(a) Complaints to TDI. Complaints received by TDI against
a URA must be processed under TDI's established procedures for investigation
and resolution of complaints.
(b) TDI inquiries. TDI may address inquiries to a URA
related to any matter connected with URA transactions TDI considers
necessary for the public good or for the proper discharge of TDI's
duties. Under Insurance Code §38.001, a URA that receives an
inquiry from TDI must respond to the inquiry in writing not later
than the 15th day after the date the inquiry is received.
(c) TDI-DWC inquiries. This section does not limit
the ability of the commissioner of workers' compensation or TDI-DWC
to make inquiries, conduct audits, or receive and investigate complaints
against URAs or personnel employed by or under contract with URAs
to perform utilization review to determine compliance with or violations
of Labor Code Title 5, the Insurance Code, or applicable TDI-DWC rules.
(d) On-site review by TDI. For scheduled and unscheduled
on-site reviews, TDI may make a complete on-site review of the operations
of each URA at the principal place of business for each agent as often
as is deemed necessary. An on-site review will only be conducted during
weekdays and normal business hours. A URA must make available all
records relating to its operation during any scheduled or unscheduled
on-site reviews.
(1) Scheduled on-site reviews. A URA will be notified
of any scheduled on-site review by letter, which will specify, at
a minimum, the identity of TDI's designated representative and the
expected arrival date and time.
(2) Unscheduled on-site reviews. At a minimum, notice
of an on-site review of a URA will be in writing and be presented
by TDI's designated representative on arrival.
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