(a) Inspections. The division may conduct inspections
to determine the adequacy of an insurance company's accident prevention
services.
(1) Affiliated companies of an insurer may be inspected
together if the same facilities, programs, and personnel are used
by each of the companies.
(2) At least 90 days before an inspection, the division
must notify the insurance company in writing of the inspection. The
notice must specify the location and date of the inspection.
(3) The division may conduct unannounced on-site visits
to determine compliance with the Labor Code and division rules in
accordance with the procedures governing on-site visits in Chapter
180 of this title (relating to Monitoring and Enforcement) regardless
of the provisions of this section.
(b) Site of inspection. The inspection of the insurance
company's accident prevention services must take place as determined
by the division:
(1) at the insurance company's office in Texas;
(2) at the division; or
(3) electronically.
(c) Pre-inspection exchange of information.
(1) At least 60 days before the date set for inspection,
in the format and manner specified by the division, the insurance
company must provide to the division a list of policyholders.
(A) For the period of time determined by the division,
the list must be organized by:
(i) policyholder name;
(ii) policy number;
(iii) effective date or expiration date of the policy;
(iv) premium;
(v) number of fatalities;
(vi) principal Texas location;
(vii) indication of whether the insurance company has
contracted with the policyholder for accident prevention services;
and
(viii) indication of whether that policyholder has
requested accident prevention services.
(B) The list must also:
(i) be taken from the insurance company's most current
records;
(ii) be separated by affiliated companies;
(iii) be arranged in descending order by premium; and
(iv) include all policies.
(2) Within 10 days of receipt of the policyholder list,
the division must select the specific policyholder files to be evaluated
and notify the insurance company of those selected files.
(3) For each policy selected by the division, the insurance
company must prepare an accident prevention services worksheet in
the format and manner prescribed by the division. The worksheet must
include the:
(A) policyholder name;
(B) policy number;
(C) number of employees;
(D) principal Texas office address or principal corporate
office address if there is no principal Texas office address;
(E) policyholder contact person's name, phone number,
and email address;
(F) insurance company name;
(G) effective date of the policy; and
(H) name of person completing the form and date completed.
(4) At least 10 days before the date of the inspection,
the insurance company must file the completed worksheets with the
division.
(d) Information to be made available at or before the
inspection. The insurance company must make available for the time
frame specified by the division:
(1) the loss control files corresponding to the requested
worksheets;
(2) a sample policy declaratory page as evidence that
each policyholder has been provided the notice required by §166.2(b)(1)
of this title;
(3) a copy of all documentation of accident prevention
services provided in accordance with this title;
(4) samples of policyholder training materials, audiovisual
aids, and training programs; and
(5) other information requested by the division necessary
to complete the inspection. Information requested may include, but
is not limited to:
(A) records of surveys;
(B) consultations;
(C) recommendations;
(D) training provided;
(E) loss analyses;
(F) industrial health and hygiene services;
(G) return-to-work coordination services information;
and
(H) the name, location, status (whether employee or
contractor), and qualifications of each person that provided accident
prevention services in the loss control files being reviewed during
the inspection.
(e) Insurance company policyholder visits and contacts.
The division may conduct scheduled visits of the jobsite of an insurance
company's policyholder and make other off-site contacts with a policyholder
to obtain information about the insurance company's accident prevention
facilities and use of services.
(f) Written report of inspection.
(1) The division must prepare a written report of the
inspection and must provide a copy to the insurance company's executive
management and to the Texas Department of Insurance, Loss Control
Regulation Division.
(2) The inspection report must contain the division's
determination of adequacy in accordance with Labor Code §411.061
and §166.2 of this title, and include specific findings and required
corrective actions. The inspection report will indicate whether the
division has issued a final determination of adequacy, a final determination
of inadequacy, or an initial determination of inadequacy with regard
to an insurance company's accident prevention services.
(3) The division will provide written notification
to the insurance company of specific deficiencies and recommendations
for corrective action if it assigns an initial determination of inadequacy.
Not later than the 60th day after the date of the initial inspection
report, the insurance company must provide written documentation evidencing
its compliance with the division's recommendations contained in the
initial inspection report. The written documentation must detail the
corrective actions taken to address each specific finding. If the
insurance company believes that it will take more than 60 days to
implement the recommendations listed in the initial inspection report,
it must request an extension from the division. After the end of the
correction period, a final determination of adequacy or inadequacy
will be assigned. The division must provide the insurance company
with notification of this final determination.
(g) Reinspection.
(1) After an inspection and a final determination of
inadequacy of an insurance company's accident prevention services,
the division will reinspect the accident prevention services of the
insurance company not earlier than the 180th day or later than the
270th day after the date the accident prevention services were determined
by the division to be inadequate.
(2) Information required under this section to be provided
at the time of initial inspection is required to again be provided
at the time of reinspection in accordance with the time frames established
within this section.
(h) This section is effective July 1, 2024.
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Source Note: The provisions of this §166.5 adopted to be effective September 1, 1995, 20 TexReg 5248; amended to be effective October 1, 2013, 38 TexReg 2000; amended to be effective July 1, 2024, 49 TexReg 2546 |