| (a) If the department believes that any person conducting
independent review is in violation of Insurance Code Chapters 1305
or 4202; any provision of Labor Code Chapters 408, 409, or 413; or
this chapter or Chapters 19, 133, 134, 140, or 180 of this title,
respectively, the department will notify the IRO of the alleged violation
and may compel the production of any and all documents or other information
necessary to determine whether or not a violation has taken place.
(b) The department or TDI-DWC may initiate appropriate
proceedings under this chapter or Labor Code Title 5 and TDI-DWC rules.
(c) Proceedings under this chapter are contested cases
for the purpose of Government Code Chapter 2001.
(d) If the commissioner determines that an IRO or a
person conducting independent reviews has violated or is violating
any provision of Insurance Code Chapter 4202 or this chapter, the
commissioner may:
(1) impose sanctions under Insurance Code Chapter 82;
(2) issue a cease and desist order under Insurance
Code Chapter 83; and
(3) assess administrative penalties under Insurance
Code Chapter 84.
(e) If the IRO has violated or is violating any provisions
of the Insurance Code other than Chapter 4202, or applicable rules
of the department, sanctions may be imposed under Insurance Code Chapters
82, 83, or 84.
(f) The commission of fraudulent or deceptive acts
or omissions in obtaining, attempting to obtain, or using a certificate
of registration or designation as an IRO is a violation of Insurance
Code Chapter 4202.
(g) If the commissioner determines that an IRO or a
person conducting independent review has violated or is violating
any provision of Labor Code Title 5 or rules adopted under Labor Code
Title 5, the commissioner may impose sanctions or penalties under
Labor Code Title 5.
(h) This chapter does not limit the ability of the
commissioner of workers' compensation or TDI-DWC to make inquiries,
conduct audits, receive and investigate complaints, and take all actions
permitted by the Labor Code against an IRO or personnel employed by
or under contract with an IRO to perform independent review to determine
compliance with Labor Code Title 5 and applicable TDI-DWC rules.
|
| Source Note: The provisions of this §12.302 adopted to be effective November 26, 1997, 22 TexReg 11363; amended to be effective December 26, 2010, 35 TexReg 11281; amended to be effective July 7, 2015, 40 TexReg 2538 |
