Texas 2025 - 89th Regular

Texas House Bill HB2369 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R8805 KKR-D
2	2	By: Patterson H.B. No. 2369
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the processes for and the adjudication and payment of
10	10	certain claims under the workers' compensation system.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 408.0042, Labor Code, is amended by
13	13	amending Subsections (a), (c), (d), (e), and (f) and adding
14	14	Subsection (a-1) to read as follows:
15	15	(a) Subject to Subsection (a-1), the [The] division shall
16	16	require an injured employee to submit to a single medical
17	17	examination to define the compensable injury on request by the
18	18	insurance carrier.
19	19	(a-1) In this subsection, the terms "custodial officer,"
20	20	"detention officer," "emergency medical technician,"
21	21	"firefighter," and "peace officer" have the meanings assigned by
22	22	Section 607.051, Government Code. On request by an injured
23	23	employee who is a custodial officer, a detention officer, an
24	24	emergency medical technician, a firefighter, or a peace officer,
25	25	the division shall authorize the performance of a medical
26	26	examination to define the compensable injury, regardless of whether
27	27	an examination under Subsection (a) was previously performed.
28	28	(c) After a [the] medical examination is performed under
29	29	Subsection (a) or (a-1), the treating doctor shall submit to the
30	30	insurance carrier and the division a report that details all
31	31	injuries and diagnoses related to the compensable injury, on
32	32	receipt of which the insurance carrier shall:
33	33	(1) accept all injuries and diagnoses as related to
34	34	the compensable injury; or
35	35	(2) dispute the determination of specific injuries and
36	36	diagnoses.
37	37	(d) Any treatment for an injury or diagnosis that is not
38	38	accepted by the insurance carrier under Subsection (c) as
39	39	compensable at the time of the medical examination under Subsection
40	40	(a) or (a-1) must be preauthorized before treatment is rendered. If
41	41	the insurance carrier denies preauthorization because the
42	42	treatment is for an injury or diagnosis unrelated to the
43	43	compensable injury, the injured employee or affected health care
44	44	provider may file an extent of injury dispute.
45	45	(e) Any treatment for an injury or diagnosis that is
46	46	accepted by the insurance carrier under Subsection (c) as
47	47	compensable at the time of the medical examination under Subsection
48	48	(a) or (a-1) may not be reviewed for compensability, but may be
49	49	reviewed for medical necessity.
50	50	(f) The commissioner may adopt rules relating to
51	51	requirements for:
52	52	(1) a request for an examination under Subsection (a)
53	53	or (a-1); or
54	54	(2) a report under this section, including
55	55	requirements regarding the contents of a report.
56	56	SECTION 2. Section 409.021, Labor Code, is amended by
57	57	adding Subsection (a-4) to read as follows:
58	58	(a-4) In this subsection, the terms "custodial officer,"
59	59	"detention officer," "emergency medical technician,"
60	60	"firefighter," and "peace officer" have the meanings assigned by
61	61	Section 607.051, Government Code. Notwithstanding any other
62	62	provision of this title, an insurance carrier who does not contest
63	63	the extent of an injury on or before the 60th day after the date the
64	64	carrier receives the report described by Section 408.0042(c) waives
65	65	its right to contest the extent of injury specifically claimed by
66	66	the employee or reasonably reflected in the employee's medical
67	67	records available to the carrier for review during that time
68	68	period, if the employee is a custodial officer, a detention
69	69	officer, an emergency medical technician, a firefighter, or a peace
70	70	officer.
71	71	SECTION 3. Section 409.022, Labor Code, is amended by
72	72	adding Subsections (c-1) and (c-2) and amending Subsection (d) to
73	73	read as follows:
74	74	(c-1) For purposes of [(d) In] this section [subsection],
75	75	the terms "custodial officer," "detention officer," "emergency
76	76	medical technician," "firefighter," and "peace officer" have the
77	77	meanings assigned by Section 607.051, Government Code.
78	78	(c-2) In addition to the other requirements of this section,
79	79	an insurance carrier's notice of refusal to pay benefits under
80	80	Section 409.021 sent in response to a claim for compensation by an
81	81	injured employee who is a custodial officer, a detention officer,
82	82	an emergency medical technician, a firefighter, or a peace officer
83	83	must include a statement by the carrier that:
84	84	(1) for purposes of Subsection (a), includes the
85	85	specific reasons why the carrier is disputing the compensability of
86	86	the injury or the extent of injury; and
87	87	(2) describes the evidence that the carrier reviewed
88	88	in making the determination to dispute the issue under Subdivision
89	89	(1).
90	90	(d) In addition to the other requirements of this section,
91	91	if an insurance carrier's notice of refusal to pay benefits under
92	92	Section 409.021 is sent in response to a claim for compensation
93	93	resulting from a custodial officer's, a detention officer's, an
94	94	emergency medical technician's, a firefighter's, or a peace
95	95	officer's disability or death for which a presumption is claimed to
96	96	be applicable under Subchapter B, Chapter 607, Government Code, the
97	97	notice must include a statement by the carrier that:
98	98	(1) explains why the carrier determined a presumption
99	99	under that subchapter does not apply to the claim for compensation;
100	100	and
101	101	(2) describes the evidence that the carrier reviewed
102	102	in making the determination described by Subdivision (1).
103	103	SECTION 4. Subchapter D, Chapter 410, Labor Code, is
104	104	amended by adding Section 410.170 to read as follows:
105	105	Sec. 410.170. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN
106	106	MEDICAL EXPENSES. (a) In this section, the terms "custodial
107	107	officer," "detention officer," "emergency medical technician,"
108	108	"firefighter," and "peace officer" have the meanings assigned by
109	109	Section 607.051, Government Code.
110	110	(b) Notwithstanding the amount of an award of benefits due
111	111	in a written decision by an administrative law judge under Section
112	112	410.168, an insurance carrier shall reimburse an injured employee
113	113	who is a custodial officer, a detention officer, an emergency
114	114	medical technician, a firefighter, or a peace officer for all
115	115	medical expenses incurred by the employee that are related to the
116	116	specific injury claimed by the employee if:
117	117	(1) the carrier denied the employee's claim for
118	118	medical benefits;
119	119	(2) the decision of the administrative law judge
120	120	includes a determination that the injury is compensable; and
121	121	(3) the decision of the administrative law judge is
122	122	not appealed to the appeals panel and becomes final.
123	123	SECTION 5. Subchapter E, Chapter 410, Labor Code, is
124	124	amended by adding Section 410.2051 to read as follows:
125	125	Sec. 410.2051. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN
126	126	MEDICAL EXPENSES. (a) In this section, the terms "custodial
127	127	officer," "detention officer," "emergency medical technician,"
128	128	"firefighter," and "peace officer" have the meanings assigned by
129	129	Section 607.051, Government Code.
130	130	(b) An insurance carrier shall directly reimburse an
131	131	injured employee who is a custodial officer, a detention officer,
132	132	an emergency medical technician, a firefighter, or a peace officer
133	133	for all medical expenses incurred by the employee that are related
134	134	to the specific injury claimed by the employee if:
135	135	(1) the carrier denied the employee's claim for
136	136	medical benefits; and
137	137	(2) either:
138	138	(A) the administrative law judge's determination
139	139	that benefits are owed becomes final without an appeal; or
140	140	(B) the appeals panel:
141	141	(i) affirms the administrative law judge's
142	142	determination that the benefits are owed; or
143	143	(ii) reverses the administrative law
144	144	judge's determination that the benefits are not owed.
145	145	(c) If the appeals panel affirms the administrative law
146	146	judge's determination that the benefits are owed, the insurance
147	147	carrier shall directly reimburse the employee for all medical
148	148	expenses incurred by the employee that are related to the specific
149	149	injury claimed by the employee, regardless of the amount of an award
150	150	of benefits due in the written decision by the administrative law
151	151	judge under Section 410.168.
152	152	(d) The insurance carrier must reimburse the injured
153	153	employee under Subsection (b), regardless of whether the appeals
154	154	panel's decision is appealed for judicial review.
155	155	SECTION 6. The changes in law made by this Act apply only to
156	156	a claim for workers' compensation benefits based on a compensable
157	157	injury that occurs on or after the effective date of this Act. A
158	158	claim based on a compensable injury that occurs before that date is
159	159	governed by the law as it existed on the date the compensable injury
160	160	occurred, and the former law is continued in effect for that
161	161	purpose.
162	162	SECTION 7. This Act takes effect September 1, 2025.