Texas Senate Bill SB1492

Texas 2013 - 83rd Regular

Caption

Relating to the dispute by an insurer of a determination of specific injuries and diagnoses in connection with a compensable injury in certain workers' compensation claims.

Impact

The impact of SB1492 is particularly significant for the medical examinations conducted in workers' compensation cases occurring after the effective date of the Act. By establishing a clear timeline for insurers to act on medical reports, the bill aims to minimize unnecessary delays in awarding benefits to claimants, ensuring that injured workers receive timely decisions regarding their claims. This could lead to improved outcomes for workers seeking compensation for injuries sustained on the job.

Summary

SB1492 relates to changes in the dispute process by an insurer regarding determinations of specific injuries and diagnoses tied to compensable injuries under Texas's workers' compensation system. The bill amends the Labor Code to stipulate that if an insurance carrier fails to dispute the treating doctor's report within 90 days, they waive their right to contest the findings unless new evidence surfaces that could not have been reasonably discovered earlier. This change is aimed at streamlining the response time from insurers and enhancing the efficiency of the claims process.

Sentiment

The general sentiment surrounding SB1492 seems to be supportive among proponents who argue that the bill will foster accountability and promptness among insurance companies. They believe that by enforcing stricter timelines for dispute submissions, the bill will protect the rights of injured workers. Conversely, there may be concerns from insurers regarding the implications of being rendered unable to contest medical findings and the potential financial impact on their operations.

Contention

Notable points of contention may arise from the balance between ensuring prompt benefits for injured workers and maintaining the rights of insurers to dispute claims that they believe are unfounded. Some may argue that the 90-day limit on disputes could pressure insurers to accept claims without adequate review, possibly leading to increased costs for insurance providers. Additionally, there is the question of what constitutes 'new evidence' that would allow an insurer to challenge a determination after the deadline, which could lead to ambiguities in the enforcement of the law.