Texas Workers' Compensation

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§ 180.4. On-Site Visits

(a) As often as it considers necessary, the division may review the operations of a system participant to determine compliance with the Act or division rules.

(b) When reviewing the operations of a system participant to determine compliance with the Act or division rules, the division may conduct on-site visits to the system participant’s premises. On-site visits may be announced or unannounced.

(c) The on-site visit will occur during the system participant’s normal business hours.

(d) An on-site visit must not disturb a health care provider’s actual provision of health care to a patient.

(e) The division shall provide written notice of each announced and unannounced on-site visit. This notice shall:

(1) be sent at least 10 days before the on-site visit unless the on-site visit is unannounced in which case the notice will be provided at the time of the on-site visit;

(2) specify the alleged violation(s) that is the subject of the on-site visit;

(3) specify the types of records that must be made available during the on-site visit;

(4) list the name and telephone number of the division staff representative; and

(5) specify the date, time, location, and conditions of the on-site visit.

(f) The person who is the subject of the on-site visit shall designate a general contact person at the premises. During the on-site visit the contact person shall:

(1) provide access to requested personnel and information;

(2) respond to the needs of division staff and to inquiries by division staff; and

(3) be familiar with the system participant’s procedures and recordkeeping systems that are related to the records and information requested during the on-site visit.

(g) The person subject to an on-site visit shall make available to the division in the format and manner specified by the division all records specified in the written notice provided under subsection (e) of this section. A written notice may specify for inspection any records related to the person’s participation in the workers’ compensation system, including:

(1) claim files;

(2) medical records and reports;

(3) payment records;

(4) billing records;

(5) electronic records;

(6) communications;

(7) adjustor notes;

(8) accident reports;

(9) notifications of lost time;

(10) notifications of injuries;

(11) payroll data and wage statements;

(12) investigative reports;

(13) filed division forms; and

(14) contracts.

The provisions of this §180.4 adopted to be effective February 14, 2012, 37 TexReg 691.

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At a Glance:

Title:

§ 180.4. On-Site Visits

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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