Law:Title 5. Workers' Compensation. Subtitle C. Workers Compensation Insurance Coverage For Certain Government Employees from Chapter 504. Workers' Compensation Insurance Coverage For Employees Of Political Subdivisions (Texas)

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Subtitle C. Workers' Compensation Insurance Coverage For Certain Government Employees

Contents

Chapter 504. Workers' Compensation Insurance Coverage For Employees Of Political Subdivisions

Subchapter A. General Provisions

Section  504.001.  Definitions.

In this chapter, unless a different meaning is plainly required by the context:

(1)  "Division" means the division of workers' compensation of the Texas Department of Insurance.

(2)  "Employee" means:

(A)  a person in the service of a political subdivision who has been employed as provided by law; or

(B)  a person for whom optional coverage is provided under Section 504.012 or 504.013.

(3)  "Political subdivision" means a county, municipality, special district, school district, junior college district, housing authority, community center for mental health and mental retardation services established under Subchapter A, Chapter 534, Health and Safety Code, or any other legally constituted political subdivision of the state.

(4)  "Pool" means two or more political subdivisions collectively self-insuring under an interlocal contract under Chapter 791, Government Code.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch. 265, Sec. 3.318, eff. September 1, 2005.



Section  504.002.  Application Of General Workers' Compensation Laws; Limit On Actions And Damages.

(a) The following provisions of Subtitles A and B apply to and are included in this chapter except to the extent that they are inconsistent with this chapter:

(1)  Chapter 401, other than Section 401.011(18) defining "employer" and Section 401.012 defining "employee";

(2)  Chapter 402;

(3)  Chapter 403, other than Sections 403.001-403.005;

(4)  Chapters 404 and 405;

(5)  Sections 406.006-406.009 and Subchapters B and D-G, Chapter 406, other than Sections 406.033, 406.034, 406.035, 406.091, and 406.096;

(6)  Chapter 408, other than Sections 408.001(b) and (c);

(7)  Chapters 409-412;

(8)  Chapter 413, except as provided by Section 504.053;

(9)  Chapters 414-417; and

(10)  Chapter 451.

(b)  For the purpose of applying the provisions listed by Subsection (a) to this chapter, "employer" means "political subdivision."

(c)  Neither this chapter nor Subtitle A authorizes a cause of action or damages against a political subdivision or an employee of a political subdivision beyond the actions and damages authorized by Chapter 101, Civil Practice and Remedies Code.

(d)  For the purpose of applying the provisions listed by Subsection (a), "written notice" to a political subdivision that self-insures, either individually or collectively through an interlocal agreement as described by Section 504.011, occurs only on written notice to the intergovernmental risk pool or other entity responsible for administering the claim.

Added by Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 1999, 76th Leg., ch. 954, Sec. 6, eff. Sept. 1, 1999; Acts 2003, 78th Leg., ch. 939, Sec. 2, eff. Sept. 1, 2003.

Amended by:

Acts 2005, 79th Leg., Ch. 265, Sec. 3.319, eff. September 1, 2005.



Section  504.003.  Election Of Remedies.

A person may not bring an action for wrongful discharge under both Chapter 451 and Chapter 554, Government Code.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(77), eff. Sept. 1, 1995.



Subchapter B. Coverage

Section  504.011.  Method Of Providing Coverage.

A political subdivision shall extend workers' compensation benefits to its employees by:

(1)  becoming a self-insurer;

(2)  providing insurance under a workers' compensation insurance policy; or

(3)  entering into an interlocal agreement with other political subdivisions providing for self-insurance.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.



Section  504.012.  Optional Coverages.

(a) A political subdivision may cover volunteer fire fighters, police officers, emergency medical personnel, and other volunteers that are specifically named. A person covered under this subsection is entitled to full medical benefits and the minimum compensation payments under the law. Notwithstanding any other law, the governing body of the political subdivision may elect to provide compensation payments to a person covered under this subsection that are greater than the minimum benefits provided under this title.

(b)  By majority vote of the members of the governing body of a political subdivision, the political subdivision may cover as employees:

(1)  an elected official;

(2)  persons paid for jury service; or

(3)  persons paid for service in the conduct of an election.

(c)  A political subdivision may cover a child who is in a program established by the political subdivision to assist children in rendering personal services to a charitable or educational institution under Section 54.041(b), Family Code.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 1999, 76th Leg., ch. 1426, Sec. 18, eff. Sept. 1, 1999.



Section  504.013.  Coverage For Trustees And Staff Of Self-insurance Fund.

By majority vote of the board of trustees of a self-insurance fund created under this chapter, the fund may cover:

(1)  members of the board of trustees;

(2)  staff of the fund, including persons with whom the fund has contracted to perform staff functions; or

(3)  any other self-insurance fund created under Chapter 791, Government Code.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.



Section  504.014.  Exclusions.

A person is not an employee and is not entitled to compensation under this chapter if the person:

(1)  is in the service of a political subdivision and is paid on a piecework basis or on a basis other than by the hour, day, week, month, or year;

(2)  is a patient or client of a political subdivision involved in vocational training;

(3)  is a prisoner incarcerated by a political subdivision; or

(4)  performs services that may benefit a political subdivision, or is employed by or under contract with a performer providing those services, but does not receive payment from the political subdivision for the performance of the services, if the services are performed in connection with the operation or production of:

(A)  a stock show;

(B)  a rodeo;

(C)  a carnival;

(D)  a circus;

(E)  a musical, vocal, or theatrical performance;

(F)  a professional baseball league or game;

(G)  a professional hockey league or game;

(H)  a wrestling event or match;

(I)  a vehicle or motorcycle event; or

(J)  another entertainment event.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 2003, 78th Leg., ch. 841, Sec. 1, eff. Sept. 1, 2003.



Section  504.015.  Municipal Utilities.

(a) This section applies to a municipal utility operated by a board of trustees established under Section 1502.070, Government Code, or a similar law.

(b)  The board of trustees of a utility has the authority of the governing body of the municipality under this chapter to:

(1)  adopt a self-insurance program or take out a policy of workers' compensation insurance; and

(2)  adopt resolutions, give notices, and do all things concerning workers' compensation regarding the utility's employees that the governing body of the municipality would be authorized to do regarding other municipal employees or groups of employees.

(c)  Funds set aside or spent for the purpose of workers' compensation insurance are considered operating expenses of the utility. Funds set aside or paid by the board of trustees for self-insurance or for premiums on insurance policies shall be paid out of utility revenues. A provision for self-insurance or an obligation incurred under an insurance policy is not a general liability of the municipality but is payable only out of utility revenues.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 8.282, eff. Sept. 1, 2001.



Section  504.016.  Joint Insurance Fund.

(a) Two or more political subdivisions may establish a joint insurance fund as provided by this section.

(b)  A political subdivision may pay into the fund its proportionate part as due and may contract for the fund, by and through its directors, to make the payments due under this chapter to employees of the political subdivision.

(c)  The fund may be operated under the rules and bylaws established by the participating political subdivisions.

(d)  A joint insurance fund created under this section may provide to the Texas Department of Insurance loss data in the same manner as an insurance company writing workers' compensation insurance. The State Board of Insurance shall use the loss data as provided by Subchapter D, Chapter 5, Insurance Code.

(e)  Except as provided by Subsection (d), a joint insurance fund created under this section is not considered insurance for purposes of any state statute and is not subject to State Board of Insurance rules.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.



Section 504.017.  Federal And State Funded Transportation Entities.

An entity is eligible to participate under Section 504.016 or Chapter 791 or 2259, Government Code, if the entity provides transportation subsidized in whole or in part by and provided to clients of:

(1)  the Department of Assistive and Rehabilitative Services;

(2)  the Department of State Health Services;

(3)  the Cancer Prevention and Research Institute of Texas;

(4)  the Texas Department of Housing and Community Affairs;

(5)  the Health and Human Services Commission;

(6)  the Department of Aging and Disability Services;

or

(7)  the Texas Youth Commission.

Amended by:

Acts 2007, 80th Leg., R.S., Ch. 266, Sec. 5, eff. November 6, 2007.



Section 504.018.  Notice To Division And Employees; Effect On Common-law Or Statutory Liability.

(a) A political subdivision shall notify the division of the method by which its employees will receive benefits, the approximate number of employees covered, and the estimated amount of payroll.

(b)  A political subdivision shall notify its employees of the method by which the employees will receive benefits and the effective date of the coverage. Employees of a political subdivision are conclusively considered to have accepted the compensation provisions instead of common-law or statutory liability or cause of action, if any, for injuries received in the course of employment or death resulting from injuries received in the course of employment.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch. 265, Sec. 3.320, eff. September 1, 2005.

Acts 2005, 79th Leg., Ch. 265, Sec. 3.321, eff. September 1, 2005.



Subchapter C. Benefits And Offsets

Section  504.051.  Offset Against Payments For Incapacity.

(a) Benefits provided under this chapter shall be offset:

(1)  to the extent applicable, by any amount for incapacity received as provided by:

(A)  Chapter 143, Local Government Code; or

(B)  any other statute in effect on June 19, 1975, that provides for the payment for incapacity to work because of injury on the job that is also covered by this chapter; and

(2)  by any amount paid under Article III, Section 52e, of the Texas Constitution, as added in 1967.

(b)  If benefits are offset, the employer may not withhold the offset portion of the employee's wages until the time that benefits under this chapter are received.

(c)  If an employee's wages are offset, the employee and employer shall contribute to the pension fund on the amount of money by which the employee's wages were offset. An employee's pension benefit may not be reduced as a result of the employee's injuries or any compensation received under this chapter unless the reduction results from a pension revision passed by a majority vote of the affected members of a pension system.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.



Section  504.052.  Sick Leave Benefits.

(a) The governing body of a political subdivision, by majority vote, may provide that while an employee of the political subdivision is receiving benefits under this chapter, the employee may elect to receive previously accrued sick leave benefits, whether statutory or contractual, in an amount equal to the difference between the benefits under this chapter and the weekly compensation that the employee was receiving before the injury that resulted in the claim.

(b)  Sick leave benefits received under Subsection (a) shall be deducted proportionately from the employee's sick leave balance.

(c)  This section does not limit the medical benefits to be paid to the employee. A sick leave plan may not require an employee to take sick leave benefits before receiving benefits under this chapter.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.



Section 504.053.  Election.

(a) A political subdivision that self-insures either individually or collectively shall provide workers' compensation medical benefits to the injured employees of the political subdivision through a workers' compensation health care network certified under Chapter 1305, Insurance Code, if the governing body of the political subdivision determines that provision of those benefits through a network is available to the employees and practical for the political subdivision.  A political subdivision may enter into interlocal agreements and other agreements with other political subdivisions to establish or contract with networks under this section.

(b)  If a political subdivision or a pool determines that a workers' compensation health care network certified under Chapter 1305, Insurance Code, is not available or practical for the political subdivision or pool, the political subdivision or pool may provide medical benefits to its injured employees or to the injured employees of the members of the pool:

(1)  in the manner provided by Chapter 408, other than Sections 408.001(b) and (c) and Section 408.002, and by Subchapters B and C, Chapter 413; or

(2)  by directly contracting with health care providers or by contracting through a health benefits pool established under Chapter 172, Local Government Code.

(c)  If the political subdivision or pool provides medical benefits in the manner authorized under Subsection (b)(2), the following do not apply:

(1)  Sections 408.004 and 408.0041, unless use of a required medical examination or designated doctor is necessary to resolve an issue relating to the entitlement to or amount of income benefits under this title;

(2)  Subchapter B, Chapter 408, except for Section 408.021;

(3)  Chapter 413, except for Section 413.042; and

(4)  Chapter 1305, Insurance Code, except for Sections 1305.501, 1305.502, and 1305.503.

(d)  If the political subdivision or pool provides medical benefits in the manner authorized under Subsection (b)(2), the following standards apply:

(1)  the political subdivision or pool must ensure that workers' compensation medical benefits are reasonably available to all injured workers of the political subdivision or the injured workers of the members of the pool within a designed service area;

(2)  the political subdivision or pool must ensure that all necessary health care services are provided in a manner that will ensure the availability of and accessibility to adequate health care providers, specialty care, and facilities;

(3)  the political subdivision or pool must have an internal review process for resolving complaints relating to the manner of providing medical benefits, including an appeal to the governing body or its designee and appeal to an independent review organization;

(4)  the political subdivision or pool must establish reasonable procedures for the transition of injured workers to contract providers and for the continuity of treatment, including notice of impending termination of providers and a current list of contract providers;

(5)  the political subdivision or pool shall provide for emergency care if an injured worker cannot reasonably reach a contract provider and the care is for medical screening or other evaluation that is necessary to determine whether a medical emergency condition exists, necessary emergency care services including treatment and stabilization, and services originating in a hospital emergency facility following treatment or stabilization of an emergency medical condition;

(6)  prospective or concurrent review of the medical necessity and appropriateness of health care services must comply with Article 21.58A, Insurance Code;

(7)  the political subdivision or pool shall continue to report data to the appropriate agency as required by Title 5 of this code and Chapter 1305, Insurance Code; and

(8)  a political subdivision or pool is subject to the requirements under Sections 1305.501, 1305.502, and 1305.503, Insurance Code.

(e)  Nothing in this chapter waives sovereign immunity or creates a new cause of action.

Added by Acts 2005, 79th Leg., Ch. 265, Sec. 3.322, eff. September 1, 2005.



Subchapter D. Administration

Section  504.071.  Rules; Forms.

A political subdivision may:

(1)  adopt and publish rules and prescribe and furnish forms necessary to effectively administer this chapter; and

(2)  adopt and enforce necessary rules for the prevention of accidents and injuries.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.



Section  504.072.  Appropriations For Disbursements; Account; Report.

(a) A political subdivision may set aside from available appropriations, other than itemized salary appropriations, an amount sufficient to pay all costs, administrative expenses, benefits, insurance, and attorney's fees authorized by this chapter.

(b)  The amount set aside under Subsection (a) shall be set up in a separate account in the political subdivision's records showing the disbursements authorized by this chapter. A statement of the amount set aside for disbursements from the account shall be included in an annual report made to the political subdivision's governing body and its treasurer.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.



Section  504.073.  Representation In Legal Proceedings.

(a) Except as provided by Subsection (b), in a proceeding in connection with workers' compensation benefits provided by a political subdivision as a self-insurer, the political subdivision may be represented by:

(1)  the political subdivision's attorney or that attorney's assistants; or

(2)  outside counsel.

(b)  In a proceeding involving workers' compensation for employees of a municipal utility operated by a board of trustees established under Section 1502.070, Government Code, or a similar law, if the board of trustees is a self-insurer, the municipality shall be represented by the regularly employed attorney or outside counsel of the board of trustees.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 8.284, eff. Sept. 1, 2001.


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