HBA-ATS C.S.H.B. 1826 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1826 By: Hochberg Business & Industry 4/8/1999 Committee Report (Substituted) 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. C.S.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 during the preceding year. Under this bill, if a dispute exists as to whether the employee's medical condition has improved, 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 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 during the preceding year. (b) Requires the Texas Workers' Compensation Commission (commission), if a dispute exists as to whether the employee's medical condition has improved, 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. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1826 modifies the original bill by deleting SECTION 1 of the original bill, which provided an exception to the general rule that an injured employee must file a statement quarterly with the employee's insurance carrier after the Texas Workers' Compensation Commission initially awards supplemental income benefits. The deleted exception authorizes an injured employee who has received supplemental income benefits for two years to file a statement annually, rather than quarterly, if the injured employee's condition has not improved during the last year of the two-year period. C.S.H.B. 1826 modifies the original bill by redesignating SECTION 2 of the original bill to SECTION 1 and deleting proposed Subsection (b) in SECTION 2 of the original bill, which would have excluded a medical examination required by the commission under Section 408.004 from the application of proposed Section 408.151. In new Subsection (b), the substitute also modifies the original bill by requiring the Texas Workers' Compensation Commission, if a dispute exists as to whether the employee's medical condition has improved, to direct the employee to be examined by a designated doctor chosen by the commission. The substitute requires the doctor to report to the commission. The substitute 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. The substitute also adds Subsection (c) to proposed Section 408.151, to authorize the commission to require an injured employee who has received benefits for two years and whose condition has not improved during the preceding year 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. SECTIONS 3 (effective date) and 4 (emergency clause) of the original bill are redesignated as SECTIONS 2 and 3 of the substitute. The substitute deletes the provision in SECTION 3 of the original bill that would have made the application of the Act prospective.