Compliance Corner: Texas Insurance Company Accident Prevention Requirements

Austin, TX (WorkersCompensation.com) -- An insurance company writing workers' compensation insurance in Texas must maintain or provide accident prevention facilities that are adequate to provide accident prevention services required by the nature of its policyholders' operations. Effective July 1, insurers' accident prevention facilities must include:

(1) surveys;
(2) recommendations;
(3) training programs;
(4) consultations;
(5) analyses of accident causes;
(6) industrial hygiene;
(7) industrial health services;
(8) qualified accident prevention personnel. To provide qualified accident prevention personnel and services, an insurance company may:

(A) employ qualified personnel;
(B) retain qualified independent contractors;
(C) contract with the policyholder to provide personnel and services; or
(D) use a combination of the methods provided in this paragraph; and

(9) written records, reports, and evidence of all accident prevention services provided to each policyholder.

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Under Texas Labor Code §411.068(a)(2), an insurance company must use accident prevention services to prevent injuries to employees of its policyholders in a reasonable manner, which at a minimum, include:

(1) Notice of availability of accident prevention services and return-to-work coordination services. Under Labor Code 411.066, an insurance company must include a notice on the information page or on the front of the policy containing text identical to the following in at least 10-point bold type for each workers' compensation insurance policy delivered or issued for delivery in Texas:

Pursuant to Texas Labor Code 411.066, (name of company) is required to notify its policyholders that accident prevention services are available from (name of company) at no additional charge. These services may include surveys, recommendations, training programs, consultations, analyses of accident causes, industrial hygiene, and industrial health services. (Name of company) is also required to provide return-to-work coordination services as required by Texas Labor Code 413.021 and to notify you of the availability of the return-to-work reimbursement program for employers under Texas Labor Code 413.022.

If you would like more information, contact (name of company) at (telephone number) and (email address) for accident prevention services or (telephone number) and (email address) for return-to-work coordination services. For information about these requirements, call the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) at 1-800-687-7080 or for information about the return-to-work reimbursement program for employers, call the TDI-DWC at (512) 804-5000.

If (name of company) fails to respond to your request for accident prevention services or return-to-work coordination services, you may file a complaint with the TDI-DWC in writing at http://www.tdi.texas.gov or by mail to Texas Department of Insurance, Division of Workers' Compensation, P.O. Box 12050, HS-WS, Austin, Texas 78711-2050;

(2) Contact and surveys following fatalities. An insurance company must contact the policyholder within seven working days of knowledge of a work-related fatality and offer a survey. Survey offers accepted by the policyholder must be initiated by the insurance company within 60 days of policyholder acceptance of the survey offer. No offer of a survey is required if the fatality occurred outside of Texas or was the result of an accident on a common carrier, unless the fatality involves an employee of the common carrier during the course and scope of normal job duties; and

(3) Services requested by a policyholder. An insurance company must provide to each policyholder accident prevention services required by the nature of their policyholders' operations within 15 days from the date of a policyholder request for services, if appropriate services can be provided without conducting a survey; and within 60 days from the date of a policyholder request, if a survey is required regardless of any provision of this section. Services can be provided at a later date if circumstances require, and the policyholder agrees to the later date.

The division may determine adequacy of an insurance company's accident prevention services in accordance with the requirements of this chapter and generally accepted tools and guidelines of loss control provision and through: 1) review of reports of annual information, as required by §166.3 of this title; and 2) inspections as specified under Texas statutes relating to Inspections of Adequacy of Accident Prevention Facilities and Services.

Accident prevention services must be provided to policyholders at no additional charge.

An insurance company must not solicit or obtain from its policyholders a prospective waiver declining all accident prevention services. Under Labor Code 411.063(a)(3), if an insurance company contracts with a policyholder to provide accident prevention personnel or services, this contract does not limit in any way the insurance company's authority or responsibility to comply with any statutory or regulatory requirement contained in this chapter. Insurance companies are responsible for maintaining or providing all services, including contracted services.

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