By: Patterson, Longoria, Frazier, Thimesch, H.B. No. 790
      Isaac, et al.
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the processes for and the adjudication and payment of
  certain claims under the workers' compensation system.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 401.026, Labor Code, is amended to read
  as follows:
         Sec. 401.026.  APPLICABILITY TO CERTAIN EMERGENCY RESPONSE
  PERSONNEL. For purposes of this subtitle, the travel of a
  firefighter, peace officer, or emergency medical personnel en route
  to an emergency call is considered to be in the course and scope of
  the firefighter's, peace officer's, or emergency medical
  personnel's employment.
         SECTION 2.  Section 408.0042, Labor Code, is amended by
  amending Subsections (a), (c), (d), (e), and (f) and adding
  Subsection (a-1) to read as follows:
         (a)  Subject to Subsection (a-1), the [The] division shall
  require an injured employee to submit to a single medical
  examination to define the compensable injury on request by the
  insurance carrier.
         (a-1)  In this subsection, the terms "custodial officer,"
  "detention officer," "emergency medical technician,"
  "firefighter," and "peace officer" have the meanings assigned by
  Section 607.051, Government Code.  On request by an injured
  employee who is a custodial officer, a detention officer, an
  emergency medical technician, a firefighter, or a peace officer,
  the division shall authorize the performance of a medical
  examination to define the compensable injury, regardless of whether
  an examination under Subsection (a) was previously performed.
         (c)  After a [the] medical examination is performed under
  Subsection (a) or (a-1), the treating doctor shall submit to the
  insurance carrier and the division a report that details all
  injuries and diagnoses related to the compensable injury, on
  receipt of which the insurance carrier shall:
               (1)  accept all injuries and diagnoses as related to
  the compensable injury; or
               (2)  dispute the determination of specific injuries and
  diagnoses.
         (d)  Any treatment for an injury or diagnosis that is not
  accepted by the insurance carrier under Subsection (c) as
  compensable at the time of the medical examination under Subsection
  (a) or (a-1) must be preauthorized before treatment is rendered.  If
  the insurance carrier denies preauthorization because the
  treatment is for an injury or diagnosis unrelated to the
  compensable injury, the injured employee or affected health care
  provider may file an extent of injury dispute.
         (e)  Any treatment for an injury or diagnosis that is
  accepted by the insurance carrier under Subsection (c) as
  compensable at the time of the medical examination under Subsection
  (a) or (a-1) may not be reviewed for compensability, but may be
  reviewed for medical necessity.
         (f)  The commissioner may adopt rules relating to
  requirements for:
               (1)  a request for an examination under Subsection (a)
  or (a-1); or
               (2)  a report under this section, including
  requirements regarding the contents of a report.
         SECTION 3.  Section 409.021, Labor Code, is amended by
  adding Subsection (a-4) to read as follows:
         (a-4)  In this subsection, the terms "custodial officer,"
  "detention officer," "emergency medical technician,"
  "firefighter," and "peace officer" have the meanings assigned by
  Section 607.051, Government Code. Notwithstanding any other
  provision of this title, an insurance carrier who does not contest
  the extent of an injury on or before the 60th day after the date the
  carrier receives the report described by Section 408.0042(c) waives
  its right to contest the extent of injury specifically claimed by
  the employee or reasonably reflected in the employee's medical
  records available to the carrier for review during that time
  period, if the employee is a custodial officer, a detention
  officer, an emergency medical technician, a firefighter, or a peace
  officer.
         SECTION 4.  Section 409.022, Labor Code, is amended by
  adding Subsections (c-1) and (c-2) and amending Subsection (d) to
  read as follows:
         (c-1)  For purposes of [(d)  In] this section [subsection],
  the terms "custodial officer," "detention officer," "emergency
  medical technician," "firefighter," and "peace officer" have the
  meanings assigned by Section 607.051, Government Code. 
         (c-2)  In addition to the other requirements of this section,
  an insurance carrier's notice of refusal to pay benefits under
  Section 409.021 sent in response to a claim for compensation by an
  injured employee who is a custodial officer, a detention officer,
  an emergency medical technician, a firefighter, or a peace officer
  must include a statement by the carrier that:
               (1)  for purposes of Subsection (a), includes the
  specific reasons why the carrier is disputing the compensability of
  the injury or the extent of injury; and
               (2)  describes the evidence that the carrier reviewed
  in making the determination to dispute the issue under Subdivision
  (1).
         (d)  In addition to the other requirements of this section,
  if an insurance carrier's notice of refusal to pay benefits under
  Section 409.021 is sent in response to a claim for compensation
  resulting from a custodial officer's, a detention officer's, an
  emergency medical technician's, a firefighter's, or a peace
  officer's disability or death for which a presumption is claimed to
  be applicable under Subchapter B, Chapter 607, Government Code, the
  notice must include a statement by the carrier that:
               (1)  explains why the carrier determined a presumption
  under that subchapter does not apply to the claim for compensation;
  and
               (2)  describes the evidence that the carrier reviewed
  in making the determination described by Subdivision (1).
         SECTION 5.  Section 410.005(a), Labor Code, is amended to
  read as follows:
         (a)  A [Unless the division determines that good cause exists
  for the selection of a different location, a] contested case
  hearing may not be conducted at a site more than 75 miles from the
  claimant's residence at the time of the injury unless:
               (1)  the division determines that good cause exists for
  the selection of a different location; or
               (2)  the contested case hearing is conducted by
  videoconference as provided by Section 410.0055.
         SECTION 6.  Subchapter A, Chapter 410, Labor Code, is
  amended by adding Section 410.0055 to read as follows:
         Sec. 410.0055.  CONDUCTING CERTAIN CONTESTED CASE HEARINGS
  BY VIDEOCONFERENCE. (a)  In this section, the terms "custodial
  officer," "detention officer," "emergency medical technician,"
  "firefighter," and "peace officer" have the meanings assigned by
  Section 607.051, Government Code.
         (b)  The division shall conduct a contested case hearing by
  videoconference on request of an injured employee who is a
  custodial officer, a detention officer, an emergency medical
  technician, a firefighter, or a peace officer.
         SECTION 7.  Subchapter D, Chapter 410, Labor Code, is
  amended by adding Section 410.170 to read as follows:
         Sec. 410.170.  EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN
  MEDICAL EXPENSES.  (a)  In this section, the terms "custodial
  officer," "detention officer," "emergency medical technician,"
  "firefighter," and "peace officer" have the meanings assigned by
  Section 607.051, Government Code.
         (b)  Notwithstanding the amount of an award of benefits due
  in a written decision by an administrative law judge under Section
  410.168, an insurance carrier shall reimburse an injured employee
  who is a custodial officer, a detention officer, an emergency
  medical technician, a firefighter, or a peace officer for all
  medical expenses incurred by the employee that are related to the
  specific injury claimed by the employee if:
               (1)  the carrier denied the employee's claim for
  medical benefits;
               (2)  the decision of the administrative law judge
  includes a determination that the injury is compensable; and
               (3)  the decision of the administrative law judge is
  not appealed to the appeals panel and becomes final.
         SECTION 8.  Subchapter E, Chapter 410, Labor Code, is
  amended by adding Section 410.2051 to read as follows:
         Sec. 410.2051.  EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN
  MEDICAL EXPENSES.  (a)  In this section, the terms "custodial
  officer," "detention officer," "emergency medical technician,"
  "firefighter," and "peace officer" have the meanings assigned by
  Section 607.051, Government Code.
         (b)  An insurance carrier shall directly reimburse an
  injured employee who is a custodial officer, a detention officer,
  an emergency medical technician, a firefighter, or a peace officer
  for all medical expenses incurred by the employee that are related
  to the specific injury claimed by the employee if:
               (1)  the carrier denied the employee's claim for
  medical benefits; and
               (2)  either:
                     (A)  the administrative law judge's determination
  that benefits are owed becomes final without an appeal; or
                     (B)  the appeals panel:
                           (i)  affirms the administrative law judge's
  determination that the benefits are owed; or
                           (ii)  reverses the administrative law
  judge's determination that the benefits are not owed.
         (c)  If the appeals panel affirms the administrative law
  judge's determination that the benefits are owed, the insurance
  carrier shall directly reimburse the employee for all medical
  expenses incurred by the employee that are related to the specific
  injury claimed by the employee, regardless of the amount of an award
  of benefits due in the written decision by the administrative law
  judge under Section 410.168.
         (d)  The insurance carrier must reimburse the injured
  employee under Subsection (b), regardless of whether the appeals
  panel's decision is appealed for judicial review.
         SECTION 9.  (a) Except as provided by Subsection (b) of this
  section, the changes in law made by this Act apply only to a claim
  for workers' compensation benefits based on a compensable injury
  that occurs on or after the effective date of this Act. A claim
  based on a compensable injury that occurs before that date is
  governed by the law as it existed on the date the compensable injury
  occurred, and the former law is continued in effect for that
  purpose.
         (b)  Section 410.0055, Labor Code, as added by this Act,
  applies to a contested case hearing held on or after the effective
  date of this Act.
         SECTION 10.  This Act takes effect September 1, 2023.