Texas 2023 - 88th Regular

Texas House Bill HB790 Compare Versions

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1	1	By: Patterson, Longoria, Frazier, Thimesch, H.B. No. 790
2	2	Isaac, et al.
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the processes for and the adjudication and payment of
8	8	certain claims under the workers' compensation system.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 401.026, Labor Code, is amended to read
11	11	as follows:
12	12	Sec. 401.026. APPLICABILITY TO CERTAIN EMERGENCY RESPONSE
13	13	PERSONNEL. For purposes of this subtitle, the travel of a
14	14	firefighter, peace officer, or emergency medical personnel en route
15	15	to an emergency call is considered to be in the course and scope of
16	16	the firefighter's, peace officer's, or emergency medical
17	17	personnel's employment.
18	18	SECTION 2. Section 408.0042, Labor Code, is amended by
19	19	amending Subsections (a), (c), (d), (e), and (f) and adding
20	20	Subsection (a-1) to read as follows:
21	21	(a) Subject to Subsection (a-1), the [The] division shall
22	22	require an injured employee to submit to a single medical
23	23	examination to define the compensable injury on request by the
24	24	insurance carrier.
25	25	(a-1) In this subsection, the terms "custodial officer,"
26	26	"detention officer," "emergency medical technician,"
27	27	"firefighter," and "peace officer" have the meanings assigned by
28	28	Section 607.051, Government Code. On request by an injured
29	29	employee who is a custodial officer, a detention officer, an
30	30	emergency medical technician, a firefighter, or a peace officer,
31	31	the division shall authorize the performance of a medical
32	32	examination to define the compensable injury, regardless of whether
33	33	an examination under Subsection (a) was previously performed.
34	34	(c) After a [the] medical examination is performed under
35	35	Subsection (a) or (a-1), the treating doctor shall submit to the
36	36	insurance carrier and the division a report that details all
37	37	injuries and diagnoses related to the compensable injury, on
38	38	receipt of which the insurance carrier shall:
39	39	(1) accept all injuries and diagnoses as related to
40	40	the compensable injury; or
41	41	(2) dispute the determination of specific injuries and
42	42	diagnoses.
43	43	(d) Any treatment for an injury or diagnosis that is not
44	44	accepted by the insurance carrier under Subsection (c) as
45	45	compensable at the time of the medical examination under Subsection
46	46	(a) or (a-1) must be preauthorized before treatment is rendered. If
47	47	the insurance carrier denies preauthorization because the
48	48	treatment is for an injury or diagnosis unrelated to the
49	49	compensable injury, the injured employee or affected health care
50	50	provider may file an extent of injury dispute.
51	51	(e) Any treatment for an injury or diagnosis that is
52	52	accepted by the insurance carrier under Subsection (c) as
53	53	compensable at the time of the medical examination under Subsection
54	54	(a) or (a-1) may not be reviewed for compensability, but may be
55	55	reviewed for medical necessity.
56	56	(f) The commissioner may adopt rules relating to
57	57	requirements for:
58	58	(1) a request for an examination under Subsection (a)
59	59	or (a-1); or
60	60	(2) a report under this section, including
61	61	requirements regarding the contents of a report.
62	62	SECTION 3. Section 409.021, Labor Code, is amended by
63	63	adding Subsection (a-4) to read as follows:
64	64	(a-4) In this subsection, the terms "custodial officer,"
65	65	"detention officer," "emergency medical technician,"
66	66	"firefighter," and "peace officer" have the meanings assigned by
67	67	Section 607.051, Government Code. Notwithstanding any other
68	68	provision of this title, an insurance carrier who does not contest
69	69	the extent of an injury on or before the 60th day after the date the
70	70	carrier receives the report described by Section 408.0042(c) waives
71	71	its right to contest the extent of injury specifically claimed by
72	72	the employee or reasonably reflected in the employee's medical
73	73	records available to the carrier for review during that time
74	74	period, if the employee is a custodial officer, a detention
75	75	officer, an emergency medical technician, a firefighter, or a peace
76	76	officer.
77	77	SECTION 4. Section 409.022, Labor Code, is amended by
78	78	adding Subsections (c-1) and (c-2) and amending Subsection (d) to
79	79	read as follows:
80	80	(c-1) For purposes of [(d) In] this section [subsection],
81	81	the terms "custodial officer," "detention officer," "emergency
82	82	medical technician," "firefighter," and "peace officer" have the
83	83	meanings assigned by Section 607.051, Government Code.
84	84	(c-2) In addition to the other requirements of this section,
85	85	an insurance carrier's notice of refusal to pay benefits under
86	86	Section 409.021 sent in response to a claim for compensation by an
87	87	injured employee who is a custodial officer, a detention officer,
88	88	an emergency medical technician, a firefighter, or a peace officer
89	89	must include a statement by the carrier that:
90	90	(1) for purposes of Subsection (a), includes the
91	91	specific reasons why the carrier is disputing the compensability of
92	92	the injury or the extent of injury; and
93	93	(2) describes the evidence that the carrier reviewed
94	94	in making the determination to dispute the issue under Subdivision
95	95	(1).
96	96	(d) In addition to the other requirements of this section,
97	97	if an insurance carrier's notice of refusal to pay benefits under
98	98	Section 409.021 is sent in response to a claim for compensation
99	99	resulting from a custodial officer's, a detention officer's, an
100	100	emergency medical technician's, a firefighter's, or a peace
101	101	officer's disability or death for which a presumption is claimed to
102	102	be applicable under Subchapter B, Chapter 607, Government Code, the
103	103	notice must include a statement by the carrier that:
104	104	(1) explains why the carrier determined a presumption
105	105	under that subchapter does not apply to the claim for compensation;
106	106	and
107	107	(2) describes the evidence that the carrier reviewed
108	108	in making the determination described by Subdivision (1).
109	109	SECTION 5. Section 410.005(a), Labor Code, is amended to
110	110	read as follows:
111	111	(a) A [Unless the division determines that good cause exists
112	112	for the selection of a different location, a] contested case
113	113	hearing may not be conducted at a site more than 75 miles from the
114	114	claimant's residence at the time of the injury unless:
115	115	(1) the division determines that good cause exists for
116	116	the selection of a different location; or
117	117	(2) the contested case hearing is conducted by
118	118	videoconference as provided by Section 410.0055.
119	119	SECTION 6. Subchapter A, Chapter 410, Labor Code, is
120	120	amended by adding Section 410.0055 to read as follows:
121	121	Sec. 410.0055. CONDUCTING CERTAIN CONTESTED CASE HEARINGS
122	122	BY VIDEOCONFERENCE. (a) In this section, the terms "custodial
123	123	officer," "detention officer," "emergency medical technician,"
124	124	"firefighter," and "peace officer" have the meanings assigned by
125	125	Section 607.051, Government Code.
126	126	(b) The division shall conduct a contested case hearing by
127	127	videoconference on request of an injured employee who is a
128	128	custodial officer, a detention officer, an emergency medical
129	129	technician, a firefighter, or a peace officer.
130	130	SECTION 7. Subchapter D, Chapter 410, Labor Code, is
131	131	amended by adding Section 410.170 to read as follows:
132	132	Sec. 410.170. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN
133	133	MEDICAL EXPENSES. (a) In this section, the terms "custodial
134	134	officer," "detention officer," "emergency medical technician,"
135	135	"firefighter," and "peace officer" have the meanings assigned by
136	136	Section 607.051, Government Code.
137	137	(b) Notwithstanding the amount of an award of benefits due
138	138	in a written decision by an administrative law judge under Section
139	139	410.168, an insurance carrier shall reimburse an injured employee
140	140	who is a custodial officer, a detention officer, an emergency
141	141	medical technician, a firefighter, or a peace officer for all
142	142	medical expenses incurred by the employee that are related to the
143	143	specific injury claimed by the employee if:
144	144	(1) the carrier denied the employee's claim for
145	145	medical benefits;
146	146	(2) the decision of the administrative law judge
147	147	includes a determination that the injury is compensable; and
148	148	(3) the decision of the administrative law judge is
149	149	not appealed to the appeals panel and becomes final.
150	150	SECTION 8. Subchapter E, Chapter 410, Labor Code, is
151	151	amended by adding Section 410.2051 to read as follows:
152	152	Sec. 410.2051. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN
153	153	MEDICAL EXPENSES. (a) In this section, the terms "custodial
154	154	officer," "detention officer," "emergency medical technician,"
155	155	"firefighter," and "peace officer" have the meanings assigned by
156	156	Section 607.051, Government Code.
157	157	(b) An insurance carrier shall directly reimburse an
158	158	injured employee who is a custodial officer, a detention officer,
159	159	an emergency medical technician, a firefighter, or a peace officer
160	160	for all medical expenses incurred by the employee that are related
161	161	to the specific injury claimed by the employee if:
162	162	(1) the carrier denied the employee's claim for
163	163	medical benefits; and
164	164	(2) either:
165	165	(A) the administrative law judge's determination
166	166	that benefits are owed becomes final without an appeal; or
167	167	(B) the appeals panel:
168	168	(i) affirms the administrative law judge's
169	169	determination that the benefits are owed; or
170	170	(ii) reverses the administrative law
171	171	judge's determination that the benefits are not owed.
172	172	(c) If the appeals panel affirms the administrative law
173	173	judge's determination that the benefits are owed, the insurance
174	174	carrier shall directly reimburse the employee for all medical
175	175	expenses incurred by the employee that are related to the specific
176	176	injury claimed by the employee, regardless of the amount of an award
177	177	of benefits due in the written decision by the administrative law
178	178	judge under Section 410.168.
179	179	(d) The insurance carrier must reimburse the injured
180	180	employee under Subsection (b), regardless of whether the appeals
181	181	panel's decision is appealed for judicial review.
182	182	SECTION 9. (a) Except as provided by Subsection (b) of this
183	183	section, the changes in law made by this Act apply only to a claim
184	184	for workers' compensation benefits based on a compensable injury
185	185	that occurs on or after the effective date of this Act. A claim
186	186	based on a compensable injury that occurs before that date is
187	187	governed by the law as it existed on the date the compensable injury
188	188	occurred, and the former law is continued in effect for that
189	189	purpose.
190	190	(b) Section 410.0055, Labor Code, as added by this Act,
191	191	applies to a contested case hearing held on or after the effective
192	192	date of this Act.
193	193	SECTION 10. This Act takes effect September 1, 2023.