HB2369 - Relating to the processes for and the adjudication and payment of certain claims under the workers' compensation system.

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