| (a) Inspections. The division may conduct inspections
to determine the adequacy of an insurance company's accident prevention
services.
(1) The division will conduct an initial inspection
of each insurance company's accident prevention facilities and the
company's use of accident prevention services after the effective
date of this section. After the initial inspection, the division may
conduct an inspection of an insurance company's accident prevention
facilities and the company's use of accident prevention services as
often as the division considers necessary to determine compliance
with this chapter.
(2) Affiliated companies of an insurer may be inspected
together if the same facilities, programs, and personnel are used
by each of the companies.
(3) At least 90 days prior to an inspection, the division
shall notify the insurance company in writing of the inspection. The
notice shall specify the location of the inspection and the date on
which the inspection will occur.
(4) Notwithstanding the provisions of this section,
the division may conduct unannounced on-site visits to determine compliance
with the Act and division rules in accordance with the procedures
governing on-site visits in Chapter 180 of this title (relating to
Monitoring and Enforcement).
(b) Site of inspection. The inspection of the insurance
company's accident prevention services shall take place as determined
by the division at:
(1) the insurance company office in Texas; or
(2) the division's Austin headquarters.
(c) Pre-inspection exchange of information.
(1) At least 60 days prior to the date set for inspection,
in the format and manner specified by the division, the insurance
company shall provide to the division:
(A) a list of policyholders, for the period of time
determined by the division, by policyholder name, policy number, effective
date or expiration date of the policy, premium, number of fatalities,
principal Texas location, indication of whether the insurance company
has contracted with the policyholder for accident prevention services,
and indication of whether that policyholder has requested accident
prevention services. The list shall be taken from the insurance company's
most current records, separated by affiliated companies, arranged
in descending order by premium, and include all policies; and
(B) a copy of all accident prevention services procedures,
including any changes since the insurance company's last annual report.
(2) Within 10 days of receipt of the policyholder list,
the division shall 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 shall prepare an accident prevention services worksheet in
the format and manner prescribed by the division. The worksheet shall
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) primary NAICS code;
(F) A. M. Best Hazard index number;
(G) policyholder contact person's name, phone number,
and email address;
(H) insurance company name;
(I) effective date of the policy;
(J) name of person completing the form and date completed;
(K) service and loss information for policy years as
requested by the division, including:
(i) total premium;
(ii) number of claims;
(iii) number of and dates of fatalities;
(iv) loss ratio;
(v) experience modifier;
(vi) surveys (list all dates);
(vii) recommendation letters (list all dates);
(viii) training programs (list all dates);
(ix) consultations (list all dates);
(x) analyses of accident causes (list all dates);
(xi) industrial hygiene services (list all dates);
(xii) industrial health services (list all dates);
(xiii) policyholder requests (list all dates requested
and dates provided);
(xiv) underwriting requests (list all dates requested
and dates provided);
(xv) insurance company determinations in accordance
with §166.2(b)(4) of this title (relating to Adequacy of Accident
Prevention Services) (list all dates need for services were determined
and dates offered);
(xvi) description of policyholder operations; and
(xvii) comments.
(4) At least 10 days prior to the date of the inspection,
the insurance company shall file the completed worksheets with the
division.
(d) Information to be made available at the inspection.
The insurance company shall 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 loss runs for each selected policyholder
that includes:
(A) number of injuries;
(B) accident or illness types;
(C) body parts involved;
(D) injury causes; and
(E) fatalities;
(4) a copy of all documentation of services provided
in accordance with §166.2(b)(2) - (5) of this title.
(5) samples of policyholder training materials, audiovisual
aids, and training programs; and
(6) other information requested by the division which
is 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 shall prepare a written report of
the inspection and shall 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 shall 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 shall provide written documentation
evidencing its compliance with the division's recommendations contained
in the initial inspection report. The written documentation shall
detail the corrective actions being 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 shall 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 shall provide the insurance
company with notification of this final determination.
(4) The division shall issue a certificate of inspection
to each insurance company after completion of an inspection in which
the accident prevention services are deemed adequate.
(5) In addition to any sanction authorized by law,
a final determination of inadequacy may be cause for withholding a
certificate of inspection or reinspection.
(g) Reinspection.
(1) After an inspection and a final determination of
inadequacy of an insurance company's accident prevention services,
the division shall 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 October 1, 2013.
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