CHAPTER 414. ENFORCEMENT OF COMPLIANCE AND PRACTICE REQUIREMENTS - Texas Statutes

LABOR CODE

TITLE 5. WORKERS' COMPENSATION

SUBTITLE A. TEXAS WORKERS' COMPENSATION ACT

CHAPTER 414. ENFORCEMENT OF COMPLIANCE AND PRACTICE REQUIREMENTS

Sec. 414.002. MONITORING DUTIES. (a) The division shall

monitor for compliance with commissioner rules, this subtitle,

and other laws relating to workers' compensation the conduct of

persons subject to this subtitle. Persons to be monitored

include:

(1) persons claiming benefits under this subtitle;

(2) employers;

(3) insurance carriers;

(4) attorneys and other representatives of parties; and

(5) health care providers.

(b) The division shall monitor conduct described by Sections

415.001, 415.002, and 415.003 and refer persons engaging in that

conduct to the division of hearings.

(c) The division shall monitor payments made to health care

providers on behalf of workers' compensation claimants who

receive medical services to ensure that the payments are made on

time as required by Section 408.027.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch.

265, Sec. 3.260, eff. September 1, 2005.

Sec. 414.003. COMPILATION AND USE OF INFORMATION. (a) The

division shall compile and maintain statistical and other

information as necessary to detect practices or patterns of

conduct by persons subject to monitoring under this chapter that:

(1) violate this subtitle, commissioner rules, or a commissioner

order or decision; or

(2) otherwise adversely affect the workers' compensation system

of this state.

(b) The commissioner shall use the information compiled under

this section to impose appropriate penalties and other sanctions

under Chapters 415 and 416.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch.

265, Sec. 3.261, eff. September 1, 2005.

Sec. 414.004. PERFORMANCE REVIEW OF INSURANCE CARRIERS. (a)

The division shall review regularly the workers' compensation

records of insurance carriers as required to ensure compliance

with this subtitle.

(b) Each insurance carrier, the carrier's agents, and those with

whom the carrier has contracted to provide, review, or monitor

services under this subtitle shall:

(1) cooperate with the division;

(2) make available to the division any records or other

necessary information; and

(3) allow the division access to the information at reasonable

times at the person's offices.

(c) The insurance carrier, other than a governmental entity,

shall pay the reasonable expenses, including travel expenses, of

an auditor who audits the workers' compensation records at the

office of the insurance carrier.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Sec. 414.005. INVESTIGATION UNIT. The division shall maintain

an investigation unit to conduct investigations relating to

alleged violations of this subtitle, commissioner rules, or a

commissioner order or decision, with particular emphasis on

violations of Chapters 415 and 416.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch.

265, Sec. 3.262, eff. September 1, 2005.

Sec. 414.006. REFERRAL TO OTHER AUTHORITIES. For further

investigation or the institution of appropriate proceedings, the

division may refer the persons involved in a case subject to an

investigation to other appropriate authorities, including

licensing agencies, district and county attorneys, or the

attorney general.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch.

265, Sec. 3.263, eff. September 1, 2005.

Sec. 414.007. MEDICAL REVIEW. The division shall review

information concerning alleged violations of this subtitle

regarding the provision of medical benefits, commissioner rules,

or a commissioner order or decision, and, under Sections 414.005

and 414.006 and Chapters 415 and 416, may conduct investigations,

make referrals to other authorities, and initiate administrative

violation proceedings.

Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.

Amended by:

Acts 2005, 79th Leg., Ch.

265, Sec. 3.264, eff. September 1, 2005.