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A BILL TO BE ENTITLED
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AN ACT
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relating to the resolution of certain medical disputes regarding |
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workers' compensation claims. |
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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), (k-2), and |
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(k-3) to 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), that remains unresolved after a |
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review of the medical service under this section is entitled to a |
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hearing. A hearing under this subsection shall be conducted by the |
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State Office of Administrative Hearings not later than the 60th day |
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after the date on which the party notifies the division of the |
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request for a hearing. The hearing shall be conducted in the manner |
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provided for 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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(k-3) An insurance carrier that is found after judicial |
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review under Subsection (k-1) to have wrongfully or negligently |
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contested a payment to a health care provider for a health care |
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service provided under this subtitle is liable for the costs of the |
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litigation, including attorney's fees. This subsection does not |
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apply to attorney's fees for which an insurance carrier may be |
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liable under Subchapter L, Chapter 408, or Chapter 410. |
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SECTION 2. The change in law made by this Act applies only |
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to a claim for workers' compensation benefits based on a |
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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 3. This Act takes effect September 1, 2007. |