This bulletin provides summaries of selected bills enacted by the 87th Legislature that affect workers’ compensation and may be relevant to individuals and entities that the Texas Department of Insurance, Division of Workers’ Compensation (DWC) regulates.
DWC is only providing summary information in this bulletin about particular provisions of the bills that may apply to the regulation of workers’ compensation. Please refer to the actual bills for the complete content of the legislation. Bills listed in this bulletin will link directly to the bill text. You may also access the bills and other legislative information at the Texas Legislature Online website.
While DWC encourages using this bulletin to aid in your compliance efforts, individuals and entities that DWC regulates are responsible for complying with all enacted legislation affecting the business they conduct.
Senate Bill 22 COVID-19 Presumption
Creates a rebuttable presumption that a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19) injury or death is work-related for certain first responders. This includes detention officers, custodial officers, firefighters, peace officers, and emergency medical technicians. To qualify for the presumption, a first responder must meet certain conditions.
SB 22 applies to a claim for benefits filed on or after June 14, 2021. Under 28 Texas Administrative Code Section 124.2(g), a "claim for benefits" means the first written notice of injury as provided in Section 124.1 (concerning Notice of Injury).
SB 22 also allows certain first responders or their beneficiaries to timely file an initial claim for benefits by December 14, 2021, if the first responder contracted SARS-CoV-2 or COVID-19 between March 13, 2020, and June 14, 2021. The changes in law from SB 22 apply to these claims.
In addition, SB 22 provides a process to allow certain first responders or their beneficiaries, who previously filed a SARS-CoV-2 or COVID-19 claim for benefits and whose claim was denied by the insurance carrier, to request in writing that the insurance carrier reprocess the claim. Insurance carriers must apply the changes in law made under SB 22 to those reprocessed claims. Insurance carriers must reprocess a claim within 60 days after receiving a written request and must notify the injured employee or beneficiary and DWC whether the claim is accepted or denied and how to dispute any denial using the PLN-15, Notice of Request to Reprocess a SARS-CoV-2 or COVID-19 Claim Subject to Texas Government Code Section 607.0545 (PLN-15) that DWC has developed. Covered employees or their beneficiaries must request that the insurance carrier reprocess the claim by June 14, 2022.
Finally, SB 22 creates a process for certain first responders to be reimbursed for out-of-pocket expenses, including copayments and partial payments, directly from the insurance carrier for SARS-CoV-2 or COVID-19 claims later determined to be work-related using the presumption Texas Government Code Section 607.0545 created. Insurance carriers will have 45 days to process written reimbursement requests from certain first responders. If denied, injured employees have up to 120 days from the denial to request medical dispute resolution under Texas Labor Code Chapter 413.
To implement SB 22, DWC adopted a new document, Sample Request to Reprocess a SARS-CoV-2 or COVID-19 Claim, and the new PLN-15, effective July 19, 2021.
Insurance carriers, including certified self-insurers, certified self-insurer groups, and governmental entities, must use the adopted PLN-15 to respond to any request to reprocess a claim under SB 22 requirements beginning July 19, 2021.
The sample request document is not required to request that the insurance carrier reprocess a claim. The injured employee, beneficiary, or attorney may request that the insurance carrier reprocess the claim in any written form.
Both the sample request and the PLN-15 are on the DWC website.
Effective June 14, 2021.
House Bill 1752 Remote Benefit Review Conferences
Allows DWC to conduct benefit review conferences (BRCs) by video conference or phone while providing a “good cause” exception to hold a BRC in person. DWC will continue to schedule all BRCs by videoconference unless it determines a good cause exception exists. This decision will be made on a case-by-case basis. To request a good cause exception, a party may file a request with DWC after they receive notice that a BRC is set.
Effective June 4, 2021.
House Bill 1753 Required Reports
Changes certain statutorily required reports that DWC submits.
- Requires the Workers’ Compensation Research and Evaluation Group to publish the network report card biennially instead of annually. The report will now be published every even-numbered year.
- Removes the requirement to issue the Setting the Standard Report, an Analysis of the 2005 Legislative Reforms.
DWC will continue to provide information on issues such as medical costs and utilization, return-to-work outcomes, access to medical care, the impact of networks, and other important system trends as part of its biennial report to the Legislature.
Effective June 15, 2021.
Senate Bill 713 Sunset Review
Pushes the Sunset Advisory Commission’s review date back two years from 2023 to 2025 for DWC, TDI, and the Office of Injured Employee Counsel, among other agencies.
Effective June 16, 2021.
House Bill 2056 Teledentistry
Adds teledentistry to current services that may be offered using telecommunications or information technology. It gives authority to the Texas State Board of Dental Examiners and Texas Health and Human Services to promulgate rules. DWC anticipates future rulemaking to incorporate teledentistry into our current telemedicine and telehealth services rule in 28 TAC Section 133.30.
Effective January 1, 2022.