79R2088 JMM-F
By: Williams S.B. No. 266
A BILL TO BE ENTITLED
AN ACT
relating to the release of certain information regarding a workers'
compensation claim.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 402.084, Labor Code, is amended by
amending Subsections (b) and (d) and adding Subsections (c-l)-(c-7)
to read as follows:
(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), [a subclaimant under Section 409.009 that is] an insurance
carrier that has adopted an antifraud plan under Subchapter B,
Chapter 704 [Article 3.97-3], Insurance Code, or the authorized
representative of such an insurance carrier [a subclaimant].
(c-1) For purposes of this section only, "insurance
carrier" means 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. The term includes:
(1) an insurance company;
(2) a group hospital service corporation under Chapter
842, Insurance Code;
(3) a health maintenance organization under Chapter
843, Insurance Code;
(4) a stipulated premium company under Chapter 884,
Insurance Code;
(5) a fully self-insured plan, as described by the
Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
1001 et seq.);
(6) a governmental plan, as defined by Section 3(32),
Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
1002(32));
(7) 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
(8) 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 commission shall provide the claims information
on a monthly basis in an electronic format to the insurance carrier
or representative. The information provided under this subsection
must include:
(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 prosecution of a subclaim 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 active claims before the
commission.
(d) [Information on a claim relating to a subclaimant under
Subsection (b)(8) may include information, in an electronic data
format, on all workers' compensation claims necessary to determine
if a subclaim exists. The information on a claim remains subject to
confidentiality requirements while in the possession of a
subclaimant or representative.] The commission by rule may
establish a reasonable fee for all information requested by an
insurance carrier described by Subsection (b)(8) or an authorized
representative of the insurance carrier [under this subsection] in
an electronic data format [by subclaimants or authorized
representatives of subclaimants]. The commission shall adopt rules
under Section 401.024(d) to establish:
(1) reasonable security parameters for all transfers
of information requested under this section [subsection] 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 [a subclaimant or the subclaimant's
representative].
SECTION 2. The change in law made by this Act applies only
to a claim for workers' compensation benefits based on a
compensable injury that occurred on or after September 1, 2004. A
claim based on a compensable injury that occurred before that date
is governed by the law in effect on the date that the compensable
injury occurred, and the former law is continued in effect for that
purpose.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2005.