| (a) Pursuant to Labor Code §411.061 and §411.068(a)(1),
an insurance company writing workers' compensation insurance in Texas
shall maintain or provide accident prevention facilities that are
adequate to provide accident prevention services required by the nature
of its policyholders' operations, and must include:
(1) surveys;
(2) recommendations;
(3) training programs;
(4) consultations;
(5) analyses of accident causes;
(6) industrial hygiene;
(7) industrial health services;
(8) qualified accident prevention personnel. To provide
qualified accident prevention personnel and services, an insurance
company may:
(A) employ qualified personnel;
(B) retain qualified independent contractors;
(C) contract with the policyholder to provide personnel
and services; or
(D) use a combination of the methods provided in this
paragraph;
(9) written procedures. An insurance company shall
maintain written procedures for:
(A) notifying policyholders of the availability of
accident prevention services;
(B) determining the appropriate accident prevention
services for a policyholder;
(C) the specific time frame and manner in which the
services will be delivered to a policyholder as required by subsection
(b) of this section;
(D) providing training programs to policyholders;
(E) providing written recommendations to the policyholders,
which identify hazardous conditions and work practices on the policyholder's
premises if the insurance company provides accident prevention services;
(F) providing written reports to the insurance company
and policyholders, which identify hazardous conditions and work practices
on the policyholder's premises if the insurance company contracts
out the accident prevention services or retains qualified independent
contractors; and
(G) items set forth in §166.3(a)(2)(G) of this
title (relating to Annual Information Submitted by Insurance Companies);
and
(10) written records, reports, and evidence of all
accident prevention services provided to each policyholder.
(b) Pursuant to Labor Code §411.068(a)(2), an
insurance company shall utilize accident prevention services to prevent
injuries to employees of its policyholders in a reasonable manner,
which at a minimum, include:
(1) Notice of availability of accident prevention services
and return-to-work coordination services. An insurance company shall
include a notice on the information page or on the front of the policy
containing text identical to the following in at least 10-point bold
type for each workers' compensation insurance policy delivered or
issued for delivery in Texas: Pursuant to Texas Labor Code §411.066,
(name of company) is required to notify its policyholders that accident
prevention services are available from (name of company) at no additional
charge. These services may include surveys, recommendations, training
programs, consultations, analyses of accident causes, industrial hygiene,
and industrial health services. (Name of company) is also required
to provide return-to-work coordination services as required by Texas
Labor Code §413.021 and to notify you of the availability of
the return-to-work reimbursement program for employers under Texas
Labor Code §413.022. If you would like more information, contact
(name of company) at (telephone number) and (email address) for accident
prevention services or (telephone number) and (email address) for
return-to-work coordination services. For information about these
requirements call the Texas Department of Insurance, Division of Workers'
Compensation (TDI-DWC) at 1-800-687-7080 or for information about
the return-to-work reimbursement program for employers call the TDI-DWC
at (512) 804-5000. If (name of company) fails to respond to your request
for accident prevention services or return-to-work coordination services,
you may file a complaint with the TDI-DWC in writing at http://www.tdi.texas.gov
or by mail to Texas Department of Insurance, Division of Workers'
Compensation, MS-8, at 7551 Metro Center Drive, Austin, Texas 78744-1645;
(2) Contact and surveys following fatalities. An insurance
company shall contact the policyholder within seven working days of
knowledge of a work-related fatality and offer a survey. Survey offers
accepted by the policyholder shall be initiated by the insurance company
within 60 days of policyholder acceptance of the survey offer. No
offer of a survey is required if the fatality occurred outside of
Texas or was the result of an accident on a common carrier, unless
the fatality involves an employee of the common carrier during the
course and scope of normal job duties;
(3) Insurance company evaluation of need for service.
An insurance company shall evaluate a policyholder's need for services
in accordance with the procedures required by subsection (a)(9) of
this section taking into consideration the following criteria:
(A) generally accepted industry standards and practices
governing occupational safety and health, such as: A.M. Best, North
American Industry Classification System (NAICS), Bureau of Labor Statistics
data, workers' compensation classification codes, occupational safety
and health standards, and underwriting requests;
(B) nature of losses;
(C) frequency of claims;
(D) loss ratio;
(E) severity of claims;
(F) risk exposure;
(G) experience modifier;
(H) premium; and
(I) any other information relevant under the circumstances;
(4) Services offered and provided by an insurance company.
After evaluating and determining the policyholder's need for services,
all offers of services and the provision of services shall be rendered
to a policyholder within a reasonable period of time and in accordance
with the insurance company's written procedures under this section
and their annual information submitted under §166.3(a)(2)(G)
of this title; and
(5) Services requested by a policyholder. Notwithstanding
any other provision of this section, an insurance company shall provide
to each policyholder accident prevention services required by the
nature of their policyholders' operations within 15 days from the
date of a policyholder request for services, if appropriate services
can be provided without conducting a survey; and within 60 days from
the date of a policyholder request, if a survey is required. Services
can be provided at a later date if circumstances require and the later
date is agreed upon by the policyholder.
(c) The division may determine adequacy of an insurance
company's accident prevention services in accordance with the requirements
of this chapter and generally accepted tools and guidelines of loss
control provision and through:
(1) review of the initial and subsequent reports of
annual information, as required by §166.3 of this title; and
(2) inspections, as specified in §166.5 of this
title (relating to Inspections of Adequacy of Accident Prevention
Facilities and Services).
(d) Accident prevention services shall be provided
to policyholders at no additional charge.
(e) An insurance company shall not solicit nor obtain
from its policyholders a prospective waiver declining all accident
prevention services. If an insurance company, pursuant to Labor Code §411.063(a)(3),
contracts with a policyholder to provide accident prevention personnel
or services, this contract does not limit in any way the insurance
company's authority or responsibility to comply with any statutory
or regulatory requirement contained in this chapter. Insurance companies
are responsible for maintaining or providing all services, including
contracted services, in accordance with this chapter.
(f) This section is effective October 1, 2013.
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