Texas Labor Code -CHAPTER 504. WORKERS' COMPENSATION INSURANCE COVERAGE FOR
EMPLOYEES OF POLITICAL SUBDIVISIONS
Texas Workers Compensation Act
Title 5 - Texas Labor Code - Chapters 401-506
TABLE OF CONTENTS
LABOR CODE
CHAPTER 504. WORKERS' COMPENSATION INSURANCE COVERAGE FOR
EMPLOYEES OF POLITICAL SUBDIVISIONS
SUBCHAPTER A. GENERAL PROVISIONS
§ 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, § 1, eff. Sept. 1, 1993. Amended
by Acts 2005, 79th Leg., ch. 265, § 3.318, eff. Sept. 1, 2005.
§ 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, § 1, eff. Sept. 1, 1993.
Amended by Acts 1999, 76th Leg., ch. 954, § 6, eff. Sept. 1,
1999; Acts 2003, 78th Leg., ch. 939, § 2, eff. Sept. 1, 2003;
Acts 2005, 79th Leg., ch. 265, § 3.319, eff. Sept. 1, 2005.
§ 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, § 1, eff. Sept. 1, 1993. Amended
by Acts 1995, 74th Leg., ch. 76, § 5.95(77), eff. Sept. 1, 1995.
SUBCHAPTER B. COVERAGE
§ 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, § 1, eff. Sept. 1, 1993.
§ 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, § 1, eff. Sept. 1, 1993. Amended
by Acts 1999, 76th Leg., ch. 1426, § 18, eff. Sept. 1, 1999.
§ 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, § 1, eff. Sept. 1, 1993.
§ 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, § 1, eff. Sept. 1, 1993. Amended
by Acts 2003, 78th Leg., ch. 841, § 1, eff. Sept. 1, 2003.
§ 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, § 1, eff. Sept. 1, 1993. Amended
by Acts 2001, 77th Leg., ch. 1420, § 8.282, eff. Sept. 1, 2001.
§ 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, § 1, eff. Sept. 1, 1993.
§ 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 Texas Department on Aging;
(2) the Texas Commission on Alcohol and Drug Abuse;
(3) the Texas Commission for the Blind;
(4) the Texas Cancer Council;
(5) the Texas Commission for the Deaf and Hard of
Hearing;
(6) the Texas Department of Housing and Community
Affairs;
(7) the Texas Department of Human Services;
(8) the Texas Department of Mental Health and Mental
Retardation;
(9) the Texas Rehabilitation Commission; or
(10) the Texas Youth Commission.
Acts 1993, 73rd Leg., ch. 269, § 1, eff. Sept. 1, 1993. Amended
by Acts 1995, 74th Leg., ch. 835, § 27, eff. Sept. 1, 1995; Acts
2001, 77th Leg., ch. 1420, § 8.283, eff. Sept. 1, 2001.
§ 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, § 1, eff. Sept. 1, 1993. Amended
by Acts 2005, 79th Leg., ch. 265, § 3.320, 3.321, eff. Sept. 1,
2005.
SUBCHAPTER C. BENEFITS AND OFFSETS
§ 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, § 1, eff. Sept. 1, 1993.
§ 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, § 1, eff. Sept. 1, 1993.
§ 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, § 3.322, eff. Sept. 1,
2005.
SUBCHAPTER D. ADMINISTRATION
§ 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, § 1, eff. Sept. 1, 1993.
§ 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, § 1, eff. Sept. 1, 1993.
§ 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, § 1, eff. Sept. 1, 1993. Amended
by Acts 2001, 77th Leg., ch. 1420, § 8.284, eff. Sept. 1, 2001.
