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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 who is a health care insurer is not |
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required to seek reimbursement from a health care provider or the |
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subclaimant's insured. |
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(d) It is not a defense to a request by a subclaimant who is |
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a health care insurer for reimbursement in a contested case hearing |
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under Chapter 410 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 as provided by Section 408.027 |
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before the 95th day after the date the services paid for by the |
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subclaimant were provided. |
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(e) If the insurance carrier does not contest |
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compensability in a claim that is the subject of a subclaim by a |
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health care insurer, the dispute shall proceed to a contested case |
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hearing under Subchapter D, Chapter 410. A benefit review |
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conference under Subchapter B, Chapter 410, is not a prerequisite |
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to a hearing under this subsection. |
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SECTION 2. 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 3. This Act takes effect September 1, 2007. |