H.B. No. 2468
AN ACT
relating to the entitlement of an injured employee to lifetime
income benefits under the workers' compensation system.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 408.0041, Labor Code, is amended by
amending Subsection (j) and adding Subsection (k-1) to read as
follows:
(j) An employee is not entitled to temporary income
benefits, or to lifetime income benefits under Section 408.1615, if
applicable to the employee, and an insurance carrier is authorized
to suspend the payment of those [temporary income] benefits, during
and for a period in which the employee fails to submit to an
examination required by Subsection (a) or (f) or, if applicable,
Section 408.1615(h), unless the commissioner determines that the
employee had good cause for the failure to submit to the
examination. The commissioner may order temporary income benefits
or lifetime income benefits under Section 408.1615, as applicable,
to be paid for the period for which the commissioner determined that
the employee had good cause. The commissioner by rule shall ensure
that:
(1) an employee receives reasonable notice of an
examination and the insurance carrier's basis for suspension; and
(2) the employee is provided a reasonable opportunity
to reschedule an examination for good cause.
(k-1) If the report of a designated doctor indicates that an
employee receiving lifetime income benefits under Section 408.1615
is no longer entitled to those benefits, the insurance carrier may
suspend the payment of lifetime income benefits as provided by that
section.
SECTION 2. Section 408.161(a), Labor Code, is amended to
read as follows:
(a) Lifetime income benefits are paid until the death of the
employee for:
(1) total and permanent loss of sight in both eyes;
(2) loss of both feet at or above the ankle;
(3) loss of both hands at or above the wrist;
(4) loss of one foot at or above the ankle and the loss
of one hand at or above the wrist;
(5) an injury to the spine that results in permanent
and complete paralysis of both arms, both legs, or one arm and one
leg;
(6) a physically traumatic injury to the brain that,
as determined using evidence-based medicine, results in a permanent
major neurocognitive disorder:
(A) for which the employee requires occasional
supervision in the performance of routine daily tasks of self-care;
and
(B) that renders the employee permanently
unemployable [resulting in incurable insanity or imbecility]; or
(7) third degree burns that cover at least 40 percent
of the body and require grafting, or third degree burns covering the
majority of:
(A) [either] both hands;
(B) [or] one hand and one foot; or
(C) one hand or one foot and the face.
SECTION 3. Subchapter I, Chapter 408, Labor Code, is
amended by adding Section 408.1615 to read as follows:
Sec. 408.1615. LIFETIME INCOME BENEFITS FOR CERTAIN FIRST
RESPONDERS. (a) In this section:
(1) "First responder" means an individual who is:
(A) a peace officer under Article 2.12, Code of
Criminal Procedure;
(B) certified under Chapter 773, Health and
Safety Code, as an emergency care attendant, advanced emergency
medical technician, emergency medical technician-paramedic or a
licensed paramedic;
(C) a firefighter subject to certification by the
Texas Commission on Fire Protection under Chapter 419, Government
Code, whose principal duties are aircraft crash and rescue or fire
fighting; or
(D) an individual covered under Section 504.012
who is providing volunteer services as:
(i) a volunteer firefighter, regardless of
whether the individual is certified under Chapter 419, Government
Code; or
(ii) an emergency medical services
volunteer, as defined by Section 773.003, Health and Safety Code.
(2) "Serious bodily injury" has the meaning assigned
by Section 1.07, Penal Code.
(b) This section applies only to an employee who sustains a
serious bodily injury, other than an injury described by Section
408.161, in the course and scope of the employee's employment or
volunteer service as a first responder that renders the employee
permanently unemployable.
(c) Except as otherwise provided by this section, an
employee to which this section applies is entitled to receive
lifetime income benefits paid until the employee's death for the
employee's injury. Sections 408.161(c) and (d) apply to the
payment of lifetime income benefits under this section.
(d) The division shall accelerate any dispute, including a
contested case hearing or appeal requested by the employee,
regarding an employee's continuing entitlement to lifetime income
benefits under this section. The employee shall provide notice to
the division that the dispute involves a first responder.
(e) An employee receiving lifetime income benefits under
this section shall annually certify to the insurance carrier, in
the form and manner prescribed by the division, that the employee
was not employed in any capacity during the preceding year.
(f) Notwithstanding Sections 410.169 and 410.205, an
insurance carrier may periodically review an employee's continuing
entitlement to lifetime income benefits under this section, but not
more than once during any five-year period.
(g) Notwithstanding Subsection (f), an insurance carrier
may review an employee's continuing entitlement to lifetime income
benefits under this section regardless of the date on which the
insurance carrier most recently reviewed the employee's continuing
entitlement, if:
(1) the employee certifies to the insurance carrier
under Subsection (e) that the employee was not employed in any
capacity during the preceding year;
(2) the insurance carrier provides evidence to the
commissioner that the certification provided by the employee under
Subsection (e) is not accurate; and
(3) the commissioner notifies the insurance carrier
that the commissioner has determined that the evidence provided by
the insurance carrier is sufficient to show that the certification
provided by the employee under Subsection (e) may not be accurate.
(h) An insurance carrier reviewing an employee's continuing
entitlement under Subsection (f) or (g) shall request the
commissioner to order a medical examination conducted by a
designated doctor under Section 408.0041. Except as otherwise
provided by this section, the requirements of Section 408.0041
apply to an examination ordered under this subsection to the same
extent as if the examination were ordered under Section
408.0041(a).
(i) An employee is not entitled to lifetime income benefits
under this section, and an insurance carrier is authorized to
suspend the payment of lifetime income benefits, during and for a
period in which the employee fails to complete the annual
certification required by Subsection (e), the employee is employed
in any capacity, or as provided under Section 408.0041(j) or (k-1),
unless the commissioner determines that there is good cause. The
commissioner by rule shall ensure that an employee receives
reasonable notice of the insurance carrier's basis for the
suspension and is provided a reasonable opportunity to complete the
annual certification under Subsection (e) or otherwise respond to
the notice.
(j) The commissioner shall adopt rules necessary to
implement this section, including rules:
(1) prescribing the deadline for the submission and
the form and the manner of the submission of the annual
certification required by Subsection (e); and
(2) establishing procedures for:
(A) the review of an employee's continuing
entitlement to lifetime income benefits under this section;
(B) the suspension and reinstatement of lifetime
income benefits under this section; and
(C) the termination of lifetime income benefits
under this section on a final determination that an employee is no
longer entitled to the benefits.
SECTION 4. The changes in law made by this Act apply to a
claim for lifetime income 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 the effective date
of this Act is governed by the law in effect on the date the
compensable injury occurred, and the former law is continued in
effect for that purpose.
SECTION 5. This Act takes effect September 1, 2023.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2468 was passed by the House on April
5, 2023, by the following vote: Yeas 146, Nays 0, 1 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 2468 was passed by the Senate on May
17, 2023, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor