Texas 2023 - 88th Regular

Texas House Bill HB2926 Compare Versions

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1	1	By: Turner, Patterson, Neave Criado, Frazier H.B. No. 2926
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to certain claims for benefits or compensation by certain
7	7	public safety employees and survivors of certain public safety
8	8	employees.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 607.0545(e), Government Code, is amended
11	11	to read as follows:
12	12	(e) This section expires September 1, 2025 [2023].
13	13	SECTION 2. Subchapter B, Chapter 607, Government Code, is
14	14	amended by adding Section 607.05451 to read as follows:
15	15	Sec. 607.05451. REPROCESSING DENIED CLAIMS REQUIRED. (a)
16	16	In this section, "insurance carrier" has the meaning assigned by
17	17	Section 401.011, Labor Code.
18	18	(b) Notwithstanding any other law, an insurance carrier
19	19	who, before June 14, 2021, denied a claim for benefits related to
20	20	severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or
21	21	coronavirus disease 2019 (COVID-19) for a person subject to Section
22	22	607.0545 or the person's beneficiary shall reprocess the denied
23	23	claim without a written request and apply the provisions of Section
24	24	607.0545 when reprocessing the claim.
25	25	(c) Notwithstanding Subsection (b), an insurance carrier is
26	26	not required to reprocess a claim the insurance carrier has
27	27	previously reprocessed in accordance with Chapter 505 (S.B. 22),
28	28	Acts of the 87th Legislature, Regular Session, 2021.
29	29	(d) Not later than October 31, 2023, an insurance carrier
30	30	shall:
31	31	(1) reprocess each denied claim as required by
32	32	Subsection (b); and
33	33	(2) notify the person in writing whether the insurance
34	34	carrier accepted or denied the claim.
35	35	(e) If the insurance carrier denies a reprocessed claim, the
36	36	denial notice must include information on the process for disputing
37	37	the denial. The insurance carrier shall use the notice prescribed
38	38	by the division of workers' compensation of the Texas Department of
39	39	Insurance.
40	40	(f) The commissioner of workers' compensation shall adopt
41	41	any rules necessary to implement this section.
42	42	(g) This section expires December 31, 2023.
43	43	SECTION 3. Sections 409.0092(a) and (d), Labor Code, are
44	44	amended to read as follows:
45	45	(a) An injured employee who is subject to Subchapter B,
46	46	Chapter 607 [Section 607.0545], Government Code, and whose claim
47	47	for benefits is determined to be compensable by an insurance
48	48	carrier or the division, may request reimbursement for health care
49	49	paid by the employee, including copayments and partial payments, by
50	50	submitting to the carrier a legible written request and
51	51	documentation showing the amounts paid to the health care provider.
52	52	(d) A person who has legal authority to act on behalf of an
53	53	injured employee or that employee's estate may submit a request for
54	54	reimbursement for health care in accordance with Subsection (a) or
55	55	a request for medical dispute resolution in accordance with
56	56	Subsection (c) [This section expires September 1, 2023].
57	57	SECTION 4. Section 415.002, Labor Code, is amended by
58	58	amending Subsection (a) and adding Subsection (c) to read as
59	59	follows:
60	60	(a) An insurance carrier or its representative commits an
61	61	administrative violation if that person:
62	62	(1) misrepresents a provision of this subtitle or
63	63	Subchapter B, Chapter 607, Government Code, to an employee, an
64	64	employer, a health care provider, or a legal beneficiary;
65	65	(2) terminates or reduces benefits without
66	66	substantiating evidence that the action is reasonable and
67	67	authorized by law;
68	68	(3) instructs an employer not to file a document
69	69	required to be filed with the division;
70	70	(4) instructs or encourages an employer to violate a
71	71	claimant's right to medical benefits under this subtitle;
72	72	(5) fails to tender promptly full death benefits if a
73	73	legitimate dispute does not exist as to the liability of the
74	74	insurance carrier;
75	75	(6) allows an employer, other than a self-insured
76	76	employer, to dictate the methods by which and the terms on which a
77	77	claim is handled and settled;
78	78	(7) fails to confirm medical benefits coverage to a
79	79	person or facility providing medical treatment to a claimant if a
80	80	legitimate dispute does not exist as to the liability of the
81	81	insurance carrier;
82	82	(8) fails, without good cause, to attend a dispute
83	83	resolution proceeding within the division;
84	84	(9) attends a dispute resolution proceeding within the
85	85	division without complete authority or fails to exercise authority
86	86	to effectuate agreement or settlement;
87	87	(10) adjusts a workers' compensation claim in a manner
88	88	contrary to license requirements for an insurance adjuster,
89	89	including the requirements of Chapter 4101, Insurance Code, or the
90	90	rules of the commissioner of insurance;
91	91	(11) fails to process claims promptly in a reasonable
92	92	and prudent manner;
93	93	(12) fails to initiate or reinstate benefits when due
94	94	if a legitimate dispute does not exist as to the liability of the
95	95	insurance carrier;
96	96	(13) misrepresents the reason for not paying benefits
97	97	or terminating or reducing the payment of benefits;
98	98	(14) dates documents to misrepresent the actual date
99	99	of the initiation of benefits;
100	100	(15) makes a notation on a draft or other instrument
101	101	indicating that the draft or instrument represents a final
102	102	settlement of a claim if the claim is still open and pending before
103	103	the division;
104	104	(16) fails or refuses to pay benefits from week to week
105	105	as and when due directly to the person entitled to the benefits;
106	106	(17) fails to pay an order awarding benefits;
107	107	(18) controverts a claim if the evidence clearly
108	108	indicates liability;
109	109	(19) unreasonably disputes the reasonableness and
110	110	necessity of health care;
111	111	(20) violates a commissioner rule;
112	112	(21) makes a statement denying all future medical care
113	113	for a compensable injury; [or]
114	114	(22) fails to apply a statutory presumption to a claim
115	115	that qualifies for a presumption under Subchapter B, Chapter 607,
116	116	Government Code, without conducting a reasonable investigation of
117	117	the facts relevant to the applicability of the presumption to the
118	118	claim;
119	119	(23) denies a claim that is subject to a statutory
120	120	presumption under Subchapter B, Chapter 607, Government Code,
121	121	without conducting a reasonable investigation of facts relevant to
122	122	determining the validity of the claim; or
123	123	(24) fails to comply with a provision of this
124	124	subtitle.
125	125	(c) With respect to any medical facts on which the insurance
126	126	carrier or its representative relied in determining a presumption
127	127	under Subchapter B, Chapter 607, Government Code, is not applicable
128	128	or in denying a claim that is subject to a statutory presumption
129	129	under that subchapter, the reasonable investigation required by
130	130	Subsection (a)(22) or (23) must include an opinion from a qualified
131	131	medical expert using evidence-based medicine that supports the
132	132	decision of the insurance carrier or its representative.
133	133	SECTION 5. As soon as practicable after the effective date
134	134	of this Act, the division of workers' compensation of the Texas
135	135	Department of Insurance shall prescribe in English and Spanish the
136	136	notices to be used by an insurance carrier under Section 607.05451,
137	137	Government Code, as added by this Act, when:
138	138	(1) notifying the injured employee or the employee's
139	139	beneficiary that the insurance carrier will be reprocessing the
140	140	previously denied claim; and
141	141	(2) notifying the injured employee or the employee's
142	142	beneficiary of the insurance carrier's acceptance or denial of a
143	143	previously denied claim.
144	144	SECTION 6. Section 415.002, Labor Code, as amended by this
145	145	Act, applies only to an administrative violation committed on or
146	146	after the effective date of this Act. An administrative violation
147	147	committed before the effective date of this Act is governed by the
148	148	law in effect on the date the administrative violation was
149	149	committed, and the former law is continued in effect for that
150	150	purpose.
151	151	SECTION 7. This Act takes effect immediately if it receives
152	152	a vote of two-thirds of all the members elected to each house, as
153	153	provided by Section 39, Article III, Texas Constitution. If this
154	154	Act does not receive the vote necessary for immediate effect, this
155	155	Act takes effect September 1, 2023.