Governor Abbott Signs New LIBs Bill
HB 2468, effective September 01, 2023, was signed into law by the governor on June 12, 2023. There are a number of important modifications to the existing rules regarding lifetime income benefits (LIBs) qualifications and eligibility. There is also a new set of provisions governing first responders.
Traumatic Brain Injuries
Under the new law, the term, “incurable insanity or imbecility” would be removed and replaced with a provision stating that benefits are available for employees who have a physically traumatic injury to the brain that, as determined using evidence-based medicine, results in a permanent major neurocognitive disorder for which the employee requires occasional supervision in the performance of routine daily tasks of self-care and that renders the employee permanently unemployable.
Ongoing Eligibility and Designated Doctor Exam
Insurance carriers would be allowed to review an employee’s eligibility for lifetime income benefits once every five years. However, this restriction would not apply if the carrier presents evidence to the workers’ compensation commissioner suggesting that the worker’s certification is inaccurate. If an employee refuses a required examination by a Designated Doctor, an insurance carrier is allowed to stop paying those benefits unless the commissioner determines that the employee had a valid reason for not undergoing the examination. The bill includes a provision that permits insurance carriers to suspend the payment of lifetime income benefits if a designated doctor’s report indicates that the employee is no longer entitled to receive them.
First Responders
A new statutory provision, Sec. 408.1615 aims to provide lifetime income benefits for certain first responders who sustain serious bodily injuries while performing their duties who are permanently unable to work due to their injuries. Key provisions:
Defining First Responders
A first responder is someone who falls under one of the following categories:
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- Peace officers
- Certified emergency care attendants, technicians, or paramedics
- Firefighters engaged in aircraft crash and rescue or firefighting duties
- Volunteer firefighters or emergency medical services volunteers.
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Eligibility Criteria
The provision applies only to employees or volunteers who suffer serious bodily injuries, excluding injuries covered by Section 408.161, during the course of their first responder duties. These injuries must render the individual permanently unemployable. Subject to the provisions of Sec. 408.161(c) and (d), eligible employees are entitled to receive lifetime income benefits.
Dispute Resolution
To expedite any disputes concerning ongoing entitlement to lifetime income benefits, including contested cases and appeals, the division responsible for oversight must prioritize these cases. Additionally, the employee must notify the division if the dispute involves a first responder.
Annual Certification
An employee receiving LIBs under this provision must annually certify to the insurance carrier that they were not employed in any capacity during the preceding year. This certification ensures the employee’s continued eligibility for benefits.
Periodic Review
Insurance carriers have the authority to periodically review an employee’s continuing entitlement to lifetime income benefits, but this review may not occur more than once every five years, as specified in Subsection (f).
Review Flexibility
Notwithstanding the five-year limitation, an insurance carrier may review an employee’s continuing entitlement regardless of the most recent review date if:
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- The employee certifies that they were not employed in any capacity during the preceding year.
- The insurance carrier provides evidence to the commissioner indicating inaccuracies in the employee’s certification.
- The commissioner determines that the evidence provided by the insurance carrier supports the claim of potential inaccuracies.
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Medical Examination
When conducting a review of an employee’s entitlement, insurance carriers must request the commissioner to order a medical examination performed by a designated doctor. The rules outlined in Section 408.0041, which govern such examinations, apply in this case as well.
Suspension of Benefits
If an employee fails to complete the annual certification required by Subsection (e) or is employed in any capacity, the employee is not entitled to lifetime income benefits. Insurance carriers have the authority to suspend benefit payments during this period. However, the commissioner must determine that there is good cause for the employee’s actions.
Commissioner’s Rules
The commissioner is responsible for establishing rules to implement this provision. These rules encompass the submission deadline, the required format and method for the annual certification, and procedures for the review, suspension, reinstatement, and termination of lifetime income benefits.
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