85R5415 KKR-F
By: Zaffirini S.B. No. 1493
A BILL TO BE ENTITLED
AN ACT
relating to changing statutory references to hearing officer and
hearings officer to administrative law judge under the workers'
compensation system.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1305.356(b), Insurance Code, is amended
to read as follows:
(b) At a contested case hearing held under Subsection (a),
the administrative law judge [hearing officer] conducting the
hearing shall consider evidence-based treatment guidelines adopted
by the network under Section 1305.304.
SECTION 2. Section 409.0091(m), Labor Code, is amended to
read as follows:
(m) In a dispute filed under Chapter 410 that arises from a
subclaim under this section, an administrative law judge [a hearing
officer] may issue an order regarding compensability or eligibility
for benefits and order the workers' compensation insurance carrier
to reimburse health care services paid by the health care insurer as
appropriate under this subtitle. Any dispute over the amount of
medical benefits owed under this section, including medical
necessity issues, shall be determined by medical dispute resolution
under Sections 413.031 and 413.032.
SECTION 3. Section 410.152, Labor Code, is amended to read
as follows:
Sec. 410.152. ADMINISTRATIVE LAW JUDGES [HEARING
OFFICERS]; QUALIFICATIONS. (a) An administrative law judge [A
hearing officer] shall conduct a contested case hearing.
(b) An administrative law judge [A hearing officer] must be
licensed to practice law in this state.
SECTION 4. Section 410.156(b), Labor Code, is amended to
read as follows:
(b) A party commits an administrative violation if the
party, without good cause as determined by the administrative law
judge [hearing officer], does not attend a contested case hearing.
SECTION 5. Section 410.158(a), Labor Code, is amended to
read as follows:
(a) Except as provided by Section 410.162, discovery is
limited to:
(1) depositions on written questions to any health
care provider;
(2) depositions of other witnesses as permitted by the
administrative law judge [hearing officer] for good cause shown;
and
(3) interrogatories as prescribed by the
commissioner.
SECTION 6. Section 410.162, Labor Code, is amended to read
as follows:
Sec. 410.162. ADDITIONAL DISCOVERY. For good cause shown,
a party may obtain permission from the administrative law judge
[hearing officer] to conduct additional discovery as necessary.
SECTION 7. Section 410.163, Labor Code, is amended to read
as follows:
Sec. 410.163. POWERS AND DUTIES OF ADMINISTRATIVE LAW JUDGE
[HEARING OFFICER]. (a) At a contested case hearing the
administrative law judge [hearing officer] shall:
(1) swear witnesses;
(2) receive testimony;
(3) allow examination and cross-examination of
witnesses;
(4) accept documents and other tangible evidence; and
(5) allow the presentation of evidence by affidavit.
(b) An administrative law judge [A hearing officer] shall
ensure the preservation of the rights of the parties and the full
development of facts required for the determinations to be made. An
administrative law judge [A hearing officer] may permit the use of
summary procedures, if appropriate, including witness statements,
summaries, and similar measures to expedite the proceedings.
SECTION 8. Section 410.164(c), Labor Code, is amended to
read as follows:
(c) At each contested case hearing, as applicable, the
insurance carrier shall file with the administrative law judge
[hearing officer] and shall deliver to the claimant a single
document stating the true corporate name of the insurance carrier
and the name and address of the insurance carrier's registered
agent for service of process. The document is part of the record of
the contested case hearing.
SECTION 9. Section 410.165, Labor Code, is amended to read
as follows:
Sec. 410.165. EVIDENCE. (a) The administrative law judge
[hearing officer] is the sole judge of the relevance and
materiality of the evidence offered and of the weight and
credibility to be given to the evidence. Conformity to legal rules
of evidence is not necessary.
(b) An administrative law judge [A hearing officer] may
accept a written statement signed by a witness and shall accept all
written reports signed by a health care provider.
SECTION 10. Section 410.167, Labor Code, is amended to read
as follows:
Sec. 410.167. EX PARTE CONTACTS PROHIBITED. A party and an
administrative law judge [a hearing officer] may not communicate
outside the contested case hearing unless the communication is in
writing with copies provided to all parties or relates to
procedural matters.
SECTION 11. Sections 410.168(a), (c), (d), and (e), Labor
Code, are amended to read as follows:
(a) The administrative law judge [hearing officer] shall
issue a written decision that includes:
(1) findings of fact and conclusions of law;
(2) a determination of whether benefits are due; and
(3) an award of benefits due.
(c) The administrative law judge [hearing officer] may
enter an interlocutory order for the payment of all or part of
medical benefits or income benefits. The order may address accrued
benefits, future benefits, or both accrued benefits and future
benefits. The order is binding during the pendency of an appeal to
the appeals panel.
(d) On a form that the commissioner by rule prescribes, the
administrative law judge [hearing officer] shall issue a separate
written decision regarding attorney's fees and any matter related
to attorney's fees. The decision regarding attorney's fees and the
form may not be made known to a jury in a judicial review of an
award, including an appeal.
(e) The commissioner by rule shall prescribe the times
within which the administrative law judge [hearing officer] must
file the decisions with the division.
SECTION 12. Section 410.169, Labor Code, is amended to read
as follows:
Sec. 410.169. EFFECT OF DECISION. A decision of an
administrative law judge [a hearing officer] regarding benefits is
final in the absence of a timely appeal by a party and is binding
during the pendency of an appeal to the appeals panel.
SECTION 13. Sections 410.202(a) and (c), Labor Code, are
amended to read as follows:
(a) To appeal the decision of an administrative law judge [a
hearing officer], a party shall file a written request for appeal
with the appeals panel not later than the 15th day after the date on
which the decision of the administrative law judge [hearing
officer] is received from the division and shall on the same date
serve a copy of the request for appeal on the other party.
(c) A request for appeal or a response must clearly and
concisely rebut or support the decision of the administrative law
judge [hearing officer] on each issue on which review is sought.
SECTION 14. Section 410.203(b), Labor Code, is amended to
read as follows:
(b) The appeals panel may:
(1) reverse the decision of the administrative law
judge [hearings officer] and render a new decision;
(2) reverse the decision of the administrative law
judge [hearings officer] and remand the case to the administrative
law judge [hearing officer] for further consideration and
development of evidence; or
(3) affirm the decision of the administrative law
judge [hearings officer] in a case described by Section
410.204(a-1).
SECTION 15. Sections 410.204(a-1) and (c), Labor Code, are
amended to read as follows:
(a-1) An appeals panel may only issue a written decision in
a case in which the panel affirms the decision of an administrative
law judge [a hearings officer] if the case:
(1) is a case of first impression;
(2) involves a recent change in law; or
(3) involves errors at the contested case hearing that
require correction but do not affect the outcome of the hearing,
including:
(A) findings of fact for which insufficient
evidence exists;
(B) incorrect conclusions of law;
(C) findings of fact or conclusions of law
regarding matters that were not properly before the administrative
law judge [hearings officer]; and
(D) legal errors not otherwise described by this
subdivision.
(c) If the appeals panel does not issue a decision in
accordance with this section, the decision of the administrative
law judge [hearing officer] becomes final and is the final decision
of the appeals panel.
SECTION 16. Sections 413.0311(b), (c), and (d), Labor Code,
are amended to read as follows:
(b) A party to a medical dispute described by Subsection (a)
is entitled to a contested case hearing. A contested case hearing
under this section shall be conducted by an administrative law
judge [a hearings officer] in the manner provided for contested
case hearings under Subchapter D, Chapter 410. Notwithstanding
Section 410.024, a benefit review conference is not a prerequisite
to a contested case hearing under this section.
(c) The decision of an administrative law judge [a hearings
officer] under this section is final in the absence of a timely
appeal by a party for judicial review under Subsection (d).
(d) A party who has exhausted all administrative remedies
under Section 413.031 and this section and who is aggrieved by a
final decision of the administrative law judge [hearings officer]
under Subsection (c) may seek judicial review of the decision.
Judicial review under this subsection shall be conducted in the
manner provided for judicial review of a contested case under
Subchapter G, Chapter 2001, Government Code, except that the party
seeking judicial review under this section must file suit not later
than the 45th day after the date on which the division mailed the
party the decision of the administrative law judge [hearings
officer]. For purposes of this subsection, the mailing date is
considered to be the fifth day after the date the decision of the
administrative law judge [hearings officer] was filed with the
division.
SECTION 17. Section 504.054(b), Labor Code, is amended to
read as follows:
(b) The administrative law judge [hearing officer]
conducting the contested case hearing under Subsection (a) shall
consider any treatment guidelines adopted by the political
subdivision or pool that provides medical benefits under Section
504.053(b)(2) if those guidelines meet the standards provided by
Section 413.011(e).
SECTION 18. This Act takes effect September 1, 2017.