HBA-ATS H.B. 1826 76(R)BILL ANALYSIS


Office of House Bill AnalysisH.B. 1826
By: Hochberg
Business & Industry
6/4/1999
Enrolled

  
BACKGROUND AND PURPOSE 

Under the Texas Workers' Compensation Act (Act), an employee injured at
work may be entitled to receive lifetime medical coverage, temporary
benefits replacing a substantial part of lost wages during convalescence,
impairment benefits, and long-term wage replacement if the employee
suffers moderately severe impairments.  For permanent injuries, income
benefits are allocated using the following two-step formula.  First,
impairment benefits are awarded in direct proportion to the extent of
impairment, without regard to the actual wage loss.  Second, supplemental
income benefits are awarded based on wage loss, if the extent of impairment
equals or exceeds 15 percent.  To keep receiving supplemental benefits, an
injured employee must file a statement quarterly with the employee's
insurance carrier specifying that the employee has earned less than 80
percent of the employee's average weekly wage as a direct result of the
employee's impairment, and that the employee has in good faith sought
employment commensurate with the employee's ability to work. 
Failure to file a statement relieves the insurance carrier of liability for
supplemental income benefits for the period during which a statement is not
filed. 

In addition to the requirements found in the Labor Code, some insurance
carriers require an injured employee to undergo a medical examination each
time the employee files the statement, even when the employee's condition
is not likely to have improved since the last examination.  H.B. 1826
prohibits an insurance carrier from requiring an employee who has received
benefits for two years to submit to a medical examination more than
annually if the injured employee's condition has not improved sufficiently
to allow the employee to return to work during the preceding year.  Under
this bill, if a dispute exists as to whether the employee's medical
condition has improved sufficiently to allow the employee to return to
work, the Texas Workers' Compensation Commission is required to direct the
employee to be examined by a designated doctor chosen by the commission.
The doctor must report to the commission, which is required to base its
determination of the dispute on the doctor's report unless the great weight
of the other medical evidence is to the contrary. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that this bill does
not expressly delegate any additional rulemaking authority to a state
officer, department, agency, or institution. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Subchapter H, Chapter 408, Labor Code, by adding Section
408.151, as follows: 

Sec. 408.151.  MEDICAL EXAMINATIONS FOR SUPPLEMENTAL INCOME BENEFITS.  (a)
Prohibits an insurance carrier,  on or after the second anniversary of the
date the Texas Workers' Compensation Commission (commission) initially
awards benefits, from requiring an employee who is receiving benefits to
submit to a medical examination more than annually if the injured
employee's condition has not improved sufficiently to allow the employee to
return to work during the preceding year. 

(b) Requires the commission, if a dispute exists as to whether the
employee's medical condition has improved sufficiently to allow the
employee to return to work, to direct the employee to be examined by a
designated doctor (doctor) chosen by the commission. Requires the doctor to
report to the commission.  Provides that the report has presumptive  weight
and requires the commission to base its determination of the dispute on
that report unless the great weight of the other medical evidence is to the
contrary. 

(c) Authorizes the commission to require an employee to whom Subsection (a)
applies to submit to a medical examination under Section 408.004 (Required
Medical Examinations; Administrative Violation) only to determine whether
the employee's medical condition is a direct result of impairment from a
compensable injury.  

SECTION 2.  Effective date: September 1, 1999.

SECTION 3.  Emergency clause.