89R8805 KKR-D
By: Patterson H.B. No. 2369
A BILL TO BE ENTITLED
AN ACT
relating to the processes for and the adjudication and payment of
certain claims under the workers' compensation system.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 408.0042, Labor Code, is amended by
amending Subsections (a), (c), (d), (e), and (f) and adding
Subsection (a-1) to read as follows:
(a) Subject to Subsection (a-1), the [The] division shall
require an injured employee to submit to a single medical
examination to define the compensable injury on request by the
insurance carrier.
(a-1) In this subsection, the terms "custodial officer,"
"detention officer," "emergency medical technician,"
"firefighter," and "peace officer" have the meanings assigned by
Section 607.051, Government Code. On request by an injured
employee who is a custodial officer, a detention officer, an
emergency medical technician, a firefighter, or a peace officer,
the division shall authorize the performance of a medical
examination to define the compensable injury, regardless of whether
an examination under Subsection (a) was previously performed.
(c) After a [the] medical examination is performed under
Subsection (a) or (a-1), the treating doctor shall submit to the
insurance carrier and the division a report that details all
injuries and diagnoses related to the compensable injury, on
receipt of which the insurance carrier shall:
(1) accept all injuries and diagnoses as related to
the compensable injury; or
(2) dispute the determination of specific injuries and
diagnoses.
(d) Any treatment for an injury or diagnosis that is not
accepted by the insurance carrier under Subsection (c) as
compensable at the time of the medical examination under Subsection
(a) or (a-1) must be preauthorized before treatment is rendered. If
the insurance carrier denies preauthorization because the
treatment is for an injury or diagnosis unrelated to the
compensable injury, the injured employee or affected health care
provider may file an extent of injury dispute.
(e) Any treatment for an injury or diagnosis that is
accepted by the insurance carrier under Subsection (c) as
compensable at the time of the medical examination under Subsection
(a) or (a-1) may not be reviewed for compensability, but may be
reviewed for medical necessity.
(f) The commissioner may adopt rules relating to
requirements for:
(1) a request for an examination under Subsection (a)
or (a-1); or
(2) a report under this section, including
requirements regarding the contents of a report.
SECTION 2. Section 409.021, Labor Code, is amended by
adding Subsection (a-4) to read as follows:
(a-4) In this subsection, the terms "custodial officer,"
"detention officer," "emergency medical technician,"
"firefighter," and "peace officer" have the meanings assigned by
Section 607.051, Government Code. Notwithstanding any other
provision of this title, an insurance carrier who does not contest
the extent of an injury on or before the 60th day after the date the
carrier receives the report described by Section 408.0042(c) waives
its right to contest the extent of injury specifically claimed by
the employee or reasonably reflected in the employee's medical
records available to the carrier for review during that time
period, if the employee is a custodial officer, a detention
officer, an emergency medical technician, a firefighter, or a peace
officer.
SECTION 3. Section 409.022, Labor Code, is amended by
adding Subsections (c-1) and (c-2) and amending Subsection (d) to
read as follows:
(c-1) For purposes of [(d) In] this section [subsection],
the terms "custodial officer," "detention officer," "emergency
medical technician," "firefighter," and "peace officer" have the
meanings assigned by Section 607.051, Government Code.
(c-2) In addition to the other requirements of this section,
an insurance carrier's notice of refusal to pay benefits under
Section 409.021 sent in response to a claim for compensation by an
injured employee who is a custodial officer, a detention officer,
an emergency medical technician, a firefighter, or a peace officer
must include a statement by the carrier that:
(1) for purposes of Subsection (a), includes the
specific reasons why the carrier is disputing the compensability of
the injury or the extent of injury; and
(2) describes the evidence that the carrier reviewed
in making the determination to dispute the issue under Subdivision
(1).
(d) In addition to the other requirements of this section,
if an insurance carrier's notice of refusal to pay benefits under
Section 409.021 is sent in response to a claim for compensation
resulting from a custodial officer's, a detention officer's, an
emergency medical technician's, a firefighter's, or a peace
officer's disability or death for which a presumption is claimed to
be applicable under Subchapter B, Chapter 607, Government Code, the
notice must include a statement by the carrier that:
(1) explains why the carrier determined a presumption
under that subchapter does not apply to the claim for compensation;
and
(2) describes the evidence that the carrier reviewed
in making the determination described by Subdivision (1).
SECTION 4. Subchapter D, Chapter 410, Labor Code, is
amended by adding Section 410.170 to read as follows:
Sec. 410.170. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN
MEDICAL EXPENSES. (a) In this section, the terms "custodial
officer," "detention officer," "emergency medical technician,"
"firefighter," and "peace officer" have the meanings assigned by
Section 607.051, Government Code.
(b) Notwithstanding the amount of an award of benefits due
in a written decision by an administrative law judge under Section
410.168, an insurance carrier shall reimburse an injured employee
who is a custodial officer, a detention officer, an emergency
medical technician, a firefighter, or a peace officer for all
medical expenses incurred by the employee that are related to the
specific injury claimed by the employee if:
(1) the carrier denied the employee's claim for
medical benefits;
(2) the decision of the administrative law judge
includes a determination that the injury is compensable; and
(3) the decision of the administrative law judge is
not appealed to the appeals panel and becomes final.
SECTION 5. Subchapter E, Chapter 410, Labor Code, is
amended by adding Section 410.2051 to read as follows:
Sec. 410.2051. EFFECT OF DECISION: REIMBURSEMENT OF CERTAIN
MEDICAL EXPENSES. (a) In this section, the terms "custodial
officer," "detention officer," "emergency medical technician,"
"firefighter," and "peace officer" have the meanings assigned by
Section 607.051, Government Code.
(b) An insurance carrier shall directly reimburse an
injured employee who is a custodial officer, a detention officer,
an emergency medical technician, a firefighter, or a peace officer
for all medical expenses incurred by the employee that are related
to the specific injury claimed by the employee if:
(1) the carrier denied the employee's claim for
medical benefits; and
(2) either:
(A) the administrative law judge's determination
that benefits are owed becomes final without an appeal; or
(B) the appeals panel:
(i) affirms the administrative law judge's
determination that the benefits are owed; or
(ii) reverses the administrative law
judge's determination that the benefits are not owed.
(c) If the appeals panel affirms the administrative law
judge's determination that the benefits are owed, the insurance
carrier shall directly reimburse the employee for all medical
expenses incurred by the employee that are related to the specific
injury claimed by the employee, regardless of the amount of an award
of benefits due in the written decision by the administrative law
judge under Section 410.168.
(d) The insurance carrier must reimburse the injured
employee under Subsection (b), regardless of whether the appeals
panel's decision is appealed for judicial review.
SECTION 6. The changes in law made by this Act apply only to
a claim for workers' compensation 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 that date is
governed by the law as it existed on the date the compensable injury
occurred, and the former law is continued in effect for that
purpose.
SECTION 7. This Act takes effect September 1, 2025.