Law:Title 5. Workers' Compensation. Subtitle A. Texas Workers Compensation Act from Chapter 414. Enforcement Of Compliance And Practice Requirements (Texas)

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Subtitle A. Texas Workers' Compensation Act

Contents

Chapter 414. Enforcement Of Compliance And Practice Requirements

Section  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.



Section 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.



Section  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.



Section 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.



Section 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.



Section 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.


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