1 | 1 | | 89R16793 SCL-D |
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2 | 2 | | By: Bonnen H.B. No. 4806 |
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3 | 3 | | |
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4 | 4 | | |
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5 | 5 | | |
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6 | 6 | | |
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7 | 7 | | A BILL TO BE ENTITLED |
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8 | 8 | | AN ACT |
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9 | 9 | | relating to recovery of damages in civil actions. |
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10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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11 | 11 | | SECTION 1. Section 18.001, Civil Practice and Remedies |
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12 | 12 | | Code, is amended by amending Subsections (b), (e), (e-1), (h), and |
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13 | 13 | | (i) and adding Subsections (b-1) and (b-2) to read as follows: |
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14 | 14 | | (b) Unless notice of intent to controvert the |
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15 | 15 | | reasonableness of the amounts charged or the necessity for health |
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16 | 16 | | care services [a controverting affidavit] is served as provided by |
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17 | 17 | | this section, an affidavit complying with this section and stating |
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18 | 18 | | that the amount a person charged for a service was reasonable at the |
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19 | 19 | | time and place that the service was provided and that the service |
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20 | 20 | | was necessary is sufficient evidence to support a finding of fact by |
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21 | 21 | | judge or jury that the amount charged was reasonable or that the |
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22 | 22 | | service was necessary. |
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23 | 23 | | (b-1) Except as provided by Section 18.0011, if notice of |
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24 | 24 | | intent to controvert the reasonableness of the amounts charged or |
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25 | 25 | | necessity for health care services is served as provided by this |
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26 | 26 | | section, an affidavit served under Subsection (b) has no effect |
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27 | 27 | | except the affidavit may prove the authenticity of the health care |
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28 | 28 | | records described by the affidavit. |
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29 | 29 | | (b-2) An [The] affidavit described by Subsection (b) is not |
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30 | 30 | | evidence of and does not support a finding of the causation element |
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31 | 31 | | of the cause of action that is the basis for the civil action. |
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32 | 32 | | (e) A party intending to controvert the reasonableness of |
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33 | 33 | | the amounts charged or necessity for health care services [a claim |
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34 | 34 | | reflected by the affidavit] must serve notice of that intent [a copy |
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35 | 35 | | of the counteraffidavit] on each other party or the party's |
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36 | 36 | | attorney of record by the earlier of: |
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37 | 37 | | (1) 120 days after the date the defendant files its |
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38 | 38 | | answer; |
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39 | 39 | | (2) the date the party serving notice [offering the |
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40 | 40 | | counteraffidavit] must designate expert witnesses under a court |
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41 | 41 | | order; or |
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42 | 42 | | (3) the date the party serving notice [offering the |
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43 | 43 | | counteraffidavit] must designate any expert witness as required by |
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44 | 44 | | the Texas Rules of Civil Procedure. |
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45 | 45 | | (e-1) Notwithstanding Subsection (e), if the party offering |
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46 | 46 | | the affidavit [in evidence] serves a copy of the affidavit under |
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47 | 47 | | Subsection (d-1), notice of intent to controvert the reasonableness |
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48 | 48 | | of the amounts charged or necessity for health care services must be |
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49 | 49 | | served [the party offering the counteraffidavit in evidence or the |
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50 | 50 | | party's attorney must serve a copy of the counteraffidavit] on each |
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51 | 51 | | other party to the case by the later of: |
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52 | 52 | | (1) 30 days after service of the affidavit on the party |
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53 | 53 | | serving notice [offering the counteraffidavit in evidence]; |
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54 | 54 | | (2) the date the party serving notice [offering the |
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55 | 55 | | counteraffidavit] must designate any expert witness under a court |
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56 | 56 | | order; or |
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57 | 57 | | (3) the date the party serving notice [offering the |
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58 | 58 | | counteraffidavit in evidence] must designate any expert witness as |
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59 | 59 | | required by the Texas Rules of Civil Procedure. |
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60 | 60 | | (h) If health care [continuing] services are provided after |
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61 | 61 | | a relevant deadline under this section: |
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62 | 62 | | (1) a party may supplement an affidavit served by the |
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63 | 63 | | party under Subsection (d) or (d-1) on or before the 60th day before |
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64 | 64 | | the date the trial commences; and |
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65 | 65 | | (2) a party that served notice [a counteraffidavit] |
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66 | 66 | | under Subsection (e) or (e-1) may serve notice related to the |
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67 | 67 | | supplemental affidavit [supplement the counteraffidavit] on or |
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68 | 68 | | before the 30th day before the date the trial commences. |
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69 | 69 | | (i) Notwithstanding Subsections (d), (d-1), (d-2), (e), |
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70 | 70 | | (e-1), [(g),] and (h), a deadline under this section may be altered |
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71 | 71 | | by all parties to an action by agreement or with leave of the court. |
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72 | 72 | | SECTION 2. Subchapter A, Chapter 18, Civil Practice and |
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73 | 73 | | Remedies Code, is amended by adding Section 18.0011 to read as |
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74 | 74 | | follows: |
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75 | 75 | | Sec. 18.0011. AFFIDAVIT OF HEALTH CARE FACILITY OR |
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76 | 76 | | PROVIDER. (a) A party may not controvert the reasonableness of the |
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77 | 77 | | charges for health care services stated in an affidavit served |
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78 | 78 | | under Section 18.001 if, as to each health care service provided by |
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79 | 79 | | the health care facility or provider: |
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80 | 80 | | (1) the affidavit states one of the following amounts |
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81 | 81 | | as the reasonable charge for the service: |
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82 | 82 | | (A) the amounts received from all sources by the |
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83 | 83 | | facility or provider to pay for the service provided to the person |
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84 | 84 | | whose injury or death is the subject of the action; or |
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85 | 85 | | (B) an amount that does not exceed 150 percent of |
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86 | 86 | | the median amount paid by nongovernmental third-party payors to |
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87 | 87 | | health care facilities or providers for the same type of service |
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88 | 88 | | provided to the person whose injury or death is the subject of the |
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89 | 89 | | action during the month in which the service was provided, as drawn |
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90 | 90 | | from the Texas All Payor Claims Database established under |
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91 | 91 | | Subchapter I, Chapter 38, Insurance Code, for the geozip: |
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92 | 92 | | (i) in which the service was provided, if |
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93 | 93 | | the service was provided in this state; or |
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94 | 94 | | (ii) in which The University of Texas |
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95 | 95 | | Health Science Center at Houston is located, if the service was |
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96 | 96 | | provided outside of this state; and |
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97 | 97 | | (2) the affidavit is accompanied by an invoice for the |
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98 | 98 | | service that would comply with the clean claim requirements of |
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99 | 99 | | Chapter 1301, Insurance Code. |
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100 | 100 | | (b) If an affidavit of a health care facility or provider |
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101 | 101 | | served under Section 18.001 complies with Subsection (a) and |
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102 | 102 | | includes a statement that the facility or provider does not intend |
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103 | 103 | | to appear at trial to testify regarding the reasonableness of the |
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104 | 104 | | facility's or provider's charges or the necessity for the facility's |
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105 | 105 | | or provider's services, then: |
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106 | 106 | | (1) a party may not seek to obtain through any pretrial |
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107 | 107 | | discovery procedure information from the facility or provider about |
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108 | 108 | | the reasonableness of the facility's or provider's charges or the |
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109 | 109 | | necessity for the facility's or provider's services; and |
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110 | 110 | | (2) the trial court shall exclude trial testimony by |
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111 | 111 | | the facility or provider regarding the reasonableness of the |
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112 | 112 | | facility's or provider's charges or the necessity for the facility's |
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113 | 113 | | or provider's services unless: |
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114 | 114 | | (A) the court finds there is good cause to allow |
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115 | 115 | | the testimony; |
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116 | 116 | | (B) the testimony will not unfairly surprise or |
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117 | 117 | | unfairly prejudice any party to the action; and |
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118 | 118 | | (C) a party opposing admission of the testimony |
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119 | 119 | | into evidence is given a reasonable opportunity to conduct |
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120 | 120 | | discovery and present evidence relevant to the testimony to be |
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121 | 121 | | offered by the facility or provider. |
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122 | 122 | | (c) An affidavit of a health care facility or provider |
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123 | 123 | | described by Subsection (a) and the statements made in the |
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124 | 124 | | affidavit may be used only in the civil action in which the |
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125 | 125 | | affidavit is served and not in other actions or for other purposes. |
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126 | 126 | | SECTION 3. Chapter 41, Civil Practice and Remedies Code, is |
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127 | 127 | | amended by designating Sections 41.001, 41.002, 41.008, 41.009, |
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128 | 128 | | 41.0105, and 41.014 as Subchapter A and adding a subchapter heading |
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129 | 129 | | to read as follows: |
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130 | 130 | | SUBCHAPTER A. GENERAL PROVISIONS |
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131 | 131 | | SECTION 4. Section 41.001, Civil Practice and Remedies |
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132 | 132 | | Code, is amended by amending Subdivisions (9), (10), and (12) and |
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133 | 133 | | adding Subdivisions (11-a) and (14) to read as follows: |
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134 | 134 | | (9) "Future damages" means damages that in reasonable |
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135 | 135 | | probability can be expected to be [are] incurred after the date of |
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136 | 136 | | the judgment. The term does [Future damages do] not include |
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137 | 137 | | exemplary damages. |
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138 | 138 | | (10) "Future loss of earnings" means a pecuniary loss |
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139 | 139 | | from reductions in income, wages, or earning capacity that in |
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140 | 140 | | reasonable probability can be expected to be incurred after the |
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141 | 141 | | date of the judgment. The term does not include [, including: |
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142 | 142 | | [(A) loss of income, wages, or earning capacity; |
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143 | 143 | | and |
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144 | 144 | | [(B)] loss of inheritance. |
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145 | 145 | | (11-a) "Mental or emotional pain or anguish" means |
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146 | 146 | | grievous and debilitating angst, distress, torment, or emotional |
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147 | 147 | | suffering or turmoil that: |
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148 | 148 | | (A) causes a substantial disruption in a person's |
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149 | 149 | | daily routine; and |
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150 | 150 | | (B) arises from loss of consortium, loss of |
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151 | 151 | | companionship and society, loss of enjoyment of life, or a similar |
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152 | 152 | | mental or emotional injury. |
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153 | 153 | | (12) "Noneconomic damages" means damages awarded for |
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154 | 154 | | the purpose of compensating a claimant for nonpecuniary losses for |
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155 | 155 | | physical pain and suffering, mental or emotional pain or anguish, |
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156 | 156 | | and [loss of consortium, disfigurement, physical impairment, loss |
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157 | 157 | | of companionship and society, inconvenience, loss of enjoyment of |
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158 | 158 | | life,] injury to reputation[, and all other nonpecuniary losses of |
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159 | 159 | | any kind other than exemplary damages]. The term does not include |
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160 | 160 | | economic or exemplary damages. |
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161 | 161 | | (14) "Physical pain and suffering" means a painful or |
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162 | 162 | | distressing sensation associated with an injury or damage to a part |
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163 | 163 | | of a person's body that: |
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164 | 164 | | (A) is consciously felt; |
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165 | 165 | | (B) is significant in magnitude; and |
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166 | 166 | | (C) arises from an observable injury or |
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167 | 167 | | impairment or is shown to exist through objectively verifiable |
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168 | 168 | | medical evaluation or testing. |
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169 | 169 | | SECTION 5. Section 41.002(d), Civil Practice and Remedies |
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170 | 170 | | Code, is amended to read as follows: |
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171 | 171 | | (d) Notwithstanding any provision to the contrary, the |
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172 | 172 | | provisions of this chapter regarding exemplary damages do [does] |
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173 | 173 | | not apply to: |
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174 | 174 | | (1) Section 15.21, Business & Commerce Code (Texas |
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175 | 175 | | Free Enterprise and Antitrust Act of 1983); |
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176 | 176 | | (2) an action brought under the Deceptive Trade |
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177 | 177 | | Practices-Consumer Protection Act (Subchapter E, Chapter 17, |
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178 | 178 | | Business & Commerce Code) except as specifically provided in |
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179 | 179 | | Section 17.50 of that Act; |
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180 | 180 | | (3) an action brought under Chapter 36, Human |
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181 | 181 | | Resources Code; or |
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182 | 182 | | (4) an action brought under Chapter 21, Insurance |
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183 | 183 | | Code. |
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184 | 184 | | SECTION 6. Chapter 41, Civil Practice and Remedies Code, is |
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185 | 185 | | amended by adding Subchapter B, and a heading is added to that |
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186 | 186 | | subchapter to read as follows: |
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187 | 187 | | SUBCHAPTER B. EXEMPLARY DAMAGES |
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188 | 188 | | SECTION 7. Sections 41.003, 41.004, 41.005, 41.006, 41.007, |
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189 | 189 | | 41.010, 41.011, 41.0115, 41.012, and 41.013, Civil Practice and |
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190 | 190 | | Remedies Code, are transferred to Subchapter B, Chapter 41, Civil |
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191 | 191 | | Practice and Remedies Code, as added by this Act, redesignated as |
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192 | 192 | | Sections 41.051, 41.052, 41.053, 41.054, 41.055, 41.056, 41.057, |
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193 | 193 | | 41.058, 41.059, and 41.060, Civil Practice and Remedies Code, |
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194 | 194 | | respectively, and amended to read as follows: |
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195 | 195 | | Sec. 41.051 [41.003]. STANDARDS FOR RECOVERY [OF |
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196 | 196 | | EXEMPLARY DAMAGES]. (a) Except as provided by Subsection (c), |
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197 | 197 | | exemplary damages may be awarded only if the claimant proves by |
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198 | 198 | | clear and convincing evidence that the harm with respect to which |
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199 | 199 | | the claimant seeks recovery of exemplary damages results from: |
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200 | 200 | | (1) fraud; |
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201 | 201 | | (2) malice; or |
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202 | 202 | | (3) gross negligence. |
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203 | 203 | | (b) The claimant must prove by clear and convincing evidence |
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204 | 204 | | the elements of exemplary damages as provided by this section. This |
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205 | 205 | | burden of proof may not be shifted to the defendant or satisfied by |
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206 | 206 | | evidence of ordinary negligence, bad faith, or a deceptive trade |
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207 | 207 | | practice. |
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208 | 208 | | (c) If the claimant relies on a statute establishing a cause |
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209 | 209 | | of action and authorizing exemplary damages in specified |
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210 | 210 | | circumstances or in conjunction with a specified culpable mental |
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211 | 211 | | state, exemplary damages may be awarded only if the claimant proves |
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212 | 212 | | by clear and convincing evidence that the damages result from the |
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213 | 213 | | specified circumstances or culpable mental state. |
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214 | 214 | | (d) Exemplary damages may be awarded only if the jury was |
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215 | 215 | | unanimous in regard to finding liability for and the amount of |
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216 | 216 | | exemplary damages. |
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217 | 217 | | (e) In all cases where the issue of exemplary damages is |
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218 | 218 | | submitted to the jury, the following instruction shall be included |
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219 | 219 | | in the charge of the court: |
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220 | 220 | | "You are instructed that, in order for you to find exemplary |
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221 | 221 | | damages, your answer to the question regarding the amount of such |
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222 | 222 | | damages must be unanimous." |
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223 | 223 | | Sec. 41.052 [41.004]. FACTORS PRECLUDING RECOVERY. (a) |
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224 | 224 | | Except as provided by Subsection (b), exemplary damages may be |
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225 | 225 | | awarded only if damages other than nominal damages are awarded. |
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226 | 226 | | (b) Exemplary damages may not be awarded to a claimant who |
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227 | 227 | | elects to have his recovery multiplied under another statute. |
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228 | 228 | | Sec. 41.053 [41.005]. HARM RESULTING FROM CRIMINAL ACT. |
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229 | 229 | | (a) In an action arising from harm resulting from an assault, |
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230 | 230 | | theft, or other criminal act, a court may not award exemplary |
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231 | 231 | | damages against a defendant because of the criminal act of another. |
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232 | 232 | | (b) The exemption provided by Subsection (a) does not apply |
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233 | 233 | | if: |
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234 | 234 | | (1) the criminal act was committed by an employee of |
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235 | 235 | | the defendant; |
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236 | 236 | | (2) the defendant is criminally responsible as a party |
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237 | 237 | | to the criminal act under the provisions of Chapter 7, Penal Code; |
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238 | 238 | | (3) the criminal act occurred at a location where, at |
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239 | 239 | | the time of the criminal act, the defendant was maintaining a common |
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240 | 240 | | nuisance under the provisions of Chapter 125, Civil Practice and |
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241 | 241 | | Remedies Code, and had not made reasonable attempts to abate the |
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242 | 242 | | nuisance; or |
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243 | 243 | | (4) the criminal act resulted from the defendant's |
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244 | 244 | | intentional or knowing violation of a statutory duty under |
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245 | 245 | | Subchapter D, Chapter 92, Property Code, and the criminal act |
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246 | 246 | | occurred after the statutory deadline for compliance with that |
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247 | 247 | | duty. |
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248 | 248 | | (c) In an action arising out of a criminal act committed by |
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249 | 249 | | an employee, the employer may be liable for punitive damages but |
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250 | 250 | | only if: |
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251 | 251 | | (1) the principal authorized the doing and the manner |
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252 | 252 | | of the act; |
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253 | 253 | | (2) the agent was unfit and the principal acted with |
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254 | 254 | | malice in employing or retaining the agent [him]; |
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255 | 255 | | (3) the agent was employed in a managerial capacity |
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256 | 256 | | and was acting in the scope of employment; or |
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257 | 257 | | (4) the employer or a manager of the employer ratified |
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258 | 258 | | or approved the act. |
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259 | 259 | | Sec. 41.054 [41.006]. AWARD SPECIFIC TO DEFENDANT. In any |
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260 | 260 | | action in which there are two or more defendants, an award of |
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261 | 261 | | exemplary damages must be specific as to a defendant, and each |
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262 | 262 | | defendant is liable only for the amount of the award made against |
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263 | 263 | | that defendant. |
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264 | 264 | | Sec. 41.055 [41.007]. PREJUDGMENT INTEREST. Prejudgment |
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265 | 265 | | interest may not be assessed or recovered on an award of exemplary |
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266 | 266 | | damages. |
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267 | 267 | | Sec. 41.056 [41.010]. CONSIDERATIONS IN MAKING AWARD. (a) |
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268 | 268 | | Before making an award of exemplary damages, the trier of fact shall |
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269 | 269 | | consider the definition and purposes of exemplary damages as |
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270 | 270 | | provided by Section 41.001. |
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271 | 271 | | (b) Subject to Section 41.008, the determination of whether |
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272 | 272 | | to award exemplary damages and the amount of exemplary damages to be |
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273 | 273 | | awarded is within the discretion of the trier of fact. |
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274 | 274 | | Sec. 41.057 [41.011]. EVIDENCE RELATING TO AMOUNT OF |
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275 | 275 | | EXEMPLARY DAMAGES. (a) In determining the amount of exemplary |
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276 | 276 | | damages, the trier of fact shall consider evidence, if any, |
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277 | 277 | | relating to: |
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278 | 278 | | (1) the nature of the wrong; |
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279 | 279 | | (2) the character of the conduct involved; |
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280 | 280 | | (3) the degree of culpability of the wrongdoer; |
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281 | 281 | | (4) the situation and sensibilities of the parties |
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282 | 282 | | concerned; |
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283 | 283 | | (5) the extent to which such conduct offends a public |
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284 | 284 | | sense of justice and propriety; and |
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285 | 285 | | (6) the net worth of the defendant. |
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286 | 286 | | (b) Evidence that is relevant only to the amount of |
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287 | 287 | | exemplary damages that may be awarded is not admissible during the |
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288 | 288 | | first phase of a bifurcated trial. |
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289 | 289 | | Sec. 41.058 [41.0115]. DISCOVERY OF EVIDENCE OF NET WORTH |
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290 | 290 | | FOR EXEMPLARY DAMAGES CLAIM. (a) On the motion of a party and after |
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291 | 291 | | notice and a hearing, a trial court may authorize discovery of |
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292 | 292 | | evidence of a defendant's net worth if the court finds in a written |
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293 | 293 | | order that the claimant has demonstrated a substantial likelihood |
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294 | 294 | | of success on the merits of a claim for exemplary damages. Evidence |
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295 | 295 | | submitted by a party to the court in support of or in opposition to a |
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296 | 296 | | motion made under this subsection may be in the form of an affidavit |
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297 | 297 | | or a response to discovery. |
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298 | 298 | | (b) If a trial court authorizes discovery under Subsection |
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299 | 299 | | (a), the court's order may only authorize use of the least |
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300 | 300 | | burdensome method available to obtain the net worth evidence. |
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301 | 301 | | (c) When reviewing an order authorizing or denying |
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302 | 302 | | discovery of net worth evidence under this section, the reviewing |
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303 | 303 | | court may consider only the evidence submitted by the parties to the |
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304 | 304 | | trial court in support of or in opposition to the motion described |
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305 | 305 | | by Subsection (a). |
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306 | 306 | | (d) If a party requests net worth discovery under this |
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307 | 307 | | section, the court shall presume that the requesting party has had |
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308 | 308 | | adequate time for the discovery of facts relating to exemplary |
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309 | 309 | | damages for purposes of allowing the party from whom net worth |
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310 | 310 | | discovery is sought to move for summary judgment on the requesting |
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311 | 311 | | party's claim for exemplary damages under Rule 166a(i), Texas Rules |
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312 | 312 | | of Civil Procedure. |
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313 | 313 | | Sec. 41.059 [41.012]. JURY INSTRUCTIONS. In a trial to a |
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314 | 314 | | jury, the court shall instruct the jury with regard to Sections |
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315 | 315 | | 41.001, 41.051 [41.003], 41.056 [41.010], and 41.057 [41.011]. |
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316 | 316 | | Sec. 41.060 [41.013]. JUDICIAL REVIEW OF AWARD. (a) |
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317 | 317 | | Except as provided for in Subsection (b), an appellate court that |
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318 | 318 | | reviews the evidence with respect to a finding by a trier of fact |
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319 | 319 | | concerning liability for exemplary damages or with respect to the |
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320 | 320 | | amount of exemplary damages awarded shall state, in a written |
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321 | 321 | | opinion, the court's reasons for upholding or disturbing the |
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322 | 322 | | finding or award. The written opinion shall address the evidence or |
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323 | 323 | | lack of evidence with specificity, as it relates to the liability |
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324 | 324 | | for or amount of exemplary damages, in light of the requirements of |
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325 | 325 | | this chapter. |
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326 | 326 | | (b) This section does not apply to the supreme court with |
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327 | 327 | | respect to its consideration of a petition for review [an |
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328 | 328 | | application for writ of error]. |
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329 | 329 | | SECTION 8. Chapter 41, Civil Practice and Remedies Code, is |
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330 | 330 | | amended by adding Subchapters C and D to read as follows: |
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331 | 331 | | SUBCHAPTER C. RECOVERY OF HEALTH CARE EXPENSES AS ECONOMIC DAMAGES |
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332 | 332 | | Sec. 41.101. DEFINITIONS. In this subchapter: |
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333 | 333 | | (1) "Database" means the Texas All Payor Claims |
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334 | 334 | | Database established under Subchapter I, Chapter 38, Insurance |
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335 | 335 | | Code. |
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336 | 336 | | (2) "Health care expenses" means amounts paid or owed |
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337 | 337 | | or that may be paid or owed to a provider for health care services, |
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338 | 338 | | supplies, or devices provided to a patient. |
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339 | 339 | | (3) "Health care services" means services provided by |
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340 | 340 | | a provider to an individual to diagnose, prevent, alleviate, cure, |
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341 | 341 | | treat, or heal the individual's condition, illness, or injury, |
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342 | 342 | | including: |
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343 | 343 | | (A) rehabilitative services provided to the |
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344 | 344 | | individual; or |
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345 | 345 | | (B) personal care provided to the individual on a |
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346 | 346 | | short-term or long-term basis. |
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347 | 347 | | (4) "Injured individual" means the individual whose |
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348 | 348 | | injury or death is the subject of a civil action to which this |
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349 | 349 | | subchapter applies. |
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350 | 350 | | (5) "Letter of protection" means an agreement, |
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351 | 351 | | regardless of the name, that includes an express or implied promise |
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352 | 352 | | of payment to a health care provider from a judgment or settlement |
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353 | 353 | | of an injured individual's civil action or that makes a payment to |
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354 | 354 | | the provider contingent on the resolution of the action. |
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355 | 355 | | (6) "Physician" means: |
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356 | 356 | | (A) an individual licensed to practice medicine; |
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357 | 357 | | and |
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358 | 358 | | (B) a professional association, partnership, |
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359 | 359 | | limited liability partnership, or other type of entity formed or |
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360 | 360 | | organized by an individual physician or group of physicians to |
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361 | 361 | | provide medical care to patients. |
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362 | 362 | | (7) "Provider" means a person, including an |
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363 | 363 | | individual, partnership, professional association, corporation, |
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364 | 364 | | facility, or institution, who is licensed, certified, registered, |
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365 | 365 | | chartered, or otherwise authorized, in this state or elsewhere, to |
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366 | 366 | | provide health care services, including: |
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367 | 367 | | (A) an acupuncturist; |
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368 | 368 | | (B) a chiropractor; |
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369 | 369 | | (C) a dentist; |
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370 | 370 | | (D) a health care institution of a type described |
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371 | 371 | | by Section 74.001(11); |
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372 | 372 | | (E) a health care collaborative; |
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373 | 373 | | (F) a nonprofit health organization; |
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374 | 374 | | (G) a nurse, including a licensed vocational |
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375 | 375 | | nurse, nurse practitioner, and registered nurse; |
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376 | 376 | | (H) an occupational therapist; |
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377 | 377 | | (I) an ophthalmologist; |
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378 | 378 | | (J) an optometrist; |
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379 | 379 | | (K) a pharmacist; |
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380 | 380 | | (L) a physical therapist; |
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381 | 381 | | (M) a physician; |
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382 | 382 | | (N) a physician's assistant; and |
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383 | 383 | | (O) a podiatrist. |
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384 | 384 | | (8) "Third-party payor" means an entity, plan, or |
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385 | 385 | | program that has a legal or contractual obligation to pay, |
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386 | 386 | | reimburse, or otherwise contract with a provider to pay the |
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387 | 387 | | provider for the provision of a health care service, supply, or |
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388 | 388 | | device to a patient, including: |
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389 | 389 | | (A) an insurance company providing health or |
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390 | 390 | | dental insurance; |
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391 | 391 | | (B) an employer-provided plan or any other |
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392 | 392 | | sponsor or administrator of a health or dental plan; |
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393 | 393 | | (C) a health maintenance organization operating |
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394 | 394 | | under Chapter 843, Insurance Code, an insurer providing a preferred |
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395 | 395 | | provider benefit plan under Chapter 1301, Insurance Code, or other |
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396 | 396 | | similar entity; |
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397 | 397 | | (D) Medicare; |
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398 | 398 | | (E) the state Medicaid program, including the |
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399 | 399 | | Medicaid managed care program operating under Chapter 540, |
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400 | 400 | | Government Code; and |
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401 | 401 | | (F) workers' compensation insurance or insurance |
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402 | 402 | | provided instead of subscribing to workers' compensation |
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403 | 403 | | insurance. |
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404 | 404 | | Sec. 41.102. APPLICABILITY OF SUBCHAPTER. This subchapter |
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405 | 405 | | applies to any civil action in which the claimant seeks recovery of |
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406 | 406 | | health care expenses as economic damages in a personal injury or |
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407 | 407 | | wrongful death action. |
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408 | 408 | | Sec. 41.103. CONFLICT WITH OTHER LAW. If there is a |
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409 | 409 | | conflict between this subchapter and Section 41.0105, this |
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410 | 410 | | subchapter controls. |
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411 | 411 | | Sec. 41.104. LIMITATIONS ON AMOUNT OF RECOVERY. (a) In |
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412 | 412 | | addition to any other limitation provided by law, the economic |
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413 | 413 | | damages that may be awarded to a claimant for health care services |
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414 | 414 | | provided in the past to an injured individual are limited to the sum |
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415 | 415 | | of: |
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416 | 416 | | (1) amounts third-party payors paid to providers for |
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417 | 417 | | health care services provided to the injured individual; |
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418 | 418 | | (2) amounts paid by the injured individual or paid on |
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419 | 419 | | behalf of the injured individual by non-third-party payors to |
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420 | 420 | | providers for health care services provided to the injured |
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421 | 421 | | individual, but not to purchase an account receivable, if paid |
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422 | 422 | | without a formal or informal agreement for the provider to refund, |
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423 | 423 | | rebate, or remit money to the payor, injured individual, claimant, |
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424 | 424 | | or claimant's attorney or anyone associated with the payor, injured |
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425 | 425 | | individual, claimant, or claimant's attorney; and |
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426 | 426 | | (3) if Subdivisions (1) and (2) do not apply, an amount |
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427 | 427 | | that does not exceed 150 percent of the median amount paid by |
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428 | 428 | | nongovernmental third-party payors to health care providers for the |
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429 | 429 | | same types of services provided to the injured individual during |
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430 | 430 | | the month in which the services were provided, as drawn from the |
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431 | 431 | | database for the geozip: |
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432 | 432 | | (A) in which the services were provided, if the |
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433 | 433 | | services were provided in this state; or |
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434 | 434 | | (B) in which The University of Texas Health |
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435 | 435 | | Science Center at Houston is located, if the services were provided |
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436 | 436 | | outside of this state. |
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437 | 437 | | (b) In addition to any other limitation provided by law, |
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438 | 438 | | economic damages awarded for health care expenses that in |
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439 | 439 | | reasonable probability can be expected to be incurred by the |
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440 | 440 | | injured individual in the future because of the injury-causing |
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441 | 441 | | event shall be limited to the reasonable value of necessary |
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442 | 442 | | services, determined in the manner provided by Subsection (a)(3) |
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443 | 443 | | for determination of past health care expenses, except that the |
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444 | 444 | | determination must use data from the database for the month |
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445 | 445 | | preceding the date the trial commenced. |
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446 | 446 | | (c) Health care provider statements or invoices presented |
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447 | 447 | | for purposes of Subsection (a) or (b) must be in a form that would |
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448 | 448 | | comply with the clean claim requirements of Chapter 1301, Insurance |
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449 | 449 | | Code. If a service does not have an industry-recognized billing |
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450 | 450 | | code, no amount of money may be awarded to the claimant for that |
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451 | 451 | | service. |
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452 | 452 | | (d) The failure of the injured individual to use available |
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453 | 453 | | health benefit coverage shall be considered a failure to mitigate |
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454 | 454 | | damages. |
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455 | 455 | | Sec. 41.105. CLAIMANT DISCLOSURE REQUIREMENTS. (a) In |
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456 | 456 | | addition to other items required to be provided by law, in an action |
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457 | 457 | | to which this subchapter applies, the claimant shall provide to |
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458 | 458 | | each other party a copy of: |
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459 | 459 | | (1) all statements or invoices generated by health |
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460 | 460 | | care providers showing health care services provided to the injured |
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461 | 461 | | individual because of the injury-causing event that is the basis |
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462 | 462 | | for the action; |
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463 | 463 | | (2) any letter of protection related to the action; |
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464 | 464 | | and |
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465 | 465 | | (3) any written agreement under which a provider may |
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466 | 466 | | refund, rebate, or remit money to a payor, injured individual, |
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467 | 467 | | claimant, claimant's attorney, or person associated with the payor, |
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468 | 468 | | injured individual, claimant, or claimant's attorney. |
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469 | 469 | | (b) In a civil action to which this subchapter applies, the |
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470 | 470 | | claimant shall, in addition to other requirements of law: |
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471 | 471 | | (1) identify any provider who provided health care |
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472 | 472 | | services to the injured individual in relation to the injury caused |
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473 | 473 | | to the injured individual in the event giving rise to the action and |
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474 | 474 | | provide an authorization to all other parties to the case that will |
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475 | 475 | | allow those parties to obtain from the provider all of the injured |
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476 | 476 | | individual's medical records; |
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477 | 477 | | (2) identify any third-party payor that may have had a |
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478 | 478 | | legal or contractual obligation to pay for health care services |
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479 | 479 | | provided to the injured individual, regardless of whether the third |
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480 | 480 | | party was legally or contractually obligated to pay for the |
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481 | 481 | | specific services provided to the injured individual; |
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482 | 482 | | (3) disclose any unwritten agreement under which a |
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483 | 483 | | provider may refund, rebate, or remit money to a payor, injured |
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484 | 484 | | individual, claimant, claimant's attorney, or person associated |
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485 | 485 | | with the payor, injured individual, claimant, or claimant's |
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486 | 486 | | attorney; and |
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487 | 487 | | (4) if the injured individual was referred to a |
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488 | 488 | | provider for services, disclose: |
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489 | 489 | | (A) the name, address, and telephone number of |
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490 | 490 | | the person who made the referral, regardless of whether that person |
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491 | 491 | | is the injured individual's attorney; |
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492 | 492 | | (B) if the person making the referral was not the |
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493 | 493 | | injured individual's attorney, the relationship between the person |
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494 | 494 | | making the referral and the injured individual or the injured |
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495 | 495 | | individual's attorney; and |
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496 | 496 | | (C) if the person making the referral was the |
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497 | 497 | | injured individual's attorney: |
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498 | 498 | | (i) an anonymized list of persons referred |
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499 | 499 | | by the attorney to the provider in the preceding two years; |
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500 | 500 | | (ii) the date and amount of each payment |
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501 | 501 | | made to the provider in the preceding two years by or at the |
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502 | 502 | | direction of the attorney; |
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503 | 503 | | (iii) if applicable, each person |
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504 | 504 | | anonymously described under Subparagraph (i) on whose behalf a |
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505 | 505 | | payment described by Subparagraph (ii) was made; and |
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506 | 506 | | (iv) other aspects of any financial |
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507 | 507 | | relationship between the attorney and the provider. |
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508 | 508 | | (c) For purposes of Subsection (b)(4)(C), a referral is |
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509 | 509 | | considered to have been made by the injured individual's attorney |
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510 | 510 | | even if made by another person when the injured individual's |
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511 | 511 | | attorney knew or had reason to know that the referral would be made. |
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512 | 512 | | Sec. 41.106. CLAIMANT'S OBLIGATION OF PROOF NOT AFFECTED. |
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513 | 513 | | Nothing in this subchapter affects the claimant's obligation to |
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514 | 514 | | prove that the health care services provided to the injured |
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515 | 515 | | individual were necessary and causally connected to a defendant's |
---|
516 | 516 | | acts or omissions. |
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517 | 517 | | Sec. 41.107. MATTERS ADMISSIBLE INTO EVIDENCE. In an |
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518 | 518 | | action to which this subchapter applies, the following matters are |
---|
519 | 519 | | admissible into evidence by any party: |
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520 | 520 | | (1) a document or information provided, disclosed, or |
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521 | 521 | | obtained under Section 41.105(a) or (b); |
---|
522 | 522 | | (2) an injured individual's health care expenses |
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523 | 523 | | incurred as a result of the injury-causing event, regardless of |
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524 | 524 | | whether the claimant seeks to recover health care expenses in the |
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525 | 525 | | action; |
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526 | 526 | | (3) evidence of health benefit plan coverage that is |
---|
527 | 527 | | available to the injured individual to pay for past or future health |
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528 | 528 | | care services; and |
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529 | 529 | | (4) treatment guidelines and drug formularies |
---|
530 | 530 | | approved by the Workers' Compensation Division of the Texas |
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531 | 531 | | Department of Insurance as evidence relating to the necessity of |
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532 | 532 | | health care services provided to the injured individual. |
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533 | 533 | | SUBCHAPTER D. NONECONOMIC DAMAGES |
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534 | 534 | | Sec. 41.151. STANDARDS FOR RECOVERY OF CERTAIN NONECONOMIC |
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535 | 535 | | DAMAGES. (a) Damages for physical pain and suffering or for mental |
---|
536 | 536 | | or emotional pain or anguish may be awarded only if the trier of |
---|
537 | 537 | | fact is unanimous in finding the amount of money that will fairly |
---|
538 | 538 | | and reasonably compensate the claimant for those injuries. |
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539 | 539 | | (b) An award of damages for physical pain and suffering or |
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540 | 540 | | mental or emotional pain or anguish: |
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541 | 541 | | (1) must provide fair and reasonable compensation to a |
---|
542 | 542 | | claimant for the claimant's injury for the period of time the pain, |
---|
543 | 543 | | suffering, or anguish has persisted or reasonably can be expected |
---|
544 | 544 | | to persist in the future; |
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545 | 545 | | (2) must be based on evidence of the nature, duration, |
---|
546 | 546 | | and severity of the injury and reflect a rational connection, |
---|
547 | 547 | | grounded in the evidence, between the injury suffered and the |
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548 | 548 | | dollar amount necessary to provide fair and reasonable compensation |
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549 | 549 | | to a claimant; |
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550 | 550 | | (3) may not be used to penalize or punish a defendant, |
---|
551 | 551 | | make an example to others, or serve a social good; and |
---|
552 | 552 | | (4) may not include amounts that are properly |
---|
553 | 553 | | considered economic losses, such as lost earnings caused by |
---|
554 | 554 | | physical impairment or medical expenses incurred for emotional or |
---|
555 | 555 | | psychological care. |
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556 | 556 | | (c) In an action to which this chapter applies, it is |
---|
557 | 557 | | reversible error for a court to allow an attorney, witness, or other |
---|
558 | 558 | | person through argument, the introduction of evidence, or otherwise |
---|
559 | 559 | | to: |
---|
560 | 560 | | (1) state or suggest that the trier of fact should |
---|
561 | 561 | | determine the amount of damages to award to a claimant for physical |
---|
562 | 562 | | pain and suffering or mental or emotional pain or anguish by |
---|
563 | 563 | | referring to objects, values, or repeating metrics having no |
---|
564 | 564 | | rational connection to the facts of the case; or |
---|
565 | 565 | | (2) characterize an award of damages for physical pain |
---|
566 | 566 | | and suffering or mental or emotional pain or anguish as |
---|
567 | 567 | | establishing a valuation of human life. |
---|
568 | 568 | | (d) Except to the extent of a conflict, this section |
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569 | 569 | | supplements court decisions and rules of procedure and evidence. |
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570 | 570 | | Sec. 41.152. JURY INSTRUCTIONS. In a trial to a jury in |
---|
571 | 571 | | which noneconomic damages are sought, the court shall provide the |
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572 | 572 | | jury definitions and instructions required by this chapter and |
---|
573 | 573 | | other law and ask the jury, if appropriate, to determine the amount |
---|
574 | 574 | | of money that will fairly and reasonably compensate the claimant |
---|
575 | 575 | | for: |
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576 | 576 | | (1) past physical pain and suffering; |
---|
577 | 577 | | (2) future physical pain and suffering; |
---|
578 | 578 | | (3) past mental or emotional pain or anguish; |
---|
579 | 579 | | (4) future mental or emotional pain or anguish; |
---|
580 | 580 | | (5) past injury to reputation; and |
---|
581 | 581 | | (6) future injury to reputation. |
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582 | 582 | | Sec. 41.153. MOTION TO REMIT NONECONOMIC DAMAGES IN CERTAIN |
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583 | 583 | | ACTIONS. (a) Except in an action in which another law limits |
---|
584 | 584 | | recovery of noneconomic damages, in a trial to a jury in a personal |
---|
585 | 585 | | injury or wrongful death action, a trial court shall state the legal |
---|
586 | 586 | | and factual support for the amount of noneconomic damages awarded |
---|
587 | 587 | | to a claimant in a judgment if a defendant requests remittitur of |
---|
588 | 588 | | noneconomic damages awarded to the claimant and the award exceeds: |
---|
589 | 589 | | (1) $1 million for past and future mental or emotional |
---|
590 | 590 | | pain or anguish in a wrongful death action; |
---|
591 | 591 | | (2) for past and future damages for physical pain and |
---|
592 | 592 | | suffering in a personal injury action, the lesser of: |
---|
593 | 593 | | (A) three times the amount awarded for past and |
---|
594 | 594 | | future health care expenses; or |
---|
595 | 595 | | (B) $100,000 per year for each year of the |
---|
596 | 596 | | claimant's life expectancy; |
---|
597 | 597 | | (3) $1 million for past and future mental or emotional |
---|
598 | 598 | | pain or anguish in a personal injury action arising from an event |
---|
599 | 599 | | primarily causing emotional injury to a claimant; or |
---|
600 | 600 | | (4) $250,000 for past and future mental or emotional |
---|
601 | 601 | | pain or anguish in a personal injury action arising from an event |
---|
602 | 602 | | primarily causing bodily injury to the claimant. |
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603 | 603 | | (b) In a statement of legal support for the amount of |
---|
604 | 604 | | noneconomic damages awarded in the judgment, the court shall |
---|
605 | 605 | | include references to judgments rendered in this state and affirmed |
---|
606 | 606 | | on appeal of comparable amounts awarded under comparable facts. |
---|
607 | 607 | | SECTION 9. Section 304.102, Finance Code, is amended to |
---|
608 | 608 | | read as follows: |
---|
609 | 609 | | Sec. 304.102. PREJUDGMENT INTEREST REQUIRED IN CERTAIN |
---|
610 | 610 | | CASES. A judgment in a wrongful death, personal injury, or property |
---|
611 | 611 | | damage case earns prejudgment interest on amounts awarded in the |
---|
612 | 612 | | judgment for economic losses, calculated from the date: |
---|
613 | 613 | | (1) the health care expenses are actually paid by the |
---|
614 | 614 | | claimant, if applicable; or |
---|
615 | 615 | | (2) other economic losses are actually suffered by the |
---|
616 | 616 | | claimant. |
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617 | 617 | | SECTION 10. Sections 18.001(f) and (g), Civil Practice and |
---|
618 | 618 | | Remedies Code, are repealed. |
---|
619 | 619 | | SECTION 11. The changes in law made by this Act apply only |
---|
620 | 620 | | to an action commenced on or after the effective date of this Act. |
---|
621 | 621 | | An action commenced before the effective date of this Act is |
---|
622 | 622 | | governed by the law applicable to the action immediately before the |
---|
623 | 623 | | effective date of this Act, and that law is continued in effect for |
---|
624 | 624 | | that purpose. |
---|
625 | 625 | | SECTION 12. This Act takes effect immediately if it |
---|
626 | 626 | | receives a vote of two-thirds of all the members elected to each |
---|
627 | 627 | | house, as provided by Section 39, Article III, Texas Constitution. |
---|
628 | 628 | | If this Act does not receive the vote necessary for immediate |
---|
629 | 629 | | effect, this Act takes effect September 1, 2025. |
---|