| (a) The division shall conduct Compliance Audits of
the workers' compensation records of system participants and their
agents for compliance with the Act and division rules.
(b) The division may conduct a compliance audit at
the offices of a system participant or at any location the division
deems appropriate. During a compliance audit, the division may, at
its discretion, utilize persons in addition to division staff to provide
additional expertise.
(c) The division shall provide reasonable notice in
advance of a compliance audit. That notice shall:
(1) be in writing;
(2) be sent at least 10 days before the compliance
audit is to be performed;
(3) specify the information that must be made available;
(4) list the name and telephone number of the audit
coordinator; and
(5) specify the date, time, location, and conditions
of the compliance audit.
(d) The system participant being audited (auditee)
shall designate a general contact person and a contact person at each
relevant location to coordinate the compliance audit. That contact
person shall:
(1) provide reasonable access to requested personnel
and information;
(2) respond to reasonable needs of auditors on-site
or to inquiries by auditors; and
(3) be familiar with the system participant's procedures
and recordkeeping systems related to the scope of the compliance audit.
(e) System participants (which may include those who
are not being audited but whose records are necessary to conduct an
audit of another system participant), upon request, shall make available
for review claim files and other workers' compensation records in
the format and manner specified by the division.
(f) Initial findings of the compliance audit will be
provided in writing to the auditee.
(g) The auditee may prepare and file with the division
a management response to the initial findings. The response may include
proposed corrective actions. If such a response is provided, the division
shall review the response and shall adjust its findings if deemed
appropriate.
(h) Final compliance audit reports may be published
on the division's Internet website and shall be redacted to not include
any confidential claim file information.
(i) The division, should it deem it appropriate or
upon request of a licensing or certification authority, shall provide
the appropriate licensing or certification authority with a copy of
all final compliance audit reports (redacted in accordance with subsection
(h) of this section) and the auditee's response to the final compliance
audit report, if any.
(j) To the extent permitted by the Act and division
rules, the division shall submit a bill to the auditee for the actual
expenses associated with the compliance audit, including audit staff
time, additional expertise, travel and per diem expenses, and copying
costs.
(k) The auditee shall submit payment by check, made
payable to the order of the Texas Department of Insurance, for the
expenses within 25 days after receipt of the bill.
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| Source Note: The provisions of this §180.3 adopted to be effective July 29, 1991, 16 TexReg 3940; amended to be effective September 14, 2003, 28 TexReg 7711; amended to be effective January 9, 2011, 35 TexReg 11873; amended to be effective February 14, 2012, 37 TexReg 691 |
