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