(a) In addition to any other provisions in this subtitle relating to violations, a person commits an administrative violation if the person violates, fails to comply with, or refuses to comply with this subtitle or a rule, order, or decision of the commissioner, including an emergency cease and desist order issued under Section 415.0211. In addition to any sanctions, administrative penalty, or other remedy authorized by this subtitle, the commissioner may assess an administrative penalty against a person who commits an administrative violation. The administrative penalty shall not exceed $25,000 per day per occurrence. Each day of noncompliance constitutes a separate violation. The commissioner’s authority under this chapter is in addition to any other authority to enforce a sanction, penalty, fine, forfeiture, denial, suspension, or revocation otherwise authorized by law.
(b) The commissioner may enter a cease and desist order against a person who:
(1) commits repeated administrative violations;
(2) allows, as a business practice, the commission of repeated administrative violations; or
(3) violates an order or decision of the commissioner.
(c) In assessing an administrative penalty:
(1) the commissioner shall consider:
(A) the seriousness of the violation, including the nature, circumstances, consequences, extent, and gravity of the prohibited act;
(B) the history and extent of previous administrative violations;
(C) the demonstrated good faith of the violator, including actions taken to rectify the consequences of the prohibited act;
(D) the penalty necessary to deter future violations;
(E) whether the administrative violation has negative impact on the delivery of benefits to an injured employee;
(F) the history of compliance with electronic data interchange requirements; and
(G) other matters that justice may require; and
(2) the commissioner shall, to the extent reasonable, consider the economic benefit resulting from the prohibited act.
(c-1) The commissioner shall adopt rules that require the division, in the assessment of an administrative penalty against a person, to communicate to the person information about the penalty, including:
(1) the relevant statute or rule violated;
(2) the conduct that gave rise to the violation; and
(3) the factors considered in determining the penalty.
(c-2) In determining whether to assess an administrative penalty involving a claim in which the insurance carrier provided notice under Section 409.021(a-3), the commissioner shall consider whether:
(1) the employee cooperated with the insurance carrier’s investigation of the claim;
(2) the employee timely authorized access to the applicable medical records before the insurance carrier’s deadline to:
(A) begin payment of benefits; or
(B) notify the division and the employee of the insurance carrier’s refusal to pay benefits; and
(3) the insurance carrier conducted an investigation of the claim, applied the statutory presumptions under Subchapter B, Chapter 607, Government Code, and expedited medical benefits under Section 504.055.
(d) A penalty may be assessed only after the person charged with an administrative violation has been given an opportunity for a hearing under Subchapter C.
Acts 1993, 73rd Leg., ch. 269, § 1, eff. Sept. 1, 1993. Amended by Acts 2001, 77th Leg., ch. 1456, § 6.07, eff. June 17, 2001.
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), § 3.275, eff. September 1, 2005.
Acts 2011, 82nd Leg., R.S., Ch. 1162 (H.B. 2605), § 31, eff. September 1, 2011.
Acts 2017, 85th Leg., R.S., Ch. 185 (S.B. 1895), § 1, eff. September 1, 2017.
Acts 2019, 86th Leg., R.S., Ch. 701 (S.B. 2551), § 5, eff. June 10, 2019.