CHAPTER 504. WORKERS' COMPENSATION INSURANCE COVERAGE FOR EMPLOYEES OF POLITICAL SUBDIVISIONS - Texas Statutes

LABOR CODE

TITLE 5. WORKERS' COMPENSATION

SUBTITLE C. WORKERS' COMPENSATION INSURANCE COVERAGE FOR CERTAIN

GOVERNMENT EMPLOYEES

CHAPTER 504. WORKERS' COMPENSATION INSURANCE COVERAGE FOR

EMPLOYEES OF POLITICAL SUBDIVISIONS

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 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.

Sec. 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.

Sec. 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

Sec. 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.

Sec. 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.

Sec. 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.

Sec. 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.

Sec. 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.

Sec. 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.

Sec. 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.

Sec. 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

Sec. 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.

Sec. 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.

Sec. 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

Sec. 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.

Sec. 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.

Sec. 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.