Amend CSHB 2926 (house committee printing) as follows:
(1) Strike page 2, line 15 through page 3, line 13, and substitute the following:
SECTION 3. Sections 409.0092(a) and (d), Labor Code, are amended to read as follows:
(a) An injured employee who is subject to Subchapter B, Chapter 607 [Section 607.0545], Government Code, and whose claim for benefits is determined to be compensable by an insurance carrier or the division, may request reimbursement for health care paid by the employee, including copayments and partial payments, by submitting to the carrier a legible written request and documentation showing the amounts paid to the health care provider.
(d) A person who has legal authority to act on behalf of an injured employee or that employee's estate may submit a request for reimbursement for health care in accordance with Subsection (a) or a request for medical dispute resolution in accordance with Subsection (c) [This section expires September 1, 2023].
(2) On page 3, strike lines 14 and 15 and substitute the following:
SECTION 4. Section 415.002, Labor Code, is amended by amending Subsection (a) and adding Subsection (c) to read as follows:
(3) On page 5, strike lines 16-21 and substitute the following:
(22) fails to apply a statutory presumption to a claim that qualifies for a presumption under Subchapter B, Chapter 607, Government Code, without conducting a reasonable investigation of the facts relevant to the applicability of the presumption to the claim;
(23) denies a claim that is subject to a statutory presumption under Subchapter B, Chapter 607, Government Code, without conducting a reasonable investigation of facts relevant to determining the validity of the claim; or
(4) On page 5, between lines 23 and 24, insert the following:
(c) With respect to any medical facts on which the insurance carrier or its representative relied in determining a presumption under Subchapter B, Chapter 607, Government Code, is not applicable or in denying a claim that is subject to a statutory presumption under that subchapter, the reasonable investigation required by Subsection (a)(22) or (23) must include an opinion from a qualified medical expert using evidence-based medicine that supports the decision of the insurance carrier or its representative.