BILL ANALYSIS

C.S.H.B. 2088

By: Smithee

State Affairs

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Under current law, if an injured worker fails to attend a designated doctor's examination or required medical examination without good cause, the insurance carrier is entitled to suspend temporary income benefits. The insurance carrier is required to reinstate temporary income benefits if the appointment is rescheduled and the injured worker attends the appointment.

The use of designated doctors has grown as a result of workers' compensation reforms. Designated doctors are used in more cases, often when an injured worker is no longer entitled to temporary income benefits but may be entitled to other income benefits. In some cases, injured workers have refused to attend a designated doctor examination, and, because the injured worker was not receiving temporary income benefits, the insurance carrier was unable to suspend other benefits. In such a case, an insurance carrier may be required to pay benefits to which the injured worker is no longer entitled. According to interested parties, measures are needed to protect the integrity of the designated doctor process by encouraging the injured employee to attend the scheduled examination.

C.S.H.B. 2088 seeks to resolve this issue and establish consistency with the workers' compensation reforms by authorizing an insurance carrier to suspend any workers' compensation income benefits if an injured worker fails to submit to a required doctor examination without good cause.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

C.S.H.B. 2088 amends the Labor Code to authorize an insurance carrier to suspend the payment of income benefits generally, rather than only temporary income benefits, during and for a period in which an injured employee fails to submit to a medical examination as ordered by the commissioner of workers' compensation unless the commissioner determines that the employee had good cause for the failure to submit to the examination.  The bill establishes that an injured employee is not entitled to any income benefits under those circumstances, rather than establishing that such employee is not entitled to only temporary income benefits.

EFFECTIVE DATE

September 1, 2011.

COMPARISON OF ORIGINAL AND SUBSTITUTE

C.S.H.B. 2088 differs from the original by removing from the authorization for an insurance carrier to suspend or reduce the payment of an injured employee's temporary income benefits based on the designated doctor's report indicating that an injured employee has reached maximum medical improvement or is otherwise able to return to work immediately the authorization that the suspension or reduction of income benefits be made immediately as well.

C.S.H.B. 2088 differs from the original, in a provision establishing that an injured employee is not entitled to income benefits for a period in which an injured employee fails to submit to a medical examination, by removing the limitation making the provision apply only to an employee's entitlement to temporary income benefits under those same circumstances, whereas the original removes language regarding the employee not being entitled to income benefits under those circumstances altogether.

 C.S.H.B. 2088 differs from the original by retaining the statutory exception to an employee not being entitled to income benefits and to an insurer's authorization to suspend payment of income benefits based on the commissioner of workers' compensation determination that the employee had good cause for the failure to submit to the examination and retaining the commissioner's statutory authorization to order income benefits to be paid for the period in question, whereas the original removes that exception and instead requires the commissioner to order income benefits to be paid if the employee attends a rescheduled examination and the employee is otherwise entitled to income benefits and establishes the retroactivity of such payments.

C.S.H.B. 2088 contains a saving provision not included in the original. The substitute differs from the original by making the bill effective on September 1, 2011, whereas the original makes the bill effective on passage or, if the bill does not receive the necessary vote, September 1, 2011.