CHAPTER 402. OPERATION AND ADMINISTRATION OF WORKERS' COMPENSATION SYSTEM
LABOR CODE
TITLE 5. WORKERS' COMPENSATION
SUBTITLE A. TEXAS WORKERS' COMPENSATION ACT
CHAPTER 402. OPERATION AND ADMINISTRATION OF WORKERS'
COMPENSATION SYSTEM
SUBCHAPTER A. GENERAL ADMINISTRATION OF SYSTEM; WORKERS'
COMPENSATION DIVISION
Sec. 402.001. ADMINISTRATION OF SYSTEM: TEXAS DEPARTMENT OF
INSURANCE; WORKERS' COMPENSATION DIVISION. (a) Except as
provided by Section 402.002, the Texas Department of Insurance is
the state agency designated to oversee the workers' compensation
system of this state.
(b) The division of workers' compensation is established as a
division within the Texas Department of Insurance to administer
and operate the workers' compensation system of this state as
provided by this title.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.02, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 1.003, eff. September 1, 2005.
Sec. 402.00111. RELATIONSHIP BETWEEN COMMISSIONER OF INSURANCE
AND COMMISSIONER OF WORKERS' COMPENSATION; SEPARATION OF
AUTHORITY; RULEMAKING. (a) The division is administered by the
commissioner of workers' compensation as provided by this
subchapter. Except as otherwise provided by this title, the
commissioner of workers' compensation shall exercise all
executive authority, including rulemaking authority, under this
title.
(b) The commissioner of insurance may delegate to the
commissioner of workers' compensation or to that person's
designee and may redact any delegation, and the commissioner of
workers' compensation may delegate to the commissioner of
insurance or to that person's designee, any power or duty
regarding workers' compensation imposed on the commissioner of
insurance or the commissioner of workers' compensation under this
title, including the authority to make final orders or decisions.
A delegation made under this subsection must be made in writing.
(c) The commissioner of insurance shall develop and implement
policies that clearly separate the respective responsibilities of
the department and the division.
(d) The commissioner of insurance may provide advice, research,
and comment regarding the adoption of rules by the commissioner
of workers' compensation under this subtitle.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00112. INVESTIGATION OF DIVISION. The department shall
investigate the conduct of the work of the division. For that
purpose, the department shall have access at any time to all
division books and records and may require an officer or employee
of the division to furnish written or oral information.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00113. ADMINISTRATIVE ATTACHMENT TO DEPARTMENT. (a)
The division of workers' compensation is administratively
attached to the department.
(b) The department shall provide the staff and facilities
necessary to enable the division to perform the duties of the
division under this title, including:
(1) administrative assistance and services to the division,
including budget planning and purchasing;
(2) personnel and financial services; and
(3) computer equipment and support.
(c) The commissioner of workers' compensation and the
commissioner of insurance may enter into agreements as necessary
to implement this title.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00114. DUTIES OF DIVISION; SINGLE POINT OF CONTACT.
(a) In addition to other duties required under this title, the
division shall:
(1) regulate and administer the business of workers'
compensation in this state; and
(2) ensure that this title and other laws regarding workers'
compensation are executed.
(b) To the extent determined feasible by the commissioner, the
division shall establish a single point of contact for injured
employees receiving services from the division.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00115. COMPOSITION OF DIVISION. The division is
composed of the commissioner of workers' compensation and other
officers and employees as required to efficiently implement:
(1) this title;
(2) other workers' compensation laws of this state; and
(3) other laws granting jurisdiction or applicable to the
division or the commissioner.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00116. CHIEF EXECUTIVE. (a) The commissioner of
workers' compensation is the division's chief executive and
administrative officer. The commissioner shall administer and
enforce this title, other workers' compensation laws of this
state, and other laws granting jurisdiction to or applicable to
the division or the commissioner. Except as otherwise
specifically provided by this title, a reference in this title to
the "commissioner" means the commissioner of workers'
compensation.
(b) The commissioner has the powers and duties vested in the
division by this title and other workers' compensation laws of
this state.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00117. APPOINTMENT; TERM. (a) The governor, with the
advice and consent of the senate, shall appoint the commissioner.
The commissioner serves a two-year term that expires on February
1 of each odd-numbered year.
(b) The governor shall appoint the commissioner without regard
to the race, color, disability, sex, religion, age, or national
origin of the appointee.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00118. QUALIFICATIONS. The commissioner must:
(1) be a competent and experienced administrator;
(2) be well-informed and qualified in the field of workers'
compensation; and
(3) have at least five years of experience as an executive in
the administration of business or government or as a practicing
attorney, physician, or certified public accountant.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00119. INELIGIBILITY FOR PUBLIC OFFICE. The
commissioner is ineligible to be a candidate for a public
elective office in this state unless the commissioner has
resigned and the governor has accepted the resignation.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00120. COMPENSATION. The commissioner is entitled to
compensation as provided by the General Appropriations Act.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00121. GROUNDS FOR REMOVAL. (a) It is a ground for
removal from office that the commissioner:
(1) does not have at the time of appointment the qualifications
required by Section 402.00118;
(2) does not maintain during service as commissioner the
qualifications required by Section 402.00118;
(3) violates a prohibition established by Section 402.00122,
402.00124, 402.00125, or 402.00126; or
(4) cannot because of illness or incapacity discharge the
commissioner's duties for a substantial part of the
commissioner's term.
(b) The validity of an action of the commissioner or the
division is not affected by the fact that it is taken when a
ground for removal of the commissioner exists.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00122. PROHIBITED GIFTS; ADMINISTRATIVE VIOLATION. (a)
The commissioner or an employee of the division may not accept a
gift, a gratuity, or entertainment from a person having an
interest in a matter or proceeding pending before the division.
(b) A violation of Subsection (a) is an administrative violation
and constitutes a ground for removal from office or termination
of employment.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00123. CIVIL LIABILITY OF COMMISSIONER. The
commissioner is not liable in a civil action for an act performed
in good faith in the execution of duties as commissioner.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00124. CONFLICT OF INTEREST. (a) In this section,
"Texas trade association" means a cooperative and voluntarily
joined statewide association of business or professional
competitors in this state designed to assist its members and its
industry or profession in dealing with mutual business or
professional problems and in promoting their common interest.
(b) A person may not be the commissioner and may not be a
division employee employed in a "bona fide executive,
administrative, or professional capacity" as that phrase is used
for purposes of establishing an exemption to the overtime
provisions of the federal Fair Labor Standards Act of 1938 (29
U.S.C. Section 201 et seq.) if:
(1) the person is an officer, employee, or paid consultant of a
Texas trade association in the field of workers' compensation; or
(2) the person's spouse is an officer, manager, or paid
consultant of a Texas trade association in the field of workers'
compensation.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00125. PROHIBITION ON CERTAIN EMPLOYMENT OR
REPRESENTATION. (a) A former commissioner or former employee of
the division involved in hearing cases under this title may not:
(1) be employed by an insurance carrier that was subject to the
scope of the commissioner's or employee's official responsibility
while the commissioner or employee was associated with the
division; or
(2) represent a person before the division or a court in a
matter:
(A) in which the commissioner or employee was personally
involved while associated with the division; or
(B) that was within the commissioner's or employee's official
responsibilities while the commissioner or employee was
associated with the division.
(b) The prohibition under Subsection (a)(1) applies until the:
(1) second anniversary of the date the commissioner ceases to
serve as the commissioner; and
(2) first anniversary of the date the employee's employment with
the division ceases.
(c) The prohibition under Subsection (a)(2) applies to a current
commissioner or employee of the division while the commissioner
or employee is involved in hearing cases under this title and at
any time thereafter.
(d) A person commits an offense if the person violates this
section. An offense under this section is a Class A misdemeanor.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00126. LOBBYING ACTIVITIES. A person may not serve as
commissioner or act as general counsel to the commissioner if the
person is required to register as a lobbyist under Chapter 305,
Government Code, because of the person's activities for
compensation related to the operation of the department or the
division.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00127. TRAINING PROGRAM FOR COMMISSIONER. (a) Not
later than the 90th day after the date on which the commissioner
takes office, the commissioner shall complete a training program
that complies with this section.
(b) The training program must provide the commissioner with
information regarding:
(1) the legislation that created the division;
(2) the programs operated by the division;
(3) the role and functions of the division;
(4) the rules of the commissioner of insurance relating to the
division, with an emphasis on the rules that relate to
disciplinary and investigatory authority;
(5) the current budget for the division;
(6) the results of the most recent formal audit of the division;
(7) the requirements of:
(A) the open meetings law, Chapter 551, Government Code;
(B) the public information law, Chapter 552, Government Code;
(C) the administrative procedure law, Chapter 2001, Government
Code; and
(D) other laws relating to public officials, including
conflict-of-interest laws; and
(8) any applicable ethics policies adopted by the division or
the Texas Ethics Commission.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.00128. GENERAL POWERS AND DUTIES OF COMMISSIONER. (a)
The commissioner shall conduct the daily operations of the
division and otherwise implement division policy.
(b) The commissioner or the commissioner's designee may:
(1) investigate misconduct;
(2) hold hearings;
(3) issue subpoenas to compel the attendance of witnesses and
the production of documents;
(4) administer oaths;
(5) take testimony directly or by deposition or interrogatory;
(6) assess and enforce penalties established under this title;
(7) enter appropriate orders as authorized by this title;
(8) institute an action in the division's name to enjoin the
violation of this title;
(9) initiate an action under Section 410.254 to intervene in a
judicial proceeding;
(10) prescribe the form, manner, and procedure for the
transmission of information to the division;
(11) correct clerical errors in the entry of orders; and
(12) exercise other powers and perform other duties as necessary
to implement and enforce this title.
(c) The commissioner is the agent for service of process on
out-of-state employers.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 1.004, eff. September 1, 2005.
Sec. 402.002. ADMINISTRATION OF SYSTEM: OFFICE OF INJURED
EMPLOYEE COUNSEL. The office of injured employee counsel
established under Chapter 404 shall perform the functions
regarding the provision of workers' compensation benefits in this
state designated by this subtitle as under the authority of that
office.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2003, 78th Leg., ch. 1170, Sec. 47.01, eff. Sept.
1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 1.005, eff. September 1, 2005.
SUBCHAPTER B. SYSTEM GOALS; GENERAL ADMINISTRATION OF SYSTEM
Sec. 402.021. GOALS; LEGISLATIVE INTENT; GENERAL WORKERS'
COMPENSATION MISSION OF DEPARTMENT. (a) The basic goals of the
workers' compensation system of this state are as follows:
(1) each employee shall be treated with dignity and respect when
injured on the job;
(2) each injured employee shall have access to a fair and
accessible dispute resolution process;
(3) each injured employee shall have access to prompt,
high-quality medical care within the framework established by
this subtitle; and
(4) each injured employee shall receive services to facilitate
the employee's return to employment as soon as it is considered
safe and appropriate by the employee's health care provider.
(b) It is the intent of the legislature that, in implementing
the goals described by Subsection (a), the workers' compensation
system of this state must:
(1) promote safe and healthy workplaces through appropriate
incentives, education, and other actions;
(2) encourage the safe and timely return of injured employees to
productive roles in the workplace;
(3) provide appropriate income benefits and medical benefits in
a manner that is timely and cost-effective;
(4) provide timely, appropriate, and high-quality medical care
supporting restoration of the injured employee's physical
condition and earning capacity;
(5) minimize the likelihood of disputes and resolve them
promptly and fairly when identified;
(6) promote compliance with this subtitle and rules adopted
under this subtitle through performance-based incentives;
(7) promptly detect and appropriately address acts or practices
of noncompliance with this subtitle and rules adopted under this
subtitle;
(8) effectively educate and clearly inform each person who
participates in the system as a claimant, employer, insurance
carrier, health care provider, or other participant of the
person's rights and responsibilities under the system and how to
appropriately interact within the system; and
(9) take maximum advantage of technological advances to provide
the highest levels of service possible to system participants and
to promote communication among system participants.
(c) This section may not be construed as:
(1) creating a cause of action; or
(2) establishing an entitlement to benefits to which a claimant
is not otherwise entitled by this subtitle.
(d) As provided by this subtitle, the division shall work to
promote and help ensure the safe and timely return of injured
employees to productive roles in the workforce.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1997, 75th Leg., ch. 1098, Sec. 7, eff. Sept. 1,
1997.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 1.0065, eff. September 1, 2005.
Sec. 402.0215. REFERENCE TO COMMISSION DIVISIONS. A reference
in this title or any other law to the division of workers' health
and safety, the division of medical review, the division of
compliance and practices, the division of hearings, and the
division of self-insurance regulation of the former Texas
Workers' Compensation Commission means the division of workers'
compensation of the Texas Department of Insurance.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 2.001, eff. September 1, 2005.
Sec. 402.022. PUBLIC INTEREST INFORMATION. (a) The
commissioner shall prepare information of public interest
describing the functions of the division and the procedures by
which complaints are filed with and resolved by the division.
(b) The commissioner shall make the information available to the
public and appropriate state agencies.
(c) The commissioner by rule shall ensure that each division
form, standard letter, and brochure under this subtitle:
(1) is written in plain language;
(2) is in a readable and understandable format; and
(3) complies with all applicable requirements relating to
minimum readability requirements.
(d) The division shall make informational materials described by
this section available in English and Spanish.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.002, eff. September 1, 2005.
Sec. 402.023. COMPLAINT INFORMATION. (a) The commissioner
shall:
(1) adopt rules regarding the filing of a complaint under this
subtitle against an individual or entity subject to regulation
under this subtitle; and
(2) ensure that information regarding the complaint process is
available on the division's Internet website.
(b) The rules adopted under this section must, at a minimum:
(1) ensure that the division clearly defines in rule the method
for filing a complaint; and
(2) define what constitutes a frivolous complaint under this
subtitle.
(c) The division shall develop and post on the division's
Internet website:
(1) a simple standardized form for filing complaints under this
subtitle; and
(2) information regarding the complaint filing process.
(d) The division shall keep an information file about each
written complaint filed with the division under this subtitle
that is unrelated to a specific workers' compensation claim,
including a complaint regarding the administration of the
workers' compensation system. The information must include:
(1) the date the complaint is received;
(2) the name of the complainant;
(3) the subject matter of the complaint;
(4) a record of all persons contacted in relation to the
complaint;
(5) a summary of the results of the review or investigation of
the complaint; and
(6) for complaints for which the division took no action, an
explanation of the reason the complaint was closed without
action.
(e) For each written complaint that is unrelated to a specific
workers' compensation claim that the division has authority to
resolve, the division shall provide to the person filing the
complaint and the person about whom the complaint is made
information about the division's policies and procedures under
this subtitle relating to complaint investigation and resolution.
The division, at least quarterly and until final disposition of
the complaint, shall notify those persons about the status of the
complaint unless the notice would jeopardize an undercover
investigation.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.08, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.003, eff. September 1, 2005.
Sec. 402.0235. PRIORITIES FOR COMPLAINT INVESTIGATIONS. (a)
The division shall assign priorities to complaint investigations
under this subtitle based on risk. In developing priorities
under this section, the division shall develop a formal,
risk-based complaint investigation system that considers:
(1) the severity of the alleged violation;
(2) whether the alleged violator showed continued or wilful
noncompliance; and
(3) whether a commissioner order has been violated.
(b) The commissioner may develop additional risk-based criteria
as determined necessary.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 2.003, eff. September 1, 2005.
Sec. 402.024. PUBLIC PARTICIPATION. (a) The commissioner shall
develop and implement policies that provide the public with a
reasonable opportunity to appear before the division and to speak
on issues under the general jurisdiction of the division.
(b) The division shall comply with federal and state laws
related to program and facility accessibility.
(c) In addition to compliance with Subsection (a), the
commissioner shall prepare and maintain a written plan that
describes how a person who does not speak English may be provided
reasonable access to the division's programs and services.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.09, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.004, eff. September 1, 2005.
SUBCHAPTER C. PERSONNEL
Sec. 402.041. APPOINTMENTS. (a) Subject to the General
Appropriations Act or other law, the commissioner shall appoint
deputies, assistants, and other personnel as necessary to carry
out the powers and duties of the commissioner and the division
under this title, other workers' compensation laws of this state,
and other laws granting jurisdiction or applicable to the
division or the commissioner.
(b) A person appointed under this section must have the
professional, administrative, and workers' compensation
experience necessary to qualify the person for the position to
which the person is appointed.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.10, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 1.007, eff. September 1, 2005.
Sec. 402.042. DIVISION OF RESPONSIBILITIES. The commissioner
shall develop and implement policies that clearly define the
respective responsibilities of the commissioner and the staff of
the division.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 1.007, eff. September 1, 2005.
Sec. 402.043. CAREER LADDER; ANNUAL PERFORMANCE EVALUATIONS.
(a) The commissioner or the commissioner's designee shall
develop an intra-agency career ladder program that addresses
opportunities for mobility and advancement for employees within
the division. The program shall require intra-agency postings of
all positions concurrently with any public posting.
(b) The commissioner or the commissioner's designee shall
develop a system of annual performance evaluations that are based
on documented employee performance. All merit pay for division
employees must be based on the system established under this
subsection.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 1.007, eff. September 1, 2005.
Sec. 402.044. EQUAL EMPLOYMENT OPPORTUNITY POLICY STATEMENT.
(a) The commissioner or the commissioner's designee shall
prepare and maintain a written policy statement to ensure
implementation of a program of equal employment opportunity under
which all personnel transactions are made without regard to race,
color, disability, sex, religion, age, or national origin. The
policy statement must include:
(1) personnel policies, including policies related to
recruitment, evaluation, selection, appointment, training, and
promotion of personnel that are in compliance with the
requirements of Chapter 21;
(2) a comprehensive analysis of the division work force that
meets federal and state guidelines;
(3) procedures by which a determination can be made of
significant underuse in the division work force of all persons
for whom federal or state guidelines encourage a more equitable
balance; and
(4) reasonable methods to appropriately address those areas of
underuse.
(b) A policy statement prepared under this section must:
(1) cover an annual period;
(2) be updated annually;
(3) be reviewed by the civil rights division of the Texas
Workforce Commission for compliance with Subsection (a)(1); and
(4) be filed with the Texas Workforce Commission.
(c) The Texas Workforce Commission shall deliver a biennial
report to the legislature based on the information received under
Subsection (b). The report may be made separately or as part of
other biennial reports made to the legislature.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.11, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 1.007, eff. September 1, 2005.
SUBCHAPTER D. GENERAL POWERS AND DUTIES OF DIVISION AND
COMMISSIONER
Sec. 402.061. ADOPTION OF RULES. The commissioner shall adopt
rules as necessary for the implementation and enforcement of this
subtitle.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.006, eff. September 1, 2005.
Sec. 402.062. ACCEPTANCE OF GIFTS, GRANTS, AND DONATIONS. (a)
The division may accept gifts, grants, or donations as provided
by rules adopted by the commissioner.
(b) Repealed by Acts 2005, 79th Leg., Ch. 265, Sec. 7.01(15),
eff. September 1, 2005.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1999, 76th Leg., ch. 1426, Sec. 4, eff. Sept. 1,
1999; Acts 2001, 77th Leg., ch. 1195, Sec. 2.08, eff. Sept. 1,
2001.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.007, eff. September 1, 2005.
Acts 2005, 79th Leg., Ch.
265, Sec. 7.01(15), eff. September 1, 2005.
Sec. 402.064. FEES. In addition to fees established by this
subtitle, the commissioner shall set reasonable fees for services
provided to persons requesting services from the division,
including services provided under Subchapter E.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.008, eff. September 1, 2005.
Sec. 402.065. EMPLOYMENT OF COUNSEL. Notwithstanding Article
1.09-1, Insurance Code, or any other law, the commissioner may
employ counsel to represent the division in any legal action the
division is authorized to initiate.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.009, eff. September 1, 2005.
Sec. 402.066. RECOMMENDATIONS TO LEGISLATURE. (a) The
commissioner shall consider and recommend to the legislature
changes to this subtitle, including any statutory changes
required by an evaluation conducted under Section 402.074.
(b) The commissioner shall forward the recommended changes to
the legislature not later than December 1 of each even-numbered
year.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.010, eff. September 1, 2005.
Sec. 402.0665. LEGISLATIVE OVERSIGHT. The legislature may adopt
requirements relating to legislative oversight of the division
and the workers' compensation system of this state. The division
shall comply with any requirements adopted by the legislature
under this section.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.13, eff. Sept. 1,
1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.011, eff. September 1, 2005.
Sec. 402.067. ADVISORY COMMITTEES. The commissioner may appoint
advisory committees as the commissioner considers necessary.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.012, eff. September 1, 2005.
Sec. 402.068. DELEGATION OF RIGHTS AND DUTIES. Except as
expressly provided by this subtitle, the division may not
delegate rights and duties imposed on it by this subchapter.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.14, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.013, eff. September 1, 2005.
Sec. 402.069. QUALIFICATIONS AND STANDARDS OF CONDUCT
INFORMATION. The commissioner or the commissioner's designee
shall provide to division employees, as often as necessary,
information regarding their:
(1) qualifications for office or employment under this subtitle;
and
(2) responsibilities under applicable law relating to standards
of conduct for state officers or employees.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.15, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.014, eff. September 1, 2005.
Sec. 402.070. ANNUAL REPORT. (a) The commission shall prepare
annually a complete and detailed written report accounting for
all funds received and disbursed by the commission during the
preceding fiscal year.
(b) The report required under this section must meet the
reporting requirements applicable to financial reporting that are
provided by the General Appropriations Act.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.16, eff. Sept.
1, 1995.
Sec. 402.071. REPRESENTATIVES. (a) The commissioner shall
establish qualifications for a representative and shall adopt
rules establishing procedures for authorization of
representatives.
(b) A representative may receive a fee for providing
representation under this subtitle only if the representative is:
(1) an adjuster representing an insurance carrier; or
(2) licensed to practice law.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.015, eff. September 1, 2005.
Sec. 402.072. SANCTIONS. (a) The division may impose sanctions
against any person regulated by the division under this subtitle.
(b) Only the commissioner may impose:
(1) a sanction that deprives a person of the right to practice
before the division or of the right to receive remuneration under
this subtitle for a period exceeding 30 days; or
(2) another sanction suspending for more than 30 days or
revoking a license, certification, or permit required for
practice in the field of workers' compensation.
(c) A sanction imposed by the division is binding pending
appeal.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.016, eff. September 1, 2005.
Sec. 402.073. COOPERATION WITH STATE OFFICE OF ADMINISTRATIVE
HEARINGS. (a) The commissioner and the chief administrative law
judge of the State Office of Administrative Hearings by rule
shall adopt a memorandum of understanding governing
administrative procedure law hearings under this subtitle
conducted by the State Office of Administrative Hearings in the
manner provided for a contested case hearing under Chapter 2001,
Government Code.
(b) In a case in which a hearing is conducted by the State
Office of Administrative Hearings under Section 413.031, 413.055,
or 415.034, the administrative law judge who conducts the hearing
for the State Office of Administrative Hearings shall enter the
final decision in the case after completion of the hearing.
(c) In a case in which a hearing is conducted in conjunction
with Section 402.072, 407.046, or 408.023, and in other cases
under this subtitle that are not subject to Subsection (b), the
administrative law judge who conducts the hearing for the State
Office of Administrative Hearings shall propose a decision to the
commissioner for final consideration and decision by the
commissioner.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.17, eff. Sept. 1,
1995. Amended by Acts 1999, 76th Leg., ch. 955, Sec. 1, eff.
Sept. 1, 1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.017, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
1007, Sec. 3, eff. September 1, 2007.
Sec. 402.074. STRATEGIC MANAGEMENT; EVALUATION. The
commissioner shall implement a strategic management plan that:
(1) requires the division to evaluate and analyze the
effectiveness of the division in implementing:
(A) the statutory goals adopted under Section 402.021,
particularly goals established to encourage the safe and timely
return of injured employees to productive work roles; and
(B) the other standards and requirements adopted under this
code, the Insurance Code, and other applicable laws of this
state; and
(2) modifies the organizational structure and programs of the
division as necessary to address shortfalls in the performance of
the workers' compensation system of this state.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 2.018, eff. September 1, 2005.
Sec. 402.075. INCENTIVES; PERFORMANCE-BASED OVERSIGHT. (a) The
commissioner by rule shall adopt requirements that:
(1) provide incentives for overall compliance in the workers'
compensation system of this state; and
(2) emphasize performance-based oversight linked to regulatory
outcomes.
(b) The commissioner shall develop key regulatory goals to be
used in assessing the performance of insurance carriers and
health care providers. The goals adopted under this subsection
must align with the general regulatory goals of the division
under this subtitle, such as improving workplace safety and
return-to-work outcomes, in addition to goals that support timely
payment of benefits and increased communication.
(c) At least biennially, the division shall assess the
performance of insurance carriers and health care providers in
meeting the key regulatory goals. The division shall examine
overall compliance records and dispute resolution and complaint
resolution practices to identify insurance carriers and health
care providers who adversely impact the workers' compensation
system and who may require enhanced regulatory oversight. The
division shall conduct the assessment through analysis of data
maintained by the division and through self-reporting by
insurance carriers and health care providers.
(d) Based on the performance assessment, the division shall
develop regulatory tiers that distinguish among insurance
carriers and health care providers who are poor performers, who
generally are average performers, and who are consistently high
performers. The division shall focus its regulatory oversight on
insurance carriers and health care providers identified as poor
performers.
(e) The commissioner by rule shall develop incentives within
each tier under Subsection (d) that promote greater overall
compliance and performance. The regulatory incentives may include
modified penalties, self-audits, or flexibility based on
performance.
(f) The division shall:
(1) ensure that high-performing entities are publicly
recognized; and
(2) allow those entities to use that designation as a marketing
tool.
(g) In conjunction with the division's accident prevention
services under Subchapter E, Chapter 411, the division shall
conduct audits of accident prevention services offered by
insurance carriers based on the comprehensive risk assessment.
The division shall periodically review those services, but may
provide incentives for less regulation of carriers based on
performance.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 2.018, eff. September 1, 2005.
Sec. 402.076. GENERAL DUTIES; FUNDING. (a) The division shall
perform the workforce education and safety functions of the
workers' compensation system of this state.
(b) The operations of the division under this section are funded
through the maintenance tax assessed under Section 403.002.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 2.018, eff. September 1, 2005.
Sec. 402.077. EDUCATIONAL PROGRAMS. (a) The division shall
provide education on best practices for return-to-work programs
and workplace safety.
(b) The division shall evaluate and develop the most efficient,
cost-effective procedures for implementing this section.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 2.018, eff. September 1, 2005.
Sec. 402.078. REGIONAL OFFICES. The department shall operate
regional offices throughout this state as necessary to implement
the duties of the division and the department under this
subtitle.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 2.018, eff. September 1, 2005.
SUBCHAPTER E. RECORDS AND EMPLOYEE INFORMATION
Sec. 402.081. DIVISION RECORDS. (a) The commissioner is the
custodian of the division's records and shall perform the duties
of a custodian required by law, including providing copies and
the certification of records.
(b) The division shall comply with records retention schedules
as provided by Chapter 441.185, Government Code.
(c) A record maintained by the division may be preserved in any
format permitted by Chapter 441, Government Code, and rules
adopted by the Texas State Library and Archives Commission under
that chapter.
(d) The division may charge a reasonable fee for making
available for inspection any of its information that contains
confidential information that must be redacted before the
information is made available. However, when a request for
information is for the inspection of 10 or fewer pages, and a
copy of the information is not requested, the division may charge
only the cost of making a copy of the page from which
confidential information must be redacted. The fee for access to
information under Chapter 552, Government Code, shall be in
accord with the rules of the attorney general that prescribe the
method for computing the charge for copies under that chapter.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1997, 75th Leg., ch. 1270, Sec. 1 eff. June 20,
1997.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.019, eff. September 1, 2005.
Acts 2005, 79th Leg., Ch.
329, Sec. 13, eff. September 1, 2005.
Acts 2005, 79th Leg., Ch.
716, Sec. 11, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
921, Sec. 10.003, eff. September 1, 2007.
Sec. 402.082. INJURY INFORMATION MAINTAINED BY DIVISION. (a)
The division shall maintain information on every compensable
injury as to the:
(1) race, ethnicity, and sex of the claimant;
(2) classification of the injury;
(3) identification of whether the claimant is receiving medical
care through a workers' compensation health care network
certified under Chapter 1305, Insurance Code;
(4) amount of wages earned by the claimant before the injury;
and
(5) amount of compensation received by the claimant.
(b) The division shall provide information maintained under
Subsection (a) to the office of injured employee counsel. The
confidentiality requirements imposed under Section 402.083 apply
to injury information maintained by the division.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.020, eff. September 1, 2005.
Sec. 402.083. CONFIDENTIALITY OF INJURY INFORMATION. (a)
Information in or derived from a claim file regarding an employee
is confidential and may not be disclosed by the division except
as provided by this subtitle or other law.
(b) Information concerning an employee who has been finally
adjudicated of wrongfully obtaining payment under Section 415.008
is not confidential.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 9.42, 14.49, eff.
Sept. 1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.021, eff. September 1, 2005.
Sec. 402.084. RECORD CHECK; RELEASE OF INFORMATION. (a) The
division shall perform and release a record check on an employee,
including current or prior injury information, to the parties
listed in Subsection (b) if:
(1) the claim is:
(A) open or pending before the division;
(B) on appeal to a court of competent jurisdiction; or
(C) the subject of a subsequent suit in which the insurance
carrier or the subsequent injury fund is subrogated to the rights
of the named claimant; and
(2) the requesting party requests the release on a form
prescribed by the division for this purpose and provides all
required information.
(b) Information on a claim may be released as provided by
Subsection (a) to:
(1) the employee or the employee's legal beneficiary;
(2) the employee's or the legal beneficiary's representative;
(3) the employer at the time of injury;
(4) the insurance carrier;
(5) the Texas Certified Self-Insurer Guaranty Association
established under Subchapter G, Chapter 407, if that association
has assumed the obligations of an impaired employer;
(6) the Texas Property and Casualty Insurance Guaranty
Association, if that association has assumed the obligations of
an impaired insurance company;
(7) a third-party litigant in a lawsuit in which the cause of
action arises from the incident that gave rise to the injury; or
(8) with regard to information described by Subsection (c-3), an
insurance carrier that has adopted an antifraud plan under
Subchapter B, Chapter 704, Insurance Code, or the authorized
representative of such an insurance carrier.
(c) The requirements of Subsection (a)(1) do not apply to a
request from a third-party litigant described by Subsection
(b)(7).
(c-1) For purposes of this section only, "insurance carrier"
means:
(1) a certified self-insurer; or
(2) an entity authorized under the Insurance Code or another
insurance law of this state that provides health insurance
coverage or health benefits in this state, including:
(A) an insurance company, including an insurance company that
holds a certificate of authority issued by the commissioner of
insurance to engage in the business of workers' compensation
insurance in this state;
(B) a group hospital service corporation under Chapter 842,
Insurance Code;
(C) a health maintenance organization under Chapter 843,
Insurance Code;
(D) a stipulated premium company under Chapter 884, Insurance
Code;
(E) a fully self-insured plan, as described by the Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
seq.);
(F) a governmental plan, as defined by Section 3(32), Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section
1002(32));
(G) an employee welfare benefit plan, as defined by Section
3(1), Employee Retirement Income Security Act of 1974 (29 U.S.C.
Section 1002(1)); and
(H) an insurer authorized by the Texas Department of Insurance
to offer disability insurance in this state.
(c-2) An insurance carrier is not required to demonstrate that a
subclaim exists in order to obtain information under Subsection
(b)(8).
(c-3) An insurance carrier described by Subsection (b)(8) or an
authorized representative of the insurance carrier may submit to
the commission on a monthly basis a written request for claims
information. The request must contain a list of the names of
persons about whom claims information is requested. The
insurance carrier must certify in the carrier's request that each
person listed is, or has been, an insured under the carrier's
insurance program. The commission shall examine the commission's
records to identify all claims related to the listed persons. If
a claims record exists for a listed person, the commission
promptly shall provide information on each workers' compensation
claim filed by that person to the carrier or the carrier's
representative in an electronic format. The information provided
under this subsection must include, if available:
(1) the full name of the workers' compensation claimant;
(2) the social security number of the workers' compensation
claimant;
(3) the date of birth of the workers' compensation claimant;
(4) the name of the employer of the workers' compensation
claimant;
(5) the date of the injury;
(6) a description of the type of injury or the body part
affected, including the workers' compensation claimant's
description of how the injury occurred;
(7) the name of the treating doctor;
(8) the name, address, and claim number of the insurance carrier
handling the claim;
(9) the name of the insurance adjustor handling the claim; and
(10) the identifying number assigned to the claim by the
commission and the commission field office handling the claim.
(c-4) A potential subclaim identified by an insurance carrier
described by Subsection (b)(8) or an authorized representative of
the insurance carrier may form the basis for the identification
and filing of a subclaim against an insurance carrier under this
subtitle.
(c-5) Information received under this section by an insurance
carrier described by Subsection (b)(8) or an authorized
representative of the insurance carrier remains subject to
confidentiality requirements of this subtitle while in the
possession of the insurance carrier or representative. However,
the following laws do not prohibit the commission from disclosing
full information regarding a claim as necessary to determine if a
valid subclaim exists:
(1) Chapter 552, Government Code;
(2) Chapter 159, Occupations Code; or
(3) any other analogous law restricting disclosure of health
care information.
(c-6) The commission may not redact claims records produced in
an electronic data format under a request made under this
section.
(c-7) An insurance carrier and its authorized representative may
request full claims data under Subsection (b)(8), and the records
shall be produced once each month. For purposes of this
subsection, "full claims data" means an electronic download or
tape in an electronic data format of the information listed in
Subsection (c-3) on all cases relating to the workers'
compensation claimants listed as insureds of the requesting
insurance carrier.
(d) The commissioner by rule may establish a reasonable fee,
not to exceed five cents for each claimant listed in an
information request, for all information requested by an
insurance carrier described by Subsection (b)(8) or an authorized
representative of the insurance carrier in an electronic data
format. The commissioner shall adopt rules under Section
401.024(d) to establish:
(1) reasonable security parameters for all transfers of
information requested under this section in electronic data
format; and
(2) requirements regarding the maintenance of electronic data in
the possession of an insurance carrier described by Subsection
(b)(8) or an authorized representative of the insurance carrier.
(e) The insurance carrier or the carrier's authorized
representative must execute a written agreement with the
commission before submitting the carrier's first request under
Subsection (c-3). The agreement must contain a provision by
which the carrier and the representative agree to comply with the
commission's rules governing security parameters applicable to
the transfer of information under Subsection (d)(1) and the
maintenance of electronic data under Subsection (d)(2).
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 2001, 77th Leg., ch. 1033, Sec. 5, eff. Sept. 1,
2001.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.022, eff. September 1, 2005.
Acts 2005, 79th Leg., Ch.
728, Sec. 11.132, eff. September 1, 2005.
Acts 2005, 79th Leg., Ch.
1190, Sec. 1, eff. June 18, 2005.
Sec. 402.085. EXCEPTIONS TO CONFIDENTIALITY. (a) The division
shall release information on a claim to:
(1) the Texas Department of Insurance for any statutory or
regulatory purpose, including a research purpose under Chapter
405;
(2) a legislative committee for legislative purposes;
(3) a state or federal elected official requested in writing to
provide assistance by a constituent who qualifies to obtain
injury information under Section 402.084(b), if the request for
assistance is provided to the division;
(4) the attorney general or another entity that provides child
support services under Part D, Title IV, Social Security Act (42
U.S.C. Section 651 et seq.), relating to:
(A) establishing, modifying, or enforcing a child support or
medical support obligation; or
(B) locating an absent parent; or
(5) the office of injured employee counsel for any statutory or
regulatory purpose that relates to a duty of that office.
(b) The division may release information on a claim to a
governmental agency, political subdivision, or regulatory body to
use to:
(1) investigate an allegation of a criminal offense or licensing
or regulatory violation;
(2) provide:
(A) unemployment compensation benefits;
(B) crime victims compensation benefits;
(C) vocational rehabilitation services; or
(D) health care benefits;
(3) investigate occupational safety or health violations;
(4) verify income on an application for benefits under an
income-based state or federal assistance program; or
(5) assess financial resources in an action, including an
administrative action, to:
(A) establish, modify, or enforce a child support or medical
support obligation;
(B) establish paternity;
(C) locate an absent parent; or
(D) cooperate with another state in an action authorized under
Part D, Title IV, Social Security Act (42 U.S.C. Section 651 et
seq.), or Chapter 231, Family Code.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 9.43(a), eff. Sept.
1, 1995; Acts 1999, 76th Leg., ch. 1426, Sec. 5, eff. Sept. 1,
1999.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.023, eff. September 1, 2005.
Sec. 402.086. TRANSFER OF CONFIDENTIALITY. (a) Information
relating to a claim that is confidential under this subtitle
remains confidential when released to any person, except when
used in court for the purposes of an appeal.
(b) This section does not prohibit an employer from releasing
information about a former employee to another employer with whom
the employee has applied for employment, if that information was
lawfully acquired by the employer releasing the information.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 402.087. INFORMATION AVAILABLE TO PROSPECTIVE EMPLOYERS.
(a) A prospective employer who has workers' compensation
insurance coverage and who complies with this subchapter is
entitled to obtain information on the prior injuries of an
applicant for employment if the employer obtains written
authorization from the applicant before making the request.
(b) The employer must make the request by telephone or file the
request in writing not later than the 14th day after the date on
which the application for employment is made.
(c) The request must include the applicant's name, address, and
social security number.
(d) If the request is made in writing, the authorization must be
filed simultaneously. If the request is made by telephone, the
employer must file the authorization not later than the 10th day
after the date on which the request is made.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Sec. 402.088. REPORT OF PRIOR INJURY. (a) On receipt of a
valid request made under and complying with Section 402.087, the
division shall review its records.
(b) If the division finds that the applicant has made two or
more general injury claims in the preceding five years, the
division shall release the date and description of each injury to
the employer.
(c) The information may be released in writing or by telephone.
(d) If the employer requests information on three or more
applicants at the same time, the division may refuse to release
information until it receives the written authorization from each
applicant.
(e) In this section, "general injury" means an injury other than
an injury limited to one or more of the following:
(1) an injury to a digit, limb, or member;
(2) an inguinal hernia; or
(3) vision or hearing loss.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.024, eff. September 1, 2005.
Sec. 402.089. FAILURE TO FILE AUTHORIZATION. An employer who
receives information by telephone from the division under Section
402.088 and who fails to file the necessary authorization in
accordance with Section 402.087 commits an administrative
violation.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.025, eff. September 1, 2005.
Sec. 402.090. STATISTICAL INFORMATION. The division, the Texas
Department of Insurance, or any other governmental agency may
prepare and release statistical information if the identity of an
employee is not explicitly or implicitly disclosed.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.026, eff. September 1, 2005.
Sec. 402.091. FAILURE TO MAINTAIN CONFIDENTIALITY; OFFENSE;
PENALTY. (a) A person commits an offense if the person
knowingly, intentionally, or recklessly publishes, discloses, or
distributes information that is confidential under this
subchapter to a person not authorized to receive the information
directly from the division.
(b) A person commits an offense if the person knowingly,
intentionally, or recklessly receives information that is
confidential under this subchapter and that the person is not
authorized to receive.
(c) An offense under this section is a Class A misdemeanor.
(d) An offense under this section may be prosecuted in a court
in the county where the information was unlawfully received,
published, disclosed, or distributed.
(e) A district court in Travis County has jurisdiction to enjoin
the use, publication, disclosure, or distribution of confidential
information under this section.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.18, eff. Sept.
1, 1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.027, eff. September 1, 2005.
Sec. 402.092. INVESTIGATION FILES CONFIDENTIAL; DISCLOSURE OF
CERTAIN INFORMATION. (a) In this section, "investigation file"
means any information compiled or maintained by the division with
respect to a division investigation authorized under this
subtitle or other workers' compensation law. The term does not
include information or material acquired by the division that is
relevant to an investigation by the insurance fraud unit and
subject to Section 701.151, Insurance Code.
(b) Information maintained in the investigation files of the
division is confidential and may not be disclosed except:
(1) in a criminal proceeding;
(2) in a hearing conducted by the division;
(3) on a judicial determination of good cause;
(4) to a governmental agency, political subdivision, or
regulatory body if the disclosure is necessary or proper for the
enforcement of the laws of this or another state or of the United
States; or
(5) to an insurance carrier if the investigation file relates
directly to a felony regarding workers' compensation or to a
claim in which restitution is required to be paid to the
insurance carrier.
(c) Division investigation files are not open records for
purposes of Chapter 552, Government Code.
(d) Information in an investigation file that is information in
or derived from a claim file, or an employer injury report or
occupational disease report, is governed by the confidentiality
provisions relating to that information.
(e) The division, upon request, shall disclose the identity of a
complainant under this section if the division finds:
(1) the complaint was groundless or made in bad faith;
(2) the complaint lacks any basis in fact or evidence;
(3) the complaint is frivolous; or
(4) the complaint is done specifically for competitive or
economic advantage.
(f) Upon completion of an investigation in which the division
determines a complaint is described by Subsection (e), the
division shall notify the person who was the subject of the
complaint of its finding and the identity of the complainant.
Added by Acts 1995, 74th Leg., ch. 980, Sec. 1.19, eff. Sept. 1,
1995.
Amended by:
Acts 2005, 79th Leg., Ch.
265, Sec. 2.028, eff. September 1, 2005.
SUBCHAPTER F. COOPERATION WITH OFFICE OF INJURED EMPLOYEE COUNSEL
Sec. 402.251. COOPERATION; FACILITIES. (a) The department and
the division shall cooperate with the office of injured employee
counsel in providing services to claimants under this subtitle.
(b) The department shall provide facilities to the office of
injured employee counsel in each regional office operated to
administer the duties of the division under this subtitle.
Added by Acts 2005, 79th Leg., Ch.
265, Sec. 2.029, eff. September 1, 2005.