CHAPTER 402. OPERATION AND ADMINISTRATION OF WORKERS' COMPENSATION SYSTEM - Texas Statutes

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.