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A BILL TO BE ENTITLED
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AN ACT
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relating to the processes for and the adjudication and payment of |
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certain claims involving a custodial officer, detention officer, |
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emergency medical technician, firefighter, or peace officer under |
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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 408.0042, Labor Code, is amended by |
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amending Subsections (a), (c), (d), (e), and (f) and adding |
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Subsection (a-1) to read as follows: |
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(a) Subject to Subsection (a-1), the [The] division shall |
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require an injured employee to submit to a single medical |
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examination to define the compensable injury on request by the |
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insurance carrier. |
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(a-1) In this subsection, the terms "custodial officer," |
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"detention officer," "emergency medical technician," |
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"firefighter," and "peace officer" have the meanings assigned by |
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Section 607.051, Government Code. On request by an injured |
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employee who is a custodial officer, a detention officer, an |
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emergency medical technician, a firefighter, or a peace officer, |
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the division shall authorize the performance of a medical |
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examination to define the compensable injury, regardless of whether |
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an examination under Subsection (a) was previously performed. |
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(c) After a [the] medical examination is performed under |
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Subsection (a) or (a-1), the treating doctor shall submit to the |
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insurance carrier and the division a report that details all |
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injuries and diagnoses related to the compensable injury, on |
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receipt of which the insurance carrier shall: |
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(1) accept all injuries and diagnoses as related to |
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the compensable injury; or |
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(2) dispute the determination of specific injuries and |
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diagnoses. |
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(d) Any treatment for an injury or diagnosis that is not |
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accepted by the insurance carrier under Subsection (c) as |
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compensable at the time of the medical examination under Subsection |
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(a) or (a-1) must be preauthorized before treatment is rendered. If |
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the insurance carrier denies preauthorization because the |
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treatment is for an injury or diagnosis unrelated to the |
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compensable injury, the injured employee or affected health care |
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provider may file an extent of injury dispute. |
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(e) Any treatment for an injury or diagnosis that is |
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accepted by the insurance carrier under Subsection (c) as |
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compensable at the time of the medical examination under Subsection |
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(a) or (a-1) may not be reviewed for compensability, but may be |
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reviewed for medical necessity. |
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(f) The commissioner may adopt rules relating to |
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requirements for: |
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(1) a request for an examination under Subsection (a) |
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or (a-1); or |
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(2) a report under this section, including |
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requirements regarding the contents of a report. |
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SECTION 2. Subchapter B, Chapter 408, Labor Code, is |
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amended by adding Section 408.0211 to read as follows: |
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Sec. 408.0211. INSURANCE CARRIER WAIVER OF RIGHT TO CONTEST |
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EXTENT OF INJURY OF CUSTODIAL OFFICER, DETENTION OFFICER, EMERGENCY |
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MEDICAL TECHNICIAN, FIREFIGHTER, OR PEACE OFFICER. (a) In this |
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section, the terms "custodial officer," "detention officer," |
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"emergency medical technician," "firefighter," and "peace officer" |
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have the meanings assigned by Section 607.051, Government Code. |
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(b) Notwithstanding any other provision of this title, an |
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insurance carrier that does not contest the extent of an injury on |
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or before the 60th day after the date the carrier receives the |
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report described by Section 408.0042(c) waives its right to contest |
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the extent of injury specifically claimed by the employee or |
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reasonably reflected in the employee's medical records available to |
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the carrier for review during that time period, if the employee is a |
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custodial officer, a detention officer, an emergency medical |
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technician, a firefighter, or a peace officer. |
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SECTION 3. Section 409.022, Labor Code, is amended by |
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adding Subsections (c-1) and (c-2) and amending Subsection (d) to |
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read as follows: |
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(c-1) For purposes of [(d) In] this section [subsection], |
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the terms "custodial officer," "detention officer," "emergency |
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medical technician," "firefighter," and "peace officer" have the |
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meanings assigned by Section 607.051, Government Code. |
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(c-2) In addition to the other requirements of this section, |
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an insurance carrier's notice of refusal to pay benefits under |
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Section 409.021 sent in response to a claim for compensation by an |
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injured employee who is a custodial officer, a detention officer, |
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an emergency medical technician, a firefighter, or a peace officer |
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must include a statement by the carrier that: |
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(1) for purposes of Subsection (a), includes the |
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specific reasons why the carrier is disputing the compensability of |
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the injury or the extent of injury; and |
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(2) describes the evidence that the carrier reviewed |
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in making the determination to dispute the issue under Subdivision |
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(1). |
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(d) In addition to the other requirements of this section, |
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if an insurance carrier's notice of refusal to pay benefits under |
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Section 409.021 is sent in response to a claim for compensation |
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resulting from a custodial officer's, a detention officer's, an |
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emergency medical technician's, a firefighter's, or a peace |
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officer's disability or death for which a presumption is claimed to |
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be applicable under Subchapter B, Chapter 607, Government Code, the |
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notice must include a statement by the carrier that: |
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(1) explains why the carrier determined a presumption |
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under that subchapter does not apply to the claim for compensation; |
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and |
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(2) describes the evidence that the carrier reviewed |
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in making the determination described by Subdivision (1). |
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SECTION 4. Subchapter D, Chapter 410, Labor Code, is |
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amended by adding Section 410.170 to read as follows: |
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Sec. 410.170. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN |
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MEDICAL EXPENSES. (a) In this section, the terms "custodial |
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officer," "detention officer," "emergency medical technician," |
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"firefighter," and "peace officer" have the meanings assigned by |
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Section 607.051, Government Code. |
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(b) Notwithstanding the amount of an award of benefits due |
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in a written decision by an administrative law judge under Section |
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410.168, an insurance carrier shall reimburse an injured employee |
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who is a custodial officer, a detention officer, an emergency |
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medical technician, a firefighter, or a peace officer for all |
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medical expenses incurred by the employee that are related to the |
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specific injury claimed by the employee if: |
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(1) the carrier denied the employee's claim for |
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medical benefits; and |
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(2) the decision of the administrative law judge |
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includes a determination that the injury is compensable. |
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SECTION 5. The changes in law made by this Act apply only to |
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a claim for workers' compensation benefits based on a compensable |
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injury that occurs on or after the effective date of this Act. A |
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claim based on a compensable injury that occurs before that date is |
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governed by the law as it existed on the date the compensable injury |
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occurred, and the former law is continued in effect for that |
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purpose. |
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SECTION 6. This Act takes effect September 1, 2027. |