New bill to penalize insurers for denying claims

A bill filed this week seeks to address the hurdles faced by first responders in receiving needed medical treatment by implementing penalties on insurers that deny coverage.

The bill, HB 1521, would allow an administrative penalty to be assessed against a political subdivision, such as a city, that self-insures and commits an administrative violation regarding an employee’s compensation claim.

The penalty would double the total amount of benefits payable in connection with the claim.

HB 1521 was filed last week by five House members, including state Rep. Oscar Longoria, D-Mission. Longoria represents Mission Firefighter Homer Salinas, whose own struggles to obtain medical coverage have made local headlines.

Salinas, a fire fighter with the Mission fire department since 2002, was diagnosed with renal cell carcinoma in 2017.

The city’s insurer, the Texas Municipal League Intergovernmental Risk Pool, initially denied Salinas’ claim, which he appealed.

In October 2018, an administrative law judge for the Texas Department of Insurance overturned TML’s denial, ruling that Salinas’ cancer was caused by his work. In December, the department’s appeals panel upheld the ruling.

However, earlier this month, TML filed a lawsuit against Salinas on behalf of the city seeking to overturn the insurance department’s decision.

TML has argued that per state law, they can only provide compensation for city employees diagnosed with testicular, prostate and non-Hodgkin lymphoma.

The basis of that argument stems from a 2006 study on the likelihood of firefighters contracting certain types of cancers.

However, Longoria, believes Salinas’ cancer was a result of his line of work.

“Research shows, and it’s pretty much been well understood, that whenever a lot of these individuals receive cancer diagnoses, a lot of it is attributable to being a firefighter,” Longoria said.

In a news release issued Feb. 7, the Texas State Association of Fire Fighters praised the proposed legislation.

“Texas cities and their workers’ comp administrators, such as Texas Municipal League, too often deny coverage of life- and career-saving medical treatment for firefighters with legitimate insurance claims. Up to now, they have done so with impunity,” TSAFF President John Riddle stated in the release. “With state law clearly on our side, Texas firefighters will continue to fight to hold workers’ comp insurers like Texas Municipal League accountable.”

The other co-authors of the bill include state Reps. Dustin Burrows, R-Lubbock, who is chairman of the Ways and Means Committee, Joe Moody, D-El Paso, speaker pro-tem and vice chairman of the Calendars Committee, Jeff Leach, R-Plano, chairman of the House Judiciary Committee, and Morgan Meyer, R-Dallas, chairman of the General Investigating Committee.

“The current workers compensation system for firefighters and police officers in Texas is plagued by delays and abuse,” Burrows stated in the TSAFF news release. “Private insurers have largely been replaced by cities that are either self-insured or in a risk pool. This has resulted in widespread denials and delays by the cities when it comes to nearly any on duty related injury or illness.”

When asked about the bill’s odds of becoming law, Longoria, vice chairman of the Appropriations Committee, noted that the co-authors of the bill come from both sides of the aisle and sit on important house committees.

“I think just at the foundation of the bill, we have a lot of support,” he said. “I’d be very surprised that it’s not a bill that we can garner the vast majority of support from the chamber.”