Workers' Compensation Legislation Enacted

The following is a summary of most of the laws enacted during recent Texas Legislative Sessions. This is not intended to be a comprehensive treatment of each law, but provides an overview. Complete versions of the laws can be obtained through the State of Texas Web site at http://www.texas.gov.

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82nd Legislative Session (2011)
81st Legislative Session (2009)
80th Legislative Session (2007)
79th Legislative Session (2005) [House Bill 7]
78th Legislative Session (2003)
77th Legislative Session (2001)
76th Legislative Session (1999)

82nd Legislative Session

House Bill (HB) 528 by Solomons; Sponsored by Van de Putte (Effective June 17, 2011)

HB 528 relates to the provision of pharmaceutical services through informal and voluntary network in the workers’ compensation system. The bill:
Allows informal and voluntary networks to contract rates below the Division’s fee schedule for pharmaceutical services.
Requires the informal and voluntary networks to notify, at least quarterly, each health care provider of any person who has been given access to the network’s contractual fee arrangements with the health care provider and specifies notification requirements.
Requires insurance carriers or networks to provide copies of contracts to the Division upon request.
Specifies any administrative penalty assessed under the subsection shall be assessed against the carrier, regardless of whether the carrier or agent committed the violation.
Requires each informal or voluntary network to report specific information, and any changes to that information, to the Division on a specific timeline.
Clarifies that prescription medication or services may not, directly or through a contract, be delivered through a workers’ compensation health care network.
Validates any contractual agreement that was in effect on any date between and including January 1, 2011 and June 17, 2011.

HB 625 by Solomons; Sponsored by Carona (Effective September 1, 2011)

HB 625 relates to notice of staff leasing services company workers’ compensation claim and payment information. The bill:

Requires workers’ compensation insurance license holders to provide within 60 days certain claim information to client companies upon written requests.
Specifies a staff leasing services company license holder commits a violation if the license holder fails to provide this information.

HB 1774 by Taylor; Sponsored by Huffman (Effective September 1, 2011)

HB 1774 relates to the continuation and functions of the Office of Injured Employee Counsel (OIEC). The bill:

OIEC is extended until September 1, 2017.
Requires OIEC to develop and implement a policy to encourage the use of negotiated rulemaking procedures and appropriate alternative dispute resolution procedures under Chapters 2008 and 2009 of the Government Code.
Requires OIEC to promptly and efficiently act on complaints filed with OIEC.
Provides that OIEC may seek and accept grant funding to enable OEIC to perform its duties.
Limits access to injured employee information to employees being assisted by OIEC.
Requires the Division to provide OIEC, upon request, claim information on injured employees being assisted by OIEC.
Changes OIEC’s legislative reporting timeline.

HB 2089 by Smithee; Sponsored by Fraser (Effective September 1, 2011)

HB 2089 relates to the resolution of overpayment or underpayment of income benefits to injured employees. The bill requires the Commissioner to establish by rule the procedures insurance carriers may use to recoup an overpayment of income benefits from future income benefit payments that are not reimbursable under Labor Code §410.209 and to pay an underpayment of income benefits.

HB 2605 by Taylor; Sponsored by Huffman (Different Effective Dates)

HB 2605 relates to the continuation and functions of the Division (Division’s Sunset Bill). The bill:

Extends the Division until September 1, 2017.
Provides that network claims are to follow the same medical necessity dispute process as non-network claims.
Requires the Division to adopt a policy outlining the Division’s complaint process and to develop procedures to formally document and analyze complaints received.
Provides that designated doctor examination assignments shall be made according to the appropriate doctor’s credentials for the area of the body affected by the injury and the injured employee’s diagnosis.
Provides that an injured employee’s treating doctor may perform a maximum medical improvement/impairment rating (MMI/IR) exam after a designated doctor’s MMI/IR exam if it is the first designated doctor’s MMI/IR exam and the injured employee disagrees with the designated doctor’s opinion.
Requires the Commissioner to develop a process by rule for the certification of designated doctors, to include standard training and testing.
Requires designated doctors to continue providing services related to an assigned case until the doctor is permitted to discontinue as provided by Division rule.
Provides that a party that fails to attend a benefit review conference may forfeit the party’s entitlement to a benefit review conference on the issue in dispute.
Provides that the appeals panel may, in certain circumstances, issue a written decision on an affirmed case.
Provides that medical fee disputes must be conducted by the State Office of Administrative Hearings’ (SOAH) contested case hearings and medical necessity disputes must be conducted by the Division’s contested case hearings.
Provides that medical fee disputes must proceed to a benefit review conference or arbitration before proceeding to a contested case hearing.
Amends requirements for the medical quality review panel.
Requires the Commissioner, in consultation with the medical advisor, to adopt criteria concerning the medical case review process.
Requires the Medical Advisor to establish a quality assurance panel (QAP) within the medical quality review panel (MQRP) to provide an additional level of evaluation in medical case review and to assist the medical advisor and the MQRP.
Requires the Commissioner, after consultation with the medical advisor, to adopt rules concerning the operation of the MQRP and rules concerning the training and requirements for members of the MQRP.
Establishes that the Commissioner or the investigation unit may review the operations of a person regulated by the Division, including an agent of the person, to determine compliance.
Requires the Commissioner to prescribe by rule the procedures to be used for both announced and unannounced on-site visits.
Provides a clean-up of statutory language regarding violations and sanctions.
Provides that the Commissioner may issue emergency cease and desist orders under certain circumstances.
Provides that an order of the Commissioner is subject to judicial review under the substantial evidence rule.
Provides that claims administered by political subdivisions or pools with unresolved medical necessity disputes are entitled to Division contested case hearings.
Provides for the expedited provision of medical benefits for certain injuries sustained by first responders, employed by certain political subdivisions, in the course and scope of employment.

SB 800 by Duncan; Sponsored by Elkins (Effective June 17, 2011)

SB 800 relates to the qualifications and operations of workers’ compensation data collection agents. The bill:

Establishes the required qualifications of data collection agents.
Establishes that the data collection agent may collect fees from reporting insurance carriers and that reporting insurance carriers must pay this fee, governmental entities are excluded.

SB 809 by Seliger; Sponsored by Giddings (Effective September 1, 2011)

SB 809 relates to adjudication of certain workers’ compensation disputes, including judicial review in district court. The bill:

Establishes that a party who exhausts all administrative remedies for a medical dispute may seek judicial review of the decision within 45 days.
Provides that injured employees covered by a certified health care network may proceed to the Division’s dispute resolution process if there is an issue regarding whether a carrier properly provided the employee the information required by §1305.451.

SB 1714 by Duncan; Sponsored by Chisum (Effective September 1, 2011)

SB 1714 relates to certain actions against an employer by an employee who is not covered by workers’ compensation insurance.

81st Legislative Session

HB 673 by Solomons; Sponsored by Watson (Effective September 1, 2009)

HB 673 allows the Office of Injured Employee Counsel (OIEC) to refuse to provide or to terminate services to injured workers who are abusive or violent or threaten an employee of OIEC. It also clarifies OIEC's authority to assist injured workers before the TDI-Division of Workers’ Compensation or the State Office of Administrative Hearings (SOAH) in administrative dispute proceedings and in enforcement actions against injured employees. It authorizes the OIEC Public Counsel to adopt, with consultation with the Commissioner of Workers' Compensation, the injured workers' rights and responsibilities, which will continue to be distributed by the Division. Finally, HB 673 clarifies OIEC's access to confidential information for the performance of its statutory duties.

HB 1058 by Solomons; Sponsored by Lucio (Effective September 1, 2009)

HB 1058 extends death benefits to non-dependent parents who do not receive burial benefits and clarifies that a failure to file a claim for death benefits in the time required bars the claim unless good cause exists for the failure to file a claim under this section. Previously, the standard for failing to file for these benefits within the statutory timeframe required a “compelling reason.”

HB 2547 by Giddings; Sponsored by Deuell (Effective September 1, 2009)

HB 2547 allows a treating doctor to request job description information from an injured worker’s employer and requires the Commissioner of Workers’ Compensation to prescribe a form to be used to identify the scope and functions the worker performed prior to the injury as well as a contact person for the employer. The purpose of this legislation is to facilitate communication between employers and treating doctors regarding the availability of alternate duty or other return-to-work options for the injured worker. The legislation applies to employees of an employer with 10 or more employees.

HB 3625 by Elkins; Sponsored by Van de Putte (Effective September 1, 2009)

HB 3625 changes the timeframe for an insurance carrier to respond to a request for preauthorization from three calendar days to three working days, which conforms the preauthorization timeframes for network and non-network claims.

HB 4545 by Raymond; Sponsored by Van de Putte (Effective September 1, 2009)

HB 4545 changes the timeframe for a party to dispute a decision by the TDI-Division of Workers’ Compensation (Division) Appeals Panel to district court. The effect of the bill is to change the current 40 days to essentially 50 days from the date the decision was filed with the Division. The actual language in the bill requires a request for judicial review to be filed not later than the 45th day after the date the decision was mailed by the Division to the party; however, additional language was added that for the purposes of this section, the mailing date is considered to be the fifth day after the date the decision of the appeals panel was filed with the Division, giving a party up to 50 days, rather than 40 days to seek judicial review.

SB 1814 by Van de Putte; Sponsored by Deshotel (Effective immediately – June 19, 2009)

SB 1814 extends a pilot program that was created by HB 7 in the 79th Legislative Session to allow small employers to be reimbursed for making workplace modifications to help return an injured employee to work. The bill increases those reimbursements to up to $5,000 annually and allows the Commissioner of Workers’ Compensation to extend these reimbursements to other categories of employers as needed. Additionally, this bill clarifies an insurance carrier’s statutory responsibility to provide return-to-work coordination services on an ongoing basis when an employer’s injured employee begins to lose time away from work and requires insurance carriers to notify their policyholders regarding the availability of the TDI-Division of Workers’ Compensation employer return-to-work reimbursement program.

80^th Legislative Session

House Bill 34

Imposes an administrative violation on an insurance adjuster, case manager, or other person if that person offers to pay, pays, solicits, or receives an improper inducement relating to the delivery of benefits to an injured employee or improperly attempts to influence the delivery of benefits to an injured employee, including through the making of improper threats.
Effective on September 1, 2007

House Bill 472

Amends the definition of administrator to include persons collecting premiums or adjusting or settling claims for workers’ compensation benefits, and expands the regulatory requirements for administrators.
Effective on September 1, 2007.

House Bill 473

Allows for deviation from fee guidelines by “informal or voluntary” workers’ compensation health care networks. It further requires these networks to be certified by January 1, 2011.
Effective on September 1, 2007 with one provision effective on January 1, 2011.

House Bill 724

Provides that a dissatisfied party to a medical fee or medical necessity dispute is entitled to an administrative review through a contested case hearing (CCH) if the review concerns a health care provider fee dispute where the reimbursement amount in dispute is under $2,000; if the appeal is of an IRO decision regarding the retrospective medical necessity of a health care service under $3,000; or where the review concerns an IRO decision concerning the concurrent or prospective medical necessity for health care services.
A benefit review conference is not a prerequisite to the CCH under this change.
Also provides for the payment of death benefits to surviving eligible parents of the deceased. A payment of death benefits made under this subsection may not exceed one payment per household and may not exceed 104 weeks.
Effective on September 1, 2007.

House Bill 886

Requires the commissioner of workers’ compensation to establish an optional preauthorization plan for eligible employers who participate in the return-to-work pilot program for small employers.
To participate in the preauthorization plan, an employer must submit a proposal to the division that describes the workplace modifications the employer would make to accommodate an injured employee’s return to work.
Requires the division to guarantee that an approved employer would be reimbursed from the workers’ compensation return-to-work account for the expenses incurred in implementing the modifications, up to the account’s $2,500 reimbursement limit, unless the division determines that the modifications differ materially from the employer’s proposal.
Effective immediately.

House Bill 888

Requires a health care provider, on the written request of an ombudsman for the Office of Injured Employee Counsel (OIEC), to provide copies of the injured employee's medical records to the ombudsman at no cost.
Requires the workers’ compensation insurance carrier to reimburse the provider for the cost of the copies, prohibits the carrier from deducting that cost from any benefit to which the employee is entitled, and provides that the cost be the amount prescribed by commissioner of workers' compensation rules for copying medical records.
Effective immediately.

House Bill 1003

Requires that an independent review organization (IRO) that uses doctors to perform reviews of health care services may only use doctors licensed to practice in this state.
Provides that the definition for IRO as used in Labor Code is the same as in Insurance Code Chapter 1305.
Effective on September 1, 2007.

House Bill 1005

Clarifies that a healthcare provider who fails to submit a medical bill within 95 days after the services are provided to the injured employee, as required by statute, does not forfeit the right to reimbursement if 1) the provider submits proof that the bill was timely filed with a group accident and health insurer, an HMO that issues coverage under which the injured employee is covered, or a workers’ comp carrier other than the carrier liable for payment; or 2) the commissioner determines that the failure resulted from a catastrophic event that substantially interfered with the provider’s normal business operations.
The provider is required to submit the claim to the correct insurer within 95 days of being notified of the erroneous submission.
Effective on September 1, 2007.

House Bill 1006

Requires that URAs and insurance carriers use doctors licensed to practice in Texas for performing utilization review or review conducted under the Workers’ Compensation Act or Insurance Code.
Provides that the definitions for “credentialing” and “retrospective review” in Labor Code Chapter 401 are the same as in Insurance Code 1305, and that the definitions for “utilization review” and “Utilization Review Agent” are the same as in Insurance Code 4201.
Effective on September 1, 2007.

House Bill 2004

Requires that doctors performing peer review, utilization review, independent review, required medical examination or as a designated doctor must be certified in the specialty appropriate to the care the injured employee is receiving.
Requires that providers reviewing dental or chiropractic services must be licensed in these specific areas.
Effective on September 1, 2007.

Senate Bill 458

Amends the Labor Code to define “orthotic device” and “prosthetic device” and to include the provision and fitting of, change or repair to, and training in the use of such devices within the meaning of “health care” as the term relates to workers’ compensation benefits.
Effective on September 1, 2007

Senate Bill 471

Requires the commissioner of insurance to establish by rule the information that must be reported on workers’ compensation claims and the reporting requirements for insurance companies relating to those claims, and removes provisions specifying such information and requirements.
Authorizes the commissioner to reduce or eliminate reporting requirements for insurance companies whose workers’ compensation insurance business falls below a specific minimum premium volume established by the commissioner.
Effective on September 1, 2007

Senate Bill 1169

Requires reimbursement from the subsequent injury fund to an insurance carrier for any overpayment of workers’ compensation benefits made by the insurance carrier based on an opinion by a designated doctor if that opinion is reversed or modified by a final arbitration award or a final order or decision of the commissioner of workers’ compensation or a court.
Specifies that an insurance carrier is entitled to reimbursement from the subsequent injury fund for the amount of death benefits as well as income benefits paid to a worker with multiple employment that are based on employment other than that during which the compensable injury occurred.
Effective on September 1, 2007.

79th Legislative Session

House Bill 7

Creation of the Division of Workers' Compensation at the Texas Department of Insurance (TDI) (Chapter 402, Labor Code)

Effective September 1, 2005, The Texas Workers' Compensation Commission (TWCC) is abolished and its functions transferred to the Division of Workers' Compensation (Division) within the Texas Department of Insurance (TDI).
The Division will be administered by a single Commissioner of Workers' Compensation, appointed by the Governor for a two-year term. HB 7 gives the Commissioner of Workers' Compensation all executive authority over the functions of the Division, including rulemaking authority.
- The Governor shall appoint the Commissioner of Workers' Compensation no later than October 1, 2005.
The Commissioner of Insurance shall develop and implement policies that clearly separate the respective responsibilities of TDI and the Division. The Commissioner of Insurance may also provide advice, research and comment regarding the adoption of rules by the Commissioner of Workers' Compensation.
TDI will provide the staff and facilities necessary to perform the administrative duties (i.e., budget planning, purchasing, human resources, and information systems) of the Division.
HB 7 clarifies the mission of the Division and sets out basic goals for the Workers' Compensation system, which include:
- Treating injured employees with dignity and respect;
- Providing a fair and accessible dispute resolution process;
- Providing access to prompt, high quality medical care within the statutory framework; and
- Providing services to facilitate an injured employee's return to work as soon as it is considered safe and appropriate by the employee's health care provider.
HB 7 removes the statutory designation of specific divisions within the Division, allowing the Commissioner of Workers' Compensation the flexibility to modify the Division's organizational structure as necessary to meet performance goals. The Division will continue to provide current customer service and dispute resolution services through regional offices.
To the extent determined feasible, the Division shall establish a single point of contact for injured employees receiving services from the Division.
HB 7 requires the Division to provide incentives for overall compliance and to link regulatory outcomes with performance-based oversight.
- At least biennially, the Division will assess the performance of insurance carriers and health care providers against regulatory goals established by the Commissioner of Workers' Compensation.
- Based on this assessment, insurance carriers and health care providers will be placed into regulatory tiers based on performance – poor performers, average performers, and consistently high performers. The Division will then focus its regulatory oversight on poor performers.
- The Commissioner of Workers' Compensation will also develop regulatory incentives designed to promote greater overall compliance and performance, including modified penalties, self-audits, or flexibility.

Creation of the Office of Injured Employee Counsel (Chapter 404, Labor Code)

HB 7 also creates a new state agency, the Office of Injured Employee Counsel (OIEC), whose primary mission is to represent the interests of injured employees in the Workers' Compensation system.
- The OIEC will be administered by a Public Counsel, appointed by the Governor no later than October 1, 2005.
- The OIEC is administratively attached to TDI and TDI will provide the staff and facilities necessary to perform the administrative duties (i.e., budget planning, purchasing, human resources, and information systems) of the OIEC.
Duties of the OIEC include:
- Advocating on behalf of injured employees as a class during rulemaking related to Workers' Compensation;
- Providing ombudsman assistance to injured employees during Division administrative dispute proceedings;
- Referring injured employees to local, state, and federal financial assistance, rehabilitation and work placement programs, and other social services;
- Identifying problems with the Workers' Compensation system from the perspective of injured employees and issuing a biennial report to the Governor, Lieutenant Governor, Speaker of the House of Representatives and the legislature that includes proposed legislative and regulatory recommendations to address these problems; and
- Submitting a notice of injured employee rights and responsibilities to TDI and the Division for adoption by both the Commissioner of Insurance and the Commissioner of Workers' Compensation.
TWCC's ombudsman program shall be transferred to the OIEC by March 1, 2006.
The Public Counsel shall adopt initial rules for the OIEC by March 1, 2006.

Workers' Compensation Research (Chapter 405, Labor Code)

HB 7 keeps the research function at TDI under the direction of the Commissioner of Insurance and renames it the "Workers' Compensation Research and Evaluation Group."
HB 7 also requires the Commissioner of Insurance to adopt an annual research agenda for the Group. Under HB 7, the Group must also produce a biennial report on the impact of networks on the cost and quality of medical care and an annual report card comparing Workers' Compensation health care delivery networks certified by TDI.

Workers' Compensation Health Care Networks (Chapter 1305, Insurance Code) (see also Health Care Networks: A New Approach for Workers' Compensation)

Workers' Compensation insurance carriers, certified self-insurers, groups of self-insurers and governmental entities that self-insure may elect to contract with or establish health care networks certified by TDI in accordance with Chapter 1305, Insurance Code.
- The Commissioner of Insurance shall adopt rules regarding the certification of Workers' Compensation health care networks by December 1, 2005.
- TDI will accept applications from networks seeking certification beginning January 1, 2006.
- An insurance carrier may begin to offer medical benefits through a network upon certification of the network by the Commissioner of Insurance.
If an employer contracts with an insurance carrier that establishes or contracts with a certified network, the employer's employees will be required to obtain medical care for their work-related injuries through the network if the employees live within the network service area. However, the insurance carrier will be liable for approved out-of-network referred care, emergency care, and health care for an employee who does not live in the network service area.
An injured employee, who lives in the network service area, may choose a treating doctor from the list of doctors maintained by the network. If an injured employee does not make an initial choice within 14 days, the network will assign a treating doctor to the injured employee. An injured employee who does not live within the network's service area would continue to choose a treating doctor from the Division's Approved Doctor's List (ADL). However, an injured employee may be liable for medical care that is related to the compensable injury if that employee is required to seek care within a network and that employee sees a non-network provider without network approval.
If an injured employee is dissatisfied with his or her initial choice of treating doctor, the injured employee is entitled to select another treating doctor from the network's list of doctors. A network cannot deny an injured employee's initial request to change treating doctors. However, any subsequent requests by an injured employee to change treating doctors are subject to network approval.
An injured employee may request that his or her primary care provider under a group health HMO plan also serve as his treating doctor if the primary care provider agrees to abide by the network requirements.
HB 7 also requires TDI to review and make recommendations to the 80th Legislature on the possibility of allowing injured employees to receive treatment from an employee's primary care provider under a Preferred Provider Organization (PPOs) plan.
Under HB 7, a network may operate under its own treatment guidelines and preauthorization requirements, although treatment guidelines used by a network must meet minimum statutory criteria. Treatment may not be denied solely because it is not specifically addressed by the treatment guidelines used by the insurance carrier or network.
The network must ensure that its list of health care providers includes an adequate number of treating doctors and specialists, who are available and accessible to employees 24 hours a day, seven days a week, within the network's service area. There must be sufficient numbers and types of health care providers to ensure choice, access, and quality of care to injured employees.
Pharmacy services are specifically excluded from workers' compensation networks. These services will continue to be provided and paid in accordance with the closed formulary and pharmacy fee guideline adopted by the Commissioner of Workers' Compensation.
An HMO or a PPO may be certified as a workers' compensation health care network if they meet all the requirements.
HB 7 also requires the Research Group at TDI to publish an annual report card comparing Workers' Compensation networks on a variety of measures, including access to care, health-related outcomes, return-to-work outcomes, employee satisfaction of care, and health care costs and utilization of care.

Approved Doctor List (ADL)(§408.023, Labor Code)

Retains the ADL and the associated requirements for non-network doctors until 9/1/2007 (or an earlier date, if determined by the Commissioner of Workers' Compensation). Network doctors are not required to be on the ADL.
However, HB 7 requires doctors, including network doctors, to comply with the Division's financial disclosure and impairment rating training and testing requirements.

Health Care Definitions (§401.001, Labor Code)

“Health care reasonably required” is defined as care that is clinically appropriate and considered effective for the employee's injury in accordance with evidence-based medicine or practice standards recognized in the medical community.
“Evidenced-based medicine” is defined as the use of current best quality scientific and medical evidence formulated from credible scientific studies, including peer-reviewed medical literature and treatment and practice guidelines.

Medical Guidelines (§§ 408.052 and 413.011, Labor Code)

HB 7 allows insurance carriers to pay above or below the Division's fee guidelines, if the insurance carrier has a contract with the provider and the contract contains a fee schedule.
Under HB 7, the Commissioner of Workers' Compensation is required to adopt a pharmacy fee guideline as well as treatment and return to work guidelines; however any treatment guidelines adopted must be "evidence-based, scientifically valid and outcome-focused."
Medical treatment may not be denied solely because it is not specifically addressed by the Division's treatment guideline.
The Commissioner of Workers' Compensation may also adopt disability management rules, including the use of treatment plans, for non-network claims.
The Division must study access to surgically implanted, inserted, or otherwise applied devices and the reimbursement rates. The Division is required to recommend any statutory changes necessary to ensure appropriate access to these medical needs.
HB 7 also gives the Commissioner of Workers' Compensation the authority to identify areas of this state in which access to health care providers is less available and to adopt appropriate standards, guidelines, and rules regarding the delivery of health care in those areas.

Preauthorization (§§408.0042 and 413.014, Labor Code)

HB 7 adds physical and occupational therapy to the list of medical services requiring preauthorization by statute.
Upon request by an insurance carrier, an injured employee must submit to a medical examination by the treating doctor to define the compensable injury. Treatment for an injury or diagnosis that is not accepted by the insurance carrier after the examination must be preauthorized before treatment is rendered.
HB 7 also clarifies that preauthorized treatments and services are not subject to retrospective review of medical necessity.
Workers' Compensation networks certified by TDI, however, are not required to abide by the list of services required to be preauthorized in the Labor Code or Division rules.

Pharmacy-Related Provisions (§§408.028 and 413.0111)

HB 7 requires the Commissioner of Workers' Compensation to adopt a closed formulary for prescription medications by rule. The formulary must include an appeal process for treating doctors to use if a determination is made and documented that a drug not on the formulary is medically necessary.
HB 7 also requires the Commissioner of Workers' Compensation to adopt a fee schedule for pharmaceutical services. The rules adopted must authorize pharmacies to use agents or assignees to process claims and act on behalf ofpharmacies.
Since pharmacy services are specifically excluded from WC networks under HB 7, the closed formulary and pharmacy fee guideline adopted by the Commissioner of Workers' Compensation would also apply to network claims.

Pain Management (§408.032, Labor Code)

HB 7 requires the Division to study the issue of requiring accreditation of interdisciplinary pain rehabilitation programs and facilities and report the findings to the legislature.

Peer Review Doctors (§408.0231, Labor Code)

The Commissioner of Workers' Compensation shall adopt rules establishing quality standards and sanctions for peer review doctors.
HB 7 also requires peer review doctors to be Texas-licensed.

Payment for Health Care (§408.027, Labor Code)

Payments by an insurance carrier must be in accordance with the Division's established fee guidelines if the treatment is not provided through a health care network and or at some other contracted rate.
A health care provider waives any right to payment unless a medical bill is submitted to the insurance carrier on or before the 95th day after the date of service.
The insurance carrier must pay, reduce, deny or determine to audit the health care provider's claim not later than the 45th day after receipt.
If there is to be an audit, the insurance carrier must within 45 days of receipt, pay 85 percent of the fee guideline amount or the contracted rate. The audit and any remaining payment must be completed within 160 days of receipt. An insurance carrier's failure to meet these deadlines is an administrative violation. These provisions are applicable to health care networks.
If an injury is found to not be compensable, a workers' compensation insurance carrier may recover medical costs paid from an accident or health benefit plan or other responsible person. Likewise, if an injury is found to be compensable, an accident or health benefit plan or other responsible person may recoup the amount paid for health care services from the Workers' Compensation carrier.

Electronic Medical Billing (§ 408.0251, Labor Code)

The Commissioner of Workers' Compensation shall adopt rules requiring insurance carriers to accept medical bills from providers electronically by January 1, 2006.
On or after January 1, 2008, the Commissioner of Workers' Compensation may adopt rules requiring insurance carriers to pay medical bills to providers electronically.

Medical Dispute Resolution (§413.031, Labor Code)

A party to a medical dispute wanting to appeal a review by an independent review organization (IRO) or by the Division must seek judicial review directly rather than appeal the IRO decision to the State Office of Administrative Hearings (SOAH).
- Effective September 1, 2005, SOAH may not accept a medical dispute that remains unresolved for a hearing. A medical dispute that is not pending for a hearing by SOAH on or before August 31, 2005, is not subject to a SOAH hearing but may be appealed to court for judicial review.
An IRO decision must meet minimum standards established by the Commissioner of Workers' Compensation.
The IRO decision is binding during the pendency of a dispute.
Insurance carriers will be required to pay for all IRO reviews relating to preauthorization and retrospective medical necessity disputes within a network. For medical disputes relating to care provided outside of a network, the insurance carrier will continue to pay for the IRO review in the case of a preauthorization dispute and the non-prevailing party will continue to pay for the IRO review in the case of retrospective medical necessity disputes.
The Division has authority to monitor IROs and report the results of monitoring activities to TDI quarterly.
For in-network medical care, fee disputes will be handled by the network's internal complaint process, while fee disputes for out-of-network medical care will continue to be resolved by the Division. Any appeal of a Division fee dispute decision must be made directly to district court rather than to SOAH.

Medical Advisory Committee

HB 7 abolishes the Medical Advisory Committee (MAC) effective September 1, 2005.

Return-to-Work Information and Assistance (§§413.023 – 413.025, Labor Code)

The Division will provide information to employers and employees about the benefits of early return to work and methods for enhancing the ability to return to work.
The Division will assist injured employees receiving income benefits to return to work, including referring injured employees to other employment assistance programs and initiating post-referral contacts with injured employees.
The Division will ensure return-to-work outcome data is tracked by using data from the Division, the Texas Workforce Commission (TWC), the Department of Assistive and Rehabilitative Services (DARS), and insurance carriers.

Return-to-Work Pilot Program (§413.022, Labor Code)

HB 7 creates a pilot return-to-work program for small employers with Workers' Compensation insurance, which provides grants for up to $2,500 per employer to pay for workplace modification initiatives that facilitate early return to work. This pilot, which begins January 1, 2006 and expires September 1, 2009, is funded by administrative penalties (up to $100,000 a year) collected by the Division.

Case Management (§413.021, Labor Code)

The insurance carrier must evaluate every compensable injury that could result in lost time as early as practical to determine if skilled case management is necessary to address return to work issues. Case managers who are appropriately licensed to practice in this State must be used to perform these evaluations. A claims adjuster may not be used as a case manager.

Vocational Rehabilitation (§409.012, Labor Code)

HB 7 requires the Division and the Department of Assistive and Rehabilitative Services (DARS) to report to the legislature by 8/1/2006 on cooperative actions taken to improve access to and effectiveness of vocational rehabilitation programs.

Determination of Compensable Injury (§408.0042, Labor Code)

Upon request by an insurance carrier, the Division shall require an injured employee to submit to a single examination with the treating doctor to define the scope of the compensable injury. The report will define the compensable injury after which the insurance carrier will either accept the injuries and diagnoses listed in the treating doctor's report or dispute the specific injuries and diagnoses. Treatment for an accepted diagnosis/injury may not be reviewed later for compensability, but may be reviewed for medical necessity. Treatment for an injury or diagnosis that is not accepted by the insurance carrier must be preauthorized before treatment is rendered.
For in-network medical care, HB 7 also requires insurance carriers to notify a health care provider in writing if the carrier decides to dispute the compensability of a claim. An insurance carrier is prohibited from denying a medical bill on the basis of compensability for services that were provided prior to the carrier's written notification to the provider. However, if the carrier successfully contests the compensability of the claim, the carrier is liable for a maximum of $7,000 in medical services.

Maximum Medical Improvement (MMI) and Impairment Ratings (§§408.123-124, Labor Code)

Once a treating doctor certifies MMI and assigns an impairment rating, an injured employee shall receive written notice about the employee's entitlement to dispute the report.
The Commissioner of Workers' Compensation may adopt subsequent editions of the AMA Guidelines by rule (currently the statute requires the use of the fourth edition of the AMA Guidelines).

Required Medical Examinations (RMEs) (§408.004-.0041, Labor Code)

Insurance carriers may only request an RME prior to a designated doctor examination in order to examine the appropriateness of the health care received outside of a network. However, an insurance carrier may continue to request an RME to examine issues relating to the employee's impairment rating or date of maximum medical improvement (MMI) after a designated doctor's examination, regardless of whether the injured employee is receiving medical care in- or outside of a network.
An injured employee may have a doctor of the employee's choice at an RME examination if the RME examination relates to the employee's impairment rating or MMI date. If the injured employee is subject to a Workers' Compensation health care network, the doctor who attends the RME examination with the employee must be the employee's treating doctor.

Designated Doctor (§408.0041, Labor Code)

HB 7 expands the list of issues that a designated doctor may examine, including issues relating to the extent of the employee's injury, whether the employee's disability is a direct result of the compensable injury, the ability of the employee to return to work, and similar issues.
The report of the designated doctor still has presumptive weight during Division benefit disputes and the Division will base its determination on the designated doctor's report unless the preponderance (as opposed to the “great weight”) of other medical evidence is to the contrary.
Additionally, HB 7 requires that the insurance carrier continue to pay benefits based on the designated doctor's opinion during the pendency of a dispute. However, the insurance carrier may still unilaterally suspend Temporary Income Benefits (TIBs) if the injured employee fails to attend a designated doctor exam without good cause.
A network doctor may not serve as a designated doctor or perform an RME examination for an employee receiving medical care through a network with which the doctor contracts or is employed.
Rules regarding the changes in the Designated Doctor and RME processes must be adopted on or before February 1, 2006.

State Average Weekly Wage (§408.047, Labor Code)

The state average weekly wage (SAWW) from September 1, 2005 through September 30, 2006 is set at $540.
On and after October 1, 2006 the state average wage will be 88% of the average weekly wage in covered employment as computed by the Texas Workforce Commission (TWC). By rule, the Commissioner of Workers' Compensation may increase this percentage up to 100%.
As a result, the change in the SAWW will result in an increase in the maximum and minimum income benefit amounts paid to employees injured after October 1, 2006 by approximately 12 percent.

Income Benefit Retroactive Period (§408.082, Labor Code)

HB 7 reduces the amount of time an injured employee must be off work before that employee may recoup income benefits for the initial waiting period (i.e., the first 7 days of disability) from four weeks to two weeks. The two-week period applies only to an injury that occurs on or after September 1, 2005.

Supplemental Income Benefits (§408.1415, Labor Code)

HB 7 clarifies the eligibility requirements for Supplemental Income Benefits (SIBs) and requires the Commissioner of Workers' Compensation to adopt rules regarding the level of activity an injured employee must have with the Texas Workforce Commission (TWC) and the Department of Assistive and Rehabilitative Services (DARS), as well as the number of job applications that must be submitted by an injured employee each quarter to meet minimum work-search requirements.

Benefit Dispute Resolution (Chapter 410, Labor Code)

HB 7 requires that information that the Division determines to be useful to parties in resolving disputes will be published by the Division and made available to the parties when a Benefit Review Conference (BRC) or Contested Case Hearing (CCH) is scheduled.
The Division may also hold BRCs telephonically by agreement of the injured employee.
HB 7 also requires any party requesting a BRC to demonstrate to the Division any previous efforts that party made to resolve the disputed issues before a BRC is scheduled by the Division.
A Benefit Review Officer (BRO) must complete at least 40 hours of training in dispute resolution/mediation techniques.
BRCs are limited to two per disputed issue, and the BRC will become more of a true mediation session, wherein the BRO will not make recommendations on the disputed issues nor issue interlocutory orders to pay benefits; however, an interlocutory order can be issued by other division staff.
HB 7 also makes the Appeals Panel a single three-member tribunal that can either reverse or remand a CCH decision instead of several panels of administrative law judges. HB 7 also requires the Appeals Panel to issue and maintain a precedent manual composed of precedent-establishing benefit dispute decisions.
The record of the CCH is admissible during judicial review in accordance with Texas Rules of Evidence, as decided in National Liability v. Allen, 15 S.W.3d 525.

Intoxication Presumption (§401.013, Labor Code)

HB 7 sets up a rebuttable presumption that an employee is intoxicated if the employee tests positive for a controlled substance as defined by Section 481.002, Health and Safety Code, through a blood test or urinalysis.

Carrier Single Point of Contact (§409.021, Labor Code)

Each insurance carrier is required to establish a single point of contact in the carrier's office for an injured employee.

Exclusive Remedy (§408.001, Labor Code)

A determination that an injury is not compensable under Sections 406.032, 409.002, or 409.004 of the Labor Code (for reasons such as the employee's: intoxication or willful attempt to injure himself; untimely notice to employer; or untimely filing of a claim, etc.) does not adversely affect the exclusive remedy requirements in the Labor Code.

Use of Post-Injury Liability Waivers by Nonsubscribing Employers (§406.033, Labor Code)

HB 7 places certain statutory limitations on the validity of post-injury waivers signed by employees of nonsubscribers, including prohibiting the signing of a waiver before the 10th business day after the employee was injured; ensuring that an employee has received a medical evaluation from a nonemergency doctor; and ensuring that the waiver is voluntary and is clearly identifiable in any written agreement.

Enforcement (Chapter 415, Labor Code)

HB 7 removes the requirement that the state show that a party committed a violation of the Act or rules "willfully or intentionally" in order to assess administrative penalties. HB 7 also removes the current classification system for administrative penalties in the Act and aligns the enforcement structure of the Division with the current enforcement structure of TDI by authorizing the Commissioner of Workers' Compensation to assess administrative penalties up to $25,000 per day per occurrence.
HB 7 also makes it clear that an insurance carrier commits an administrative violation if that carrier makes a statement denying all future medical care for a compensable injury.
Finally, HB 7 establishes civil and administrative penalties for the deceptive use of words and symbols resembling the Division's, TDI's, or a state agency's name.

Fraud (§409.092, Labor Code)

Allows the Division to share investigative material that relates to a felony regarding Workers' Compensation or involves restitution with insurance carriers.

Health and Safety (Chapter 411, Labor Code)

Inspection of insurance carriers for the adequacy of accident prevention services is discretionary rather than being required every two years.
The hazardous employer and drug-free workplace programs are eliminated, as is the requirement for carriers and the agency to use "qualified" field safety representatives in providing accident prevention services.
The Division is to provide educational materials for employees and employers relating to safe working conditions and prohibited retaliation and on best practices for return-to-work programs and workplace safety.

The University of Texas System (UT), Texas A&M University System (A&M), and Political Subdivisions (Chapters 501-505, Labor Code)

HB 7 aligns the sick and annual leave provisions for UT and A&M employees with similar provisions for other state employees by clarifying that a employee in each of these programs may use their accrued sick or annual leave in lieu of receiving Temporary Income Benefits (TIBs). If an employee chooses to use sick leave, that employee must first exhaust this leave before receiving TIBs. Once an employee's sick leave has been exhausted, that employee may then choose to use one or more weeks of annual leave in lieu of receiving TIBs.

HB 7 also requires political subdivisions to evaluate whether it is feasible to establish or contract with a WC network that is certified by TDI and, if feasible, to do so. If not feasible, political subdivisions can exercise other options laid out in Chapter 504, Labor Code, including direct contracting with health care providers. However, political subdivisions will still be subject to the same data reporting and report card requirements as other Workers' Compensation health care delivery networks certified by TDI.

Insurance Rates and Premiums (Articles 5.55-5.60A, Insurance Code)

The Commissioner of Insurance shall report (not later than December 1, 2006) to the Governor, Lieutenant Governor, Speaker of the House of Representatives and members of the legislature each even-numbered year regarding the effect HB 7 has had on the affordability and availability of Workers' Compensation insurance for employers.
Insurance carriers are required to file their underwriting guidelines with TDI.
The Commissioner of Insurance will conduct a public hearing biennially (beginning not later than December 1, 2008) to review Workers' Compensation insurance rates. The Commissioner of Insurance by rule may mandate rate or premium changes if a determination is made that rates or premiums charged do not meet established rating standards.

Sunset Dates

HB 7 includes a 2009 sunset date for TDI, the Division and the new OIEC.

Effective Date

Except as otherwise provided, this Act takes effect September 1, 2005.

HB 1353

Incorporates the unanimous recommendations of the Texas Group Self-Insurance Guaranty Association Advisory Committee and creates the Texas Self-Insurance Group Guaranty Fund.
The fund will be governed by a board provided for in the bill and be responsible for ensuring the payment of workers' compensation benefits in the event a self-insured group becomes insolvent.
Effective on September 1, 2005.

78th Legislative Session

House Bill 4

Amends Chapter 33 of the Civil Practice & Remedies Code re “proportionate responsibility”.
Reduces other parties’ liability to the extent that an employer with workers' compensation caused or contributed to causing in any way the harm for which recovery of damages is sought.
An insurance carrier’s subrogation interest may be reduced based upon the responsibility assigned by the court to the employer, regardless of whether the employer is a subscriber.

House Bill 145

Authorizes the Commission to bring suit in Travis County if a person refuses or fails to comply with a Commission interlocutory order, final order or decision and provides for recovery of reasonable attorney fees and costs for the prosecution and collection of the claim.
Requires a party seeking judicial review to simultaneously file the petition with the court, serve any opposing party to the suit, and provide written notice of the suit to the Commission. A party that does not provide the simultaneous written notice may not seek judicial review of a decision.

House Bill 833

Requires the Commission to adopt a rule that allows an injured worker to select brand name pharmaceuticals and pay for the difference in price between the brand name and the generic or over-the-counter medication.
Requires the Commission to change rules to help pharmacies bill insurance carriers when the injured worker has purchased a brand name pharmaceutical.
Requires the Commission to consider a rule making petition based on a study designed to determine pharmacy fees paid by other payers and administrative costs and expenses incurred by pharmacy providers to process claims under the Texas workers’ compensation system. The study is to be funded by the collaborative efforts of workers’ compensation insurance carriers and pharmacy providers. The Commission is required to adopt a rule no later than six months after receipt of the rulemaking petition and the rule must clearly define the methodology for determining payment amounts for prescription drugs.
The Commission is to streamline the procedures for presenting, processing, and paying claims for prescription drugs in the workers’ compensation system.

House Bill 1230

Requires the State Office of Risk Management (SORM) to provide risk management services for employees of community supervision and corrections departments.

House Bill 1865

Amends the Insurance Code definition of “group” to include two or more members of a trade association of business entities that join together with the approval of the Insurance Commissioner to purchase individual workers' compensation insurance policies covering each participating trade association member.
To be eligible to join a group, a business entity must be a member of the same trade association as the other business entities participating in the group.

House Bill 1878

Requires a workers’ compensation insurance carrier that receives an order or writ of withholding under Chapter 158 of the Family Code (relating to withholding of earnings for child support), to withhold an amount not to exceed the maximum amount allowed regardless of whether the income benefits are paid as a lump sum or as a periodic payment.

House Bill 2095

Allows five or more employers in the same or similar type of business and belonging to a bona fide trade or professional association in Texas to join together to pool their liabilities for workers’ compensation.
Requires issuance of a certificate of approval from the Commissioner of Insurance before a group may act as a self-insured group.
Names the Commissioner of Insurance as attorney for service of legal process for the group.
Allows the Commissioner of Insurance to promulgate rules required by this legislation.
Requires the State Office of Administrative Hearings (SOAH) to conduct hearings required by this legislation.
All provisions of the workers’ compensation law apply to such a self-insurance group.
Amends the definition of “insurance carrier” in the Labor Code and the definition of “group” in the Insurance Code.

House Bill 2116

Provides that members of TEXAS TASK FORCE 1, a program of the Texas Engineering Extension Service that provides training and responds to assist in search, rescue and recovery efforts following natural or man-made disasters, are covered by workers’ compensation insurance when the task force is activated or during any training session sponsored or sanctioned by the task force.

House Bill 2198

Addresses the issues that have arisen as a result of the Fulton v. Associated Indemnity Corporation court decision.
- House Bill 3168 and Senate Bill 820 also address this issue.
Provides that the first certification of maximum medical improvement (MMI) and assignment of an impairment rating becomes final if not disputed within 90 days after written notification is provided.
Includes the following exceptions to the 90-day dispute deadline:
- A significant error on the part of the certifying doctor in applying the appropriate AMA guides and/or in calculating the impairment rating.
- A clear misdiagnosis or undiagnosed medical condition.
- Prior improper or inadequate treatment of the injury that would render the certification of MMI or impairment rating invalid.
- Allows the Commission to adopt rules to prescribe additional exceptions when “compelling circumstances” exist.
Provides that the exceptions to the 90-day dispute deadline apply to certifications of MMI and assignments of impairment ratings made after reaching statutory MMI or after a certification of MMI or assignment of an impairment rating is overturned.

House Bill 2199

Addresses the issues that have arisen from the Continental Casualty Co. v. Downs court decision:
- Clarifies that an insurance carrier does not waive the right to dispute compensability of an injury until after the 60th day following receipt of notice of the injury.
- Assesses specific, graduated, administrative penalties for insurance carriers that do not initiate payments or file a notice of dispute timely.
- Eliminates the need for “cert-21s” in order to preserve the right to dispute up until the 60th day if no income benefits become due.
Changes the insurance carrier’s “pay or dispute” period from seven days to 15 days. This does not affect the accrual due date or the requirement to begin payment within seven days of the eighth day of disability.
Clarifies that the date a certified self-insurer receives notice of an injury for purposes of “pay or dispute” is the date the qualified claims servicing contractor receives notice.
Clarifies that the date a political subdivision that self-insures receives notice of an injury for purposes of “pay or dispute” is the date the intergovernmental risk pool or other entity responsible for administering the claim for the political subdivision receives notice.

House Bill 2323

Provides that a court, in which a suit for judicial review of a Commission decision or order is filed, upon determining the suit has been filed in the wrong court, shall transfer the case to the proper court. If the suit was initially timely filed, it is considered to be timely filed in the court to which it is transferred.

House Bill 3168

Addresses the issues that have arisen as a result of the Fulton v. Associated Indemnity Corporation court decision (See HB 2198, above).
Authorizes the Commission to prescribe, by rule, an alternate dispute resolution process to resolve disputes regarding medical services costing less than the cost of a review by an independent review organization (IRO).
Provides that the non-prevailing party shall pay the cost of a review under the alternate process.

Senate Bill 104

If the Commission or the Texas State Board of Medical Examiners discovers an act or omission by a physician that may constitute a felony, a misdemeanor involving moral turpitude, a violation of a state or federal narcotics or controlled substance law, an offense involving fraud or abuse under the Medicare or Medicaid program, or a violation of the workers’ compensation law, the agency is required to immediately report that act or omission to the other entity.

Senate Bill 287

Sets staggered, two-year terms for TWCC Commissioners, expiring February 1 of each year.
Provides that current commissioner terms expire on 2/1/05.
On or after February 1, 2005, the Governor is to appoint one member representing employers and two members representing wage earners to terms expiring 2/1/06.
On or after February 1, 2005, the Governor is to appoint one member representing wage earners and two members representing employers to terms expiring 2/1/07.

Senate Bill 478

Excludes from the definition of employee of a political subdivision for workers’ compensation purposes, certain workers who provide services that may benefit a political subdivision, but who do not receive payment from the political subdivision for those services (i.e., stock show, rodeo, carnival, circus, musical, vocal or theatrical performance, professional baseball league or game, professional hockey league or game, wrestling event or match, vehicle or motorcycle event or other entertainment event).

Senate Bill 482

Amends the Government Code to provide that a survivor of certain law enforcement, fire suppression, or emergency medical services employees is eligible for financial assistance if the employee died as a result of a personal injury sustained in the line of duty.
Provides that, if there is reasonable doubt as to the circumstances surrounding the death of the employee, it shall be resolved in favor of providing the assistance to the survivor.

Senate Bill 820

Addresses the issues that have arisen as a result of the Fulton v. Associated Indemnity Corporation court decision (see House Bill 2198).

Senate Bill 1192

Amends the Insurance Code to provide that a claim for workers’ compensation benefits by a claimant of an impaired or insolvent insurer may not result in a recovery to the claimant that is less than would have been provided had the insurer not been impaired or insolvent.

Senate Bill 1282

Clarifies that the date a certified self-insurer receives notice of an injury for purposes of “pay or dispute” is the date the qualified claims servicing contractor receives notice.
Clarifies that the date a political subdivision that self-insures receives notice of an injury for purposes of “pay or dispute” is the date the intergovernmental risk pool or other entity responsible for administering the claim for the political subdivision receives notice.

Senate Bill 1572

Authorizes the Commission to adopt individual treatment protocols and guidelines.
If a nationally recognized treatment protocol or guideline is not available, allows the Commission to adopt a treatment guideline or protocol as long as it is scientifically valid and outcome-based.

Senate Bill 1574

Provides immunity from suit and civil liability for members of the Commission’s Medical Quality Review Panel (MQRP).
Provides confidentiality protections to information collected by the Commission’s Medical Advisor or members of the MQRP in the conduct of their duties.
Permits the Commission, Board of Medical Examiners and the Board of Chiropractic Examiners to share confidential information.
Establishes the state average weekly wage for state fiscal year 2003 at $537 and for state fiscal year 2004 at $539.

Senate Bill 1652

Extends workers’ compensation insurance coverage to out-of-state employees of the University of Texas System or the Texas A&M University System.
If the employee pursues the claim in the state where the injury occurred, the employee is not entitled to Texas workers’ compensation benefits.

Senate Bill 1804

Provides that insurance carriers that “voluntarily preauthorize” treatment and pharmaceutical services are liable for payment for those treatments and services.
Requires independent review organizations (IROs) to consider Commission-adopted payment policies and guidelines when resolving a medical necessity dispute if those policies and guidelines are raised by one of the parties to the dispute.
If the IRO’s decision is contrary to the commission's adopted policies or guidelines, the IRO must indicate in the decision the specific basis for its divergence in the review of medical necessity.
The IRO is not prohibited from considering the payment policies adopted under section 413.011 in any dispute, regardless of whether those policies are raised by a party to the dispute.

Senate Concurrent Resolution 48

Requires the Commission to consider a rule making petition based on a study designed to determine pharmacy fees paid by other payers and administrative costs and expenses incurred by pharmacy providers to process claims under the Texas workers’ compensation system.
The study is to be funded by the collaborative efforts of workers’ compensation insurance carriers and pharmacy providers.
The Commission is required to adopt a rule no later than six months after receipt of the rulemaking petition and the rule must clearly define the methodology for determining payment amounts for prescription drugs (see House Bill 833).

77th Legislative Session

House Bill 1203

Requires the State Office of Risk Management (SORM) to operate as a “full service insurance and risk manager” for state agencies (except Texas Tech University), and requires all agency insurance coverage, except health and life insurance, to be obtained by SORM.
Charges SORM with overseeing the purchase of surety bonds for state officers and employees.
Requires SORM and exempt state agencies to report to the legislature regarding the insurance purchased and premium dollars spent, and losses.
Allows Texas Department of Transportation (TXDOT) employees with work-related injuries to elect to use sick and annual leave time in lieu of weekly workers’ compensation benefits (same as Senate Bill 453, except for effective date).
Generally effective by September 1, 2002, but varies by bill section House Bill 1562.
Amends the Insurance Code to require insurers, including workers’ compensation insurers, to adopt an anti-fraud plan and to file that plan annually with TDI.
Provides for immunity from liability and confidentiality of information.
Requires an insurer who provides a form for a person to use to make a claim to provide on that form certain text regarding false or fraudulent claims.
Amends the Occupations Code to define “unprofessional conduct” by a health care provider to include activities related to a false or fraudulent claim for payment of a loss under an insurance policy. Provides that this unprofessional conduct constitutes cause for revocation or suspension of a provider’s license, permit, registration, etc., or other disciplinary action.
Amends the Labor Code to allow claim file information to be released to a subclaimant that is an insurance carrier with an antifraud plan. The information, which includes electronic data, remains subject to confidentiality requirements. The Commission may establish fees and security parameters for transfer of electronic data, and maintenance of the data by the carrier.

House Bill 1922

If a state government collects information about a person by means of a form that the person completes, the person has, with some exceptions, the right to be informed about that information, and a right to review and correct it if necessary.

House Bill 2600

Article 1

Improves TWCC’s ability to regulate and sanction the various types of doctors providing services in the workers’ compensation system.
Requires doctors to register with and be approved by the Commission.
Requires TWCC to establish training, monitoring, and disclosure requirements for registered doctors.
Formalizes the role of the Medical Advisor and creates a Medical Quality Review Panel Allows TWCC to impose sanctions on insurance carriers and recommend actions regarding Utilization Review Agents.
Requires Commission to adopt rules no later than Feb. 1, 2002.

Article 2

Requires a feasibility study on the creation of regional workers’ compensation medical networks, and if networks are determined to be feasible, it
Requires TWCC to contract with regional networks.
Provides an option for injured workers and insurance carriers to participate in regional medical networks.
Establishes an advisory committee to set standards for quality, satisfaction, and evaluation.
Requires Commission to adopt rules no later than Oct. 1, 2002.

Article 3

Requires employers to, by request, report to the worker, treating doctor, and insurance carrier whether they offer modified duty opportunities for injured workers.
Requires insurance carriers to offer return-to-work coordination services.
Requires the Commission to adopt rules no earlier than Jan. 1, 2004.

Article 4

Eliminates the current second opinion process for spinal surgery and includes those services in the pre-authorization process.
Establishes a minimum list of medical services requiring preauthorization and/or concurrent review.
Allows insurance carriers and health care providers to voluntarily offer and use certification programs for health care providers.
Allows the Commission to adopt rules requiring insurance carriers to pay for pharmaceutical services for the first 7 days after an injury if the health care provider receives verification of coverage and confirmation of injury.
Requires Commission to adopt rules no later than Feb. 1, 2002, except for the pharmaceutical coverage rules, which shall be adopted on or after Sept. 1, 2002.

Article 5

Modifies the required medical examination process to bring TWCC designated doctors into the process more quickly to resolve questions on impairment and maximum medical improvement.
Modifies qualification requirements for designated doctors.
Requires the Commission to adopt rules on or after Jan. 1, 2002.

Article 6

Requires the TWCC to adopt a pharmaceutical formulary including generic and over-the-counter medications.
Modifies statutory requirements for fee and treatment guidelines.
Requires the use of independent review organizations for resolving preauthorization and medical necessity disputes.
Clarifies administrative violation provisions.
Modifies health care practitioner financial disclosure requirements.
Requires the TWCC to adopt rules for pharmaceutical services no later than Feb. 1, 2002; for treatment guidelines no later than May 1, 2002; for health care practitioner to disclose health care provider information to TWCC no later than June 1, 2002; and for administrative violations no later than Sept.1, 2002 (Applies to medical dispute resolution requested on or after Jan. 1, 2002).

Article 7

Moves the TWCC Sunset review date up from Sept. 1, 2007 to Sept. 1, 2005.
Provides that the TWCC is subject to audit by the State Auditor.

Article 8

Establishes that the insurance carrier must pay a claimant’s attorney’s fees when the carrier requests judicial review and the claimant prevails in that review (applies to requests for judicial review on or after Sept. 1, 2001).

Article 9

Provides that employees with third-degree burns covering over 40 percent of the body and requiring grafting, or with third-degree burns covering the majority of both hands or one hand and the face are eligible for Lifetime Income Benefits.
Applies to a compensable injury that occurs on or after June 17, 2001.

Article 10

Allows workers to count all IRS-reportable wages, including multiple jobs, for calculating their average weekly wage (applies to a compensable injury that occurs on or after July 1, 2002).
Expands the Subsequent Injury Fund’s (SIF) responsibility for reimbursements to a carrier to include initial pharmaceuticals in which the injury is determined not to be compensable and to the payment of additional benefits paid to multiple job holders.
Provides for the SIF to make partial payment of insurance carrier claims.
Provides for a maintenance tax increase, if necessary, to fund the SIF.
Amends the determination of temporary income benefits for school district employees to be based on the wages earned in a week rather than wages paid in a week (applies to a compensable injury that occurs on or after Dec. 1, 2001).

Article 11

Requires insurance carriers at contested case hearings to file, and deliver to the claimant, the carrier’s true corporate name and the name and address of the carrier’s registered agent for service of process.
Requires the Appeals Panel decisions to include the same information.
Effective immediately.

Article 12

Provides that Saturdays, Sundays, and holidays are not included in computing time relating to when an appeal to the TWCC Appeals Panel, or response to the Appeals Panel must be filed.
Effective immediately.

Article 13

Requires the Commission to conduct a study of the implementation and development of drug-free workplace policies (expires Sept. 1, 2003).
Effective immediately.

Article 14

Provides that the cost of risk management services be allocated to state agencies in the same manner as workers’ compensation.
Creates a risk/reward program for workers’ compensation costs of state agencies.
Allows TXDOT injured workers to elect to use sick and annual leave time prior to receiving income benefits for their injury.
Effective immediately.

Article 15

Requires the Commission to use the treasury constant maturity rate for one-year treasury bills as published by the Federal Reserve Board for the computation of interest and discount rates.
Effective immediately.

Article 16

Prohibits the waiver of an employee’s cause of legal action against a non-subscribing employer before the employee’s injury, illness, or death.
Effective immediately.

House Bill 2976

Allocates the cost of risk management services provided by SORM to state agencies (same as House Bill 2600, Article 14).
Effective Sept. 1, 2001.

House Bill 3458

Restructures the Texas Workers’ Compensation Insurance Fund, and changes the name of the Fund to the Texas Mutual Insurance Company.
Effective Sept. 1, 2001.

Senate Bill 11

Pertains to the privacy of medical records. Section 181.054 exempts workers’ compensation insurance or a function authorized by Title 5, Labor Code, and any person or entity in connection with providing, administering, supporting, or coordinating any benefits under a self-insured program for workers’ compensation.
Effective date is Sept 1, 2001, but varies by bill section.

Senate Bill 453

Permits injured TXDOT employees to use sick and annual leave prior to receiving workers’ compensation income benefits (same as House Bill 1203, Section 2.01, except for effective date).
Effective Sept. 1, 2001 for a compensable injury that occurs on or after Sept. 1, 2001.

Senate Bill 643

Adds an acupuncturist to the Medical Advisory Committee.
Effective Sept. 1, 2001Senate Bill 850.
Provides that if a peace officer employed by the state or a local governmental entity sustains an injury that results in permanent incapacity for work, and total disability has persisted for more than 12months, the peace officer is entitled to an annual payment equal to the difference between various benefit payments (including workers’ compensation) and an amount equal to the officer’s average annual salary during the officer’s final three years as a peace officer.
Effective Sept. 1, 2001.

Senate Bill 994

Allows the Texas Department of Insurance to issue a license to write workers’ compensation policies in Texas without having to first have an approved accident prevention plan. The plan must be submitted and approved by TWCC before the insurer can write policies, but not before the license can be issued.
Effective Sept. 1, 2001.

76th Legislative Session

HB 729

Requires carriers to offer payment of benefits by electronic funds transfer to employees who have been entitled to benefits for a period of time as defined by Commission rules.
Clarifies the meaning of “timely” payment of benefits.
Effective September 1, 1999, except the timely payment of benefits clarification, which is effective June 19, 1999, and offer of EFT for benefits due on or after the effective date, which is effective September 1, 2000.

HB 1826

Prohibits a carrier from requiring an employee to submit to medical exams more frequently than annually if the employee’s medical condition has not improved to allow him or her to return to work in the past year and two years have elapsed since the Commission’s initial award of supplemental income benefits.
Requires the use of a designated doctor and provides for presumptive weight in handling cases in which return-to-work status is in dispute.
Effective September1, 1999.

HB 2509

Allows state employees to use all or part of their accrued annual leave after they have exhausted their sick leave rather than receiving income benefits. HB 2509 also provides for other SORM responsibilities and reporting requirements.
Effective September 1, 1999, for dates of injury on or after the effective date.

HB 2510

Amends the intoxication definition to be consistent with the Penal Code.
Adds 3.5 percent to the interest and discount rates as currently calculated.
Modifies the Commissioner reimbursement provisions.
Allows the Commission to accept a grant from the Texas Workers’ Compensation Insurance Fund to control medical costs and ensure the delivery of quality medical care.
Adds provisions related to the ROC.
Provides mechanisms for an insurance carrier to suspend TIBs based on an RME examination or for failure to attend an RME examination; changes “health care facility” to “health care provider.”
Changes “fee-charged” language to fee guideline reimbursement notion.
Allows for monthly payment of income and death benefits as provided by Commission rules.
Allows the Commission to change to fourth edition of AMA Guides by rule.
Allows for payment of lifetime income and death benefits by annuity as provided by Commission rules.
Increses maximum for burial benefits to $6,000.
Adds an insurance carrier representative to the MAC.
Allows political subdivisions to compensate volunteer emergency personnel more than the minimum benefit level.
Includes other technical cleanup and corrections.
Effective September 1, 1999 (for compensable injuries on or after the effective date, where applicable, and for agreements for payment of income or death benefits entered into on or after that effective date), except interest and discount rate increase, which is effective October 1, 1999, and suspension of TIBs based on RMEs scheduled to occur on or after the effective date, which becomes effective January 1, 2000.

HB 2511

Allows the Commission to permit or require electronic transmission of information among workers’ compensation system participants; require employers or insurance carriers to verify coverage and claim administration contact; and designate a data-collection agent.
Broadens the criteria of who is subject to the coverage filing requirement to include political subdivisions and certified self-insureds and requires the Commission to develop a plan on electronic reporting and submittals by October 1, 2000.
Effective September 1, 1999, except for application of filing requirement for political subdivisions and certified self-insureds not previously under requirement, which becomes effective January 1, 2000.

HB 2512

Allows benefit review officers and hearing officers to issue an interlocutory order for payment of part or all medical and income benefits.
Provides reimbursement from the subsequent injury fund for any overpayments made on interlocutory orders that are reversed or modified; authorizes the executive director to issue interlocutory orders for payment of medical benefits.
Allows for reimbursement from the SIF.
Effective September 1, 1999, for interlocutory orders or decisions issued on or after the effective date.

HB 2513

Authorizes the Commission to require certain credentials for private rehabilitation providers by rule.
Requires the Commission to notify the carrier of need for rehabilitation or training services.
Changes lost-time guidelines to guidelines for expected and average return-to-work times.
Requires the Commission to encourage modified duty and early return-to-work through an outreach program for employers and doctors by January 1, 2000.
Authorizes the Commission to require the treating doctor or another doctor to perform a functional capacity examination on re-quest of employer, insurance carrier, or commission.
Effective September 1, 1999, except implementation of program to encourage employers and health care providers to discuss modified duty and return to work, which becomes effective January 1, 2000.

HB 2514

Clarifies that immunity from liability for safety consultations includes accidents, injuries, or occupational diseases.
Renames the extra-hazardous employer program and revises the program’s applicability to be consistent with the court rulings.
Allows for re-inspection of accident prevention services determined to be inadequate and requires reimbursement for their inspection.
Effective September 1, 1999.

HB 2706

Provides that persons performing volunteer service under the direction of an officer/employee of the state or a political subdivision in a declared disaster area are covered (with certain conditions) by workers’ compensation for medical benefits if an injury is sustained.
Effective June 19, 1999, for compensable injuries on or after the effective date.

HB 2842

Addresses salary continuation and supplementation with regard to the accrual and payment of temporary income benefits and clarifies that payments do not affect exclusive remedy provisions.
Effective September 1, 1999, for injuries on or after the effective date.

HB 3697

Modifies statutory provisions regarding Texas Workers’ Compensation Insurance Fund operations and tax status and requires the Fund and the ROC to enter a joint venture in conducting interim studies on worker safety, return to work, quality and cost-effectiveness of health care delivery system, and medical provider treatment and insurance carrier utilization review practices (expires March 1, 2001).
Effective August 30, 1999.

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Last updated: 09/29/2011

Workers' Compensation

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Workers' Compensation Legislation Enacted

82nd Legislative Session

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80^th Legislative Session

79th Legislative Session

78th Legislative Session

77th Legislative Session

76th Legislative Session

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Translation by WorldLingo

Workers' Compensation

Division of Workers' Compensation Menu

Workers' Compensation Legislation Enacted

82nd Legislative Session

81st Legislative Session

80th Legislative Session

79th Legislative Session

78th Legislative Session

77th Legislative Session

76th Legislative Session

Contact Information and Other Helpful Links

About TDI

Helpful State Links

Site Resources

Stay Informed

Translation by WorldLingo

80^th Legislative Session