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COMMITTEE VOTE |
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YeaNayAbsentPNV |
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SchwertnerX |
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KingX |
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BirdwellX |
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CampbellX |
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CreightonX |
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JohnsonX |
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A BILL TO BE ENTITLED
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AN ACT
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relating to the entitlement of an injured employee to lifetime |
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income benefits under the workers' compensation system. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 408.0041, Labor Code, is amended by |
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amending Subsection (j) and adding Subsection (k-1) to read as |
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follows: |
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(j) An employee is not entitled to temporary income |
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benefits, or to lifetime income benefits under Section 408.1615, if |
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applicable to the employee, and an insurance carrier is authorized |
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to suspend the payment of those [temporary income] benefits, during |
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and for a period in which the employee fails to submit to an |
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examination required by Subsection (a) or (f) or, if applicable, |
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Section 408.1615(h), unless the commissioner determines that the |
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employee had good cause for the failure to submit to the |
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examination. The commissioner may order temporary income benefits |
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or lifetime income benefits under Section 408.1615, as applicable, |
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to be paid for the period for which the commissioner determined that |
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the employee had good cause. The commissioner by rule shall ensure |
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that: |
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(1) an employee receives reasonable notice of an |
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examination and the insurance carrier's basis for suspension; and |
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(2) the employee is provided a reasonable opportunity |
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to reschedule an examination for good cause. |
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(k-1) If the report of a designated doctor indicates that an |
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employee receiving lifetime income benefits under Section 408.1615 |
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is no longer entitled to those benefits, the insurance carrier may |
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suspend the payment of lifetime income benefits as provided by that |
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section. |
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SECTION 2. Section 408.161(a), Labor Code, is amended to |
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read as follows: |
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(a) Lifetime income benefits are paid until the death of the |
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employee for: |
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(1) total and permanent loss of sight in both eyes; |
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(2) loss of both feet at or above the ankle; |
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(3) loss of both hands at or above the wrist; |
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(4) loss of one foot at or above the ankle and the loss |
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of one hand at or above the wrist; |
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(5) an injury to the spine that results in permanent |
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and complete paralysis of both arms, both legs, or one arm and one |
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leg; |
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(6) a physically traumatic injury to the brain that, |
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as determined using evidence-based medicine, results in a permanent |
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major neurocognitive disorder: |
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(A) for which the employee requires occasional |
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supervision in the performance of routine daily tasks of self-care; |
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and |
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(B) that renders the employee permanently |
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unemployable [resulting in incurable insanity or imbecility]; or |
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(7) third degree burns that cover at least 40 percent |
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of the body and require grafting, or third degree burns covering the |
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majority of: |
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(A) [either] both hands; |
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(B) [or] one hand and one foot; or |
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(C) one hand or one foot and the face. |
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SECTION 3. Subchapter I, Chapter 408, Labor Code, is |
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amended by adding Section 408.1615 to read as follows: |
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Sec. 408.1615. LIFETIME INCOME BENEFITS FOR CERTAIN FIRST |
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RESPONDERS. (a) In this section: |
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(1) "First responder" means an individual who is: |
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(A) a peace officer under Article 2.12, Code of |
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Criminal Procedure; |
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(B) certified under Chapter 773, Health and |
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Safety Code, as an emergency care attendant, advanced emergency |
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medical technician, emergency medical technician-paramedic or a |
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licensed paramedic; |
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(C) a firefighter subject to certification by the |
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Texas Commission on Fire Protection under Chapter 419, Government |
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Code, whose principal duties are aircraft crash and rescue or fire |
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fighting; or |
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(D) an individual covered under Section 504.012 |
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who is providing volunteer services as: |
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(i) a volunteer firefighter, regardless of |
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whether the individual is certified under Chapter 419, Government |
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Code; or |
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(ii) an emergency medical services |
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volunteer, as defined by Section 773.003, Health and Safety Code. |
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(2) "Serious bodily injury" has the meaning assigned |
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by Section 1.07, Penal Code. |
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(b) This section applies only to an employee who sustains a |
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serious bodily injury, other than an injury described by Section |
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408.161, in the course and scope of the employee's employment or |
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volunteer service as a first responder that renders the employee |
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permanently unemployable. |
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(c) Except as otherwise provided by this section, an |
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employee to which this section applies is entitled to receive |
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lifetime income benefits paid until the employee's death for the |
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employee's injury. Sections 408.161(c) and (d) apply to the |
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payment of lifetime income benefits under this section. |
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(d) The division shall accelerate any dispute, including a |
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contested case hearing or appeal requested by the employee, |
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regarding an employee's continuing entitlement to lifetime income |
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benefits under this section. The employee shall provide notice to |
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the division that the dispute involves a first responder. |
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(e) An employee receiving lifetime income benefits under |
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this section shall annually certify to the insurance carrier, in |
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the form and manner prescribed by the division, that the employee |
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was not employed in any capacity during the preceding year. |
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(f) Notwithstanding Sections 410.169 and 410.205, an |
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insurance carrier may periodically review an employee's continuing |
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entitlement to lifetime income benefits under this section, but not |
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more than once during any five-year period. |
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(g) Notwithstanding Subsection (f), an insurance carrier |
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may review an employee's continuing entitlement to lifetime income |
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benefits under this section regardless of the date on which the |
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insurance carrier most recently reviewed the employee's continuing |
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entitlement, if: |
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(1) the employee certifies to the insurance carrier |
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under Subsection (e) that the employee was not employed in any |
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capacity during the preceding year; |
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(2) the insurance carrier provides evidence to the |
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commissioner that the certification provided by the employee under |
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Subsection (e) is not accurate; and |
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(3) the commissioner notifies the insurance carrier |
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that the commissioner has determined that the evidence provided by |
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the insurance carrier is sufficient to show that the certification |
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provided by the employee under Subsection (e) may not be accurate. |
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(h) An insurance carrier reviewing an employee's continuing |
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entitlement under Subsection (f) or (g) shall request the |
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commissioner to order a medical examination conducted by a |
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designated doctor under Section 408.0041. Except as otherwise |
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provided by this section, the requirements of Section 408.0041 |
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apply to an examination ordered under this subsection to the same |
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extent as if the examination were ordered under Section |
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408.0041(a). |
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(i) An employee is not entitled to lifetime income benefits |
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under this section, and an insurance carrier is authorized to |
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suspend the payment of lifetime income benefits, during and for a |
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period in which the employee fails to complete the annual |
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certification required by Subsection (e), the employee is employed |
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in any capacity, or as provided under Section 408.0041(j) or (k-1), |
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unless the commissioner determines that there is good cause. The |
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commissioner by rule shall ensure that an employee receives |
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reasonable notice of the insurance carrier's basis for the |
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suspension and is provided a reasonable opportunity to complete the |
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annual certification under Subsection (e) or otherwise respond to |
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the notice. |
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(j) The commissioner shall adopt rules necessary to |
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implement this section, including rules: |
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(1) prescribing the deadline for the submission and |
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the form and the manner of the submission of the annual |
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certification required by Subsection (e); and |
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(2) establishing procedures for: |
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(A) the review of an employee's continuing |
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entitlement to lifetime income benefits under this section; |
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(B) the suspension and reinstatement of lifetime |
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income benefits under this section; and |
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(C) the termination of lifetime income benefits |
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under this section on a final determination that an employee is no |
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longer entitled to the benefits. |
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SECTION 4. The changes in law made by this Act apply to a |
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claim for lifetime income benefits based on a compensable injury |
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that occurs on or after the effective date of this Act. A claim |
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based on a compensable injury that occurs before the effective date |
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of this Act is governed by the law in effect on the date 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 5. This Act takes effect September 1, 2023. |
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* * * * * |