subsection (c); |
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(4) a claim for workers' compensation benefits, other |
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than a subclaim as described by Section 410.104(b-1), Labor Code; |
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or |
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(5) an agreement made before January 1, 1966. |
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SECTION 4. The change in law made by this Act applies only |
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to a subclaim based on a workers' compensation claim filed under |
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Chapter 409, Labor Code, on or after September 1, 2002. A subclaim |
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based on a claim filed before that date is governed by the law in |
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effect on the date the claim was filed, and the former law is |
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continued in effect for that purpose. |
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SECTION 5. This Act takes effect September 1, 2007. |