Texas Labor Code - Section 402.084. Record Check; Release Of Information
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Texas Lawyer > Labor Code > Texas Labor Code - Section 402.084. Record Check; Release Of Information
§ 402.084. RECORD CHECK; RELEASE OF INFORMATION. (a)
The division shall perform and release a record check on an
employee, including current or prior injury information, to the
parties listed in Subsection (b) if:
(1) the claim is:
(A) open or pending before the division;
(B) on appeal to a court of competent
jurisdiction; or
(C) the subject of a subsequent suit in which the
insurance carrier or the subsequent injury fund is subrogated to
the rights of the named claimant; and
(2) the requesting party requests the release on a
form prescribed by the division for this purpose and provides all
required information.
(b) Information on a claim may be released as provided by
Subsection (a) to:
(1) the employee or the employee's legal beneficiary;
(2) the employee's or the legal beneficiary's
representative;
(3) the employer at the time of injury;
(4) the insurance carrier;
(5) the Texas Certified Self-Insurer Guaranty
Association established under Subchapter G, Chapter 407, if that
association has assumed the obligations of an impaired employer;
(6) the Texas Property and Casualty Insurance Guaranty
Association, if that association has assumed the obligations of an
impaired insurance company;
(7) a third-party litigant in a lawsuit in which the
cause of action arises from the incident that gave rise to the
injury; or
(8) with regard to information described by Subsection
(c-3), an insurance carrier that has adopted an antifraud plan
under Subchapter B, Chapter 704, Insurance Code, or the authorized
representative of such an insurance carrier.
(c) The requirements of Subsection (a)(1) do not apply to a
request from a third-party litigant described by Subsection (b)(7).
(c-1) For purposes of this section only, "insurance
carrier" means:
(1) a certified self-insurer; or
(2) an entity authorized under the Insurance Code or
another insurance law of this state that provides health insurance
coverage or health benefits in this state, including:
(A) an insurance company, including an insurance
company that holds a certificate of authority issued by the
commissioner of insurance to engage in the business of workers'
compensation insurance in this state;
(B) a group hospital service corporation under
Chapter 842, Insurance Code;
(C) a health maintenance organization under
Chapter 843, Insurance Code;
(D) a stipulated premium company under Chapter
884, Insurance Code;
(E) a fully self-insured plan, as described by
the Employee Retirement Income Security Act of 1974 (29 U.S.C.
Section 1001 et seq.);
(F) a governmental plan, as defined by Section
3(32), Employee Retirement Income Security Act of 1974 (29 U.S.C.
Section 1002(32));
(G) an employee welfare benefit plan, as defined
by Section 3(1), Employee Retirement Income Security Act of 1974
(29 U.S.C. Section 1002(1)); and
(H) an insurer authorized by the Texas Department
of Insurance to offer disability insurance in this state.
(c-2) An insurance carrier is not required to demonstrate
that a subclaim exists in order to obtain information under
Subsection (b)(8).
(c-3) An insurance carrier described by Subsection (b)(8)
or an authorized representative of the insurance carrier may submit
to the commission on a monthly basis a written request for claims
information. The request must contain a list of the names of
persons about whom claims information is requested. The insurance
carrier must certify in the carrier's request that each person
listed is, or has been, an insured under the carrier's insurance
program. The commission shall examine the commission's records to
identify all claims related to the listed persons. If a claims
record exists for a listed person, the commission promptly shall
provide information on each workers' compensation claim filed by
that person to the carrier or the carrier's representative in an
electronic format. The information provided under this subsection
must include, if available:
(1) the full name of the workers' compensation
claimant;
(2) the social security number of the workers'
compensation claimant;
(3) the date of birth of the workers' compensation
claimant;
(4) the name of the employer of the workers'
compensation claimant;
(5) the date of the injury;
(6) a description of the type of injury or the body
part affected, including the workers' compensation claimant's
description of how the injury occurred;
(7) the name of the treating doctor;
(8) the name, address, and claim number of the
insurance carrier handling the claim;
(9) the name of the insurance adjustor handling the
claim; and
(10) the identifying number assigned to the claim by
the commission and the commission field office handling the claim.
(c-4) A potential subclaim identified by an insurance
carrier described by Subsection (b)(8) or an authorized
representative of the insurance carrier may form the basis for the
identification and filing of a subclaim against an insurance
carrier under this subtitle.
(c-5) Information received under this section by an
insurance carrier described by Subsection (b)(8) or an authorized
representative of the insurance carrier remains subject to
confidentiality requirements of this subtitle while in the
possession of the insurance carrier or representative. However,
the following laws do not prohibit the commission from disclosing
full information regarding a claim as necessary to determine if a
valid subclaim exists:
(1) Chapter 552, Government Code;
(2) Chapter 159, Occupations Code; or
(3) any other analogous law restricting disclosure of
health care information.
(c-6) The commission may not redact claims records produced
in an electronic data format under a request made under this
section.
(c-7) An insurance carrier and its authorized
representative may request full claims data under Subsection
(b)(8), and the records shall be produced once each month. For
purposes of this subsection, "full claims data" means an electronic
download or tape in an electronic data format of the information
listed in Subsection (c-3) on all cases relating to the workers'
compensation claimants listed as insureds of the requesting
insurance carrier.
(d) The commissioner by rule may establish a reasonable fee,
not to exceed five cents for each claimant listed in an information
request, for all information requested by an insurance carrier
described by Subsection (b)(8) or an authorized representative of
the insurance carrier in an electronic data format. The
commissioner shall adopt rules under Section 401.024(d) to
establish:
(1) reasonable security parameters for all transfers
of information requested under this section in electronic data
format; and
(2) requirements regarding the maintenance of
electronic data in the possession of an insurance carrier described
by Subsection (b)(8) or an authorized representative of the
insurance carrier.
(e) The insurance carrier or the carrier's authorized
representative must execute a written agreement with the commission
before submitting the carrier's first request under Subsection
(c-3). The agreement must contain a provision by which the carrier
and the representative agree to comply with the commission's rules
governing security parameters applicable to the transfer of
information under Subsection (d)(1) and the maintenance of
electronic data under Subsection (d)(2).
Acts 1993, 73rd Leg., ch. 269, § 1, eff. Sept. 1, 1993. Amended
by Acts 2001, 77th Leg., ch. 1033, § 5, eff. Sept. 1, 2001; Acts
2005, 79th Leg., ch. 265, § 2.022, eff. Sept. 1, 2005; Acts
2005, 79th Leg., ch. 728, § 11.132, eff. Sept. 1, 2005; Acts
2005, 79th Leg., ch. 1190, § 1, eff. June 18, 2005.
Section: 402.075 402.076 402.077 402.078 402.081 402.082 402.083 402.084 402.085 402.086 402.087 402.088 402.089 402.090 402.091
Last modified: August 10, 2007
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