Tex.
Labor Code Section 408.1615
Lifetime Income Benefits for Certain First Responders
(a)
In this section:(1)
“First responder” means an individual who is:(A)
a peace officer under Article 2.12 (Who Are Peace Officers), Code of Criminal Procedure;(B)
certified under Chapter 773 (Emergency Medical Services), Health and Safety Code, as an emergency care attendant, advanced emergency medical technician, emergency medical technician-paramedic or a licensed paramedic;(C)
a firefighter subject to certification by the Texas Commission on Fire Protection under Chapter 419 (Texas Commission on Fire Protection), Government Code, whose principal duties are aircraft crash and rescue or fire fighting; or(D)
an individual covered under Section 504.012 (Optional Coverages) who is providing volunteer services as:(i)
a volunteer firefighter, regardless of whether the individual is certified under Chapter 419 (Texas Commission on Fire Protection), Government Code; or(ii)
an emergency medical services volunteer, as defined by Section 773.003 (Definitions), Health and Safety Code.(2)
“Serious bodily injury” has the meaning assigned by Section 1.07 (Definitions), Penal Code.(b)
This section applies only to an employee who sustains a serious bodily injury, other than an injury described by Section 408.161 (Lifetime Income Benefits), in the course and scope of the employee’s employment or volunteer service as a first responder that renders the employee permanently unemployable.(c)
Except as otherwise provided by this section, an employee to which this section applies is entitled to receive lifetime income benefits paid until the employee’s death for the employee’s injury. Sections 408.161 (Lifetime Income Benefits)(c) and (d) apply to the payment of lifetime income benefits under this section.(d)
The division shall accelerate any dispute, including a contested case hearing or appeal requested by the employee, regarding an employee’s continuing entitlement to lifetime income benefits under this section. The employee shall provide notice to the division that the dispute involves a first responder.(e)
An employee receiving lifetime income benefits under this section shall annually certify to the insurance carrier, in the form and manner prescribed by the division, that the employee was not employed in any capacity during the preceding year.(f)
Notwithstanding Sections 410.169 (Effect of Decision) and 410.205 (Effect of Decision), an insurance carrier may periodically review an employee’s continuing entitlement to lifetime income benefits under this section, but not more than once during any five-year period.(g)
Notwithstanding Subsection (f), an insurance carrier may review an employee’s continuing entitlement to lifetime income benefits under this section regardless of the date on which the insurance carrier most recently reviewed the employee’s continuing entitlement, if:(1)
the employee certifies to the insurance carrier under Subsection (e) that the employee was not employed in any capacity during the preceding year;(2)
the insurance carrier provides evidence to the commissioner that the certification provided by the employee under Subsection (e) is not accurate; and(3)
the commissioner notifies the insurance carrier that the commissioner has determined that the evidence provided by the insurance carrier is sufficient to show that the certification provided by the employee under Subsection (e) may not be accurate.(h)
An insurance carrier reviewing an employee’s continuing entitlement under Subsection (f) or (g) shall request the commissioner to order a medical examination conducted by a designated doctor under Section 408.0041 (Designated Doctor Examination). Except as otherwise provided by this section, the requirements of Section 408.0041 (Designated Doctor Examination) apply to an examination ordered under this subsection to the same extent as if the examination were ordered under Section 408.0041 (Designated Doctor Examination)(a).(i)
An employee is not entitled to lifetime income benefits under this section, and an insurance carrier is authorized to suspend the payment of lifetime income benefits, during and for a period in which the employee fails to complete the annual certification required by Subsection (e), the employee is employed in any capacity, or as provided under Section 408.0041 (Designated Doctor Examination)(j) or (k-1), unless the commissioner determines that there is good cause. The commissioner by rule shall ensure that an employee receives reasonable notice of the insurance carrier’s basis for the suspension and is provided a reasonable opportunity to complete the annual certification under Subsection (e) or otherwise respond to the notice.(j)
The commissioner shall adopt rules necessary to implement this section, including rules:(1)
prescribing the deadline for the submission and the form and the manner of the submission of the annual certification required by Subsection (e); and(2)
establishing procedures for:(A)
the review of an employee’s continuing entitlement to lifetime income benefits under this section;(B)
the suspension and reinstatement of lifetime income benefits under this section; and(C)
the termination of lifetime income benefits under this section on a final determination that an employee is no longer entitled to the benefits.
Source:
Section 408.1615 — Lifetime Income Benefits for Certain First Responders, https://statutes.capitol.texas.gov/Docs/LA/htm/LA.408.htm#408.1615 (accessed Apr. 20, 2024).
