H.B. No. 251




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-1)-(c-7) and (e) 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: (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) [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, 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 [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]. (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). SECTION 2. Section 671.013, Health and Safety Code, is amended by adding Subsections (d) and (e) to read as follows: (d) Except as provided by Subsection (e), an autopsy report released in connection with the determination of the cause of death in relation to a workers' compensation claim under Subsection (a) shall be released not later than the 15th business day after the date the request is received from the authorized person. (e) If the report has not been filed as provided by Section 671.012, a representative of the office designated by the autopsy order shall, not later than the 10th business day after the date of the request, notify the requesting person that the report has not been filed and of the date, to the best of the knowledge of the representative, that the requesting person may anticipate receiving the report. SECTION 3. 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, 2002. A claim based on a compensable injury that occurred before that date is governed by the law in effect on the date the compensable injury occurred, and the former law is continued in effect for that purpose. SECTION 4. 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. ______________________________ ______________________________ President of the Senate Speaker of the House I certify that H.B. No. 251 was passed by the House on May 11, 2005, by the following vote: Yeas 138, Nays 0, 1 present, not voting. ______________________________ Chief Clerk of the House I certify that H.B. No. 251 was passed by the Senate on May 25, 2005, by the following vote: Yeas 31, Nays 0. ______________________________ Secretary of the Senate APPROVED: _____________________ Date _____________________ Governor