28 Tex. Admin. Code § 19.2014 - Regulatory Requirements Subsequent to Certification or Registration
(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
working days 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.
Notes
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