# The Attorney General of Texas July 7, 1980 MARK WHITE Attorney General Honorable Ii. S.Harris, Jr., Chairman Opinion No. NH-202 Texas Industrial Accident Board LBJState Office Buftdhg Re: Release of worker ’s comAustin, Texas 767ll pensation claim files to certain governmental agencies. Dear Mr.Harris: Youask what information, if any, the Texas Industrial Accident Board may make available from work&a compensation claim files to certain federal and state agencies. The United States Treasury Department seeks information regarditg the income of claimants’ attorneys. The State Barof Texas inquires regard@ the conduct of attorneys. The Texas Department of Human Resources inquires regard@ welfare fraud, and the United States Social Security Administration wishes to have information about the awards claimants receive so that social security benefits might be integrated with them. The Occupational Safety Board of the State Department of Health ale0 seeks information. In Is77 the Texas Legislature amended the workmen’s compensation law byaddirg section 9ato article 6307, V.T.C.S., specifying inpart:

(a) Information in a worker’s claim file is confidential and may not be disclosed except as provided inthis section. (b) If there is a. ..claim

...open or pendirg

... or 00 appeal

.. .or. . . the shject matter of a s&sequent suit where the aarrier is shrogated

. .. the information shell be furnished as provided in this section.

... The Board will furnish the requested information... only to the following: (1) the claimant; (2) the attorney for the claimant; (3) the carrier; (4) the employer at the time of the current injury; (5) third-party litigants; or (6) the State Board ofInsurance.

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Honorable H.S.Harris, Jr. - Page Two G4W-2021

A third-party litigant

. .. is entitled to the information without regard to whether

. .. the

. ..claim isstill pending. (cl All information of the Industrial Accident Board concerning any person who has been finally adjudicated to be a fraudulent claimant as provided in this section is snot confidential.

. .. (Emphasis added). Other provisions allow the board to release limited information to employers interviewing job applicants that lwve a multipl~claim history if written authorization from the employee is obtained. The act makes it the &ty ofthe Attorney General to investigate allegations of fraud relating to a claim, specifying that the Attorney General is to “cooperate with professional grievance committees, law enforcement officiels, the Industrial Accident Board, and other state agencies inthe investigation and prosecution of fraudulent practices.” Legislative committees can obtain information to use for legislative purposes. &, V.T.C.S., art. 8307, subsections cd), (e)(l), (11. Of noteworthy importance is a somewhat ambiguous provision, st&ection 61, which provides: (ml Any information pertain@ to a. .. file which isconfidential

by virtue of

... this Act shall retain such confidentiality when released to any investigative, legislative, or law enforcement eency include the attorney general, district attorneys, grand juries, or legislative committees. It also makes criminal the furnishirg or receipt of such information to or bypersons not entitled to get it directly from the board, but the act allows release ofany information in statistical form not disclosing names or identities. I&.,V.T.C.S., art. 8307, s& sec. (n). This 1977statute reflects legislative reaction to aTexas Supreme Court decision in 1976, Industrial Foundation of the South v. Texas Industrial Accident Boa&, 540 S.W.2d :rnconfidential, the claim files of iniured workers were ordinarilv avaIlable to anv&e tmder the state’s Open Records Act, article 6252-17a, V.T.C.S. S& also Attorney General Open Records Decision No. 8(1973). The initial provisions of section 9a clearly limit claim file information to certain persons and state agencies only, and then in certain situations only - i.e., when aclaim is being prosecuted or is otherwise involved in litigation, and when aprospective employer secures authorization from the claimant. Because one of the purposes of the act is to uncover and punish fraud, however, see Attorney General Opinion H-B94 (19781,it is argued that the statute makes such sormation available to any governmental egency investigating any type of fraud, whether the suspected fraud relates to the worker’s compensation claim file at issue ornot. It isargued that stisection (ml implies as much.

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Weoennot sgree that the “investigation” provision is so broad. Subsections (e) and (g)ofthe statute read inpart:

(e)(l) The attorney general shall promptly investigate any allegation of fraud

.. .relating to any claim. Inorder to carry out the requirements of this section, the attorney general is vested with complete power to investigate and prosecute any and all allegations of fraudulent claim practices which may be stimitted to the Board or . .. uncovered through the attorney general’s own efforts. The attorney general shall cooperate with professional grievance committees, law enforcement officials, the Industrial Accident Board, and other state agencies in the investigation and prosecution of fraudulent practices. It shall be the responsibility of the attorney general to prosecute those cases in which he finds the reasonable probability that acts of fraud exist before all hearings of the Board or on appeal from the &termsuch hearmgs.

**. .**  **. .**  (e)(3)Ifthe Attorney General finds that areasonable probability of fraud exists, the attorney general shall request ahearing and the Board shall set the matter **for**hearing.

...

. .. .After this hearing,

... Iilf the Board determines that the claimant has been fraudulent in any or all of his claims for corn n&ion the Board shall then classify that claimant asa lFiisbm;imallt..

.. If the Board determines that any other person except an employer under investigation has been fraudulent in connection with a claim for compensation, the Board may ... report its find& to the appropriate professional grievance committee, law enforcement officials, or other state agencies for pmsecution, or both.

. . . (Emphasis added). Ii is quite clear that the anly “fraudulent practices” the act seeks to discover and punish are those relating to claims for compensation cognizable by the Industrial Accident Board. The direction that the attorney general “cooperate” with other agencies cr professional associations - or that files, when “released” to them, retain their confidentiality - looks to the time such claims have been determined by the board to be tainted with fraud and thereafter referred by the board to such egenciea or associations.

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Although the State Board ofInsurance may be given claim file information when a claim isbeh prosecuted or isotherwise inlitigation, and other agencies intheir roles as employers may obtain certain information rpcn written authorization, see V.T.C.S. ert. 9309g, Sl5(b), no agency other than the Attorney General is to begiven 8cce.w to aclaim fle in order to %vestigate” fraudulent practices unless the board has determined that worker’s compensation fraud exists with respect to such claims and refers the matter to selected agencies IXassociations for prosecution. Moreover, only those agencies which could bve obtained the material directly from the board may be given access to it thereafter. Absent a court order, there are no paramount federal laws which would require the release of such information to the federal sgenciea seeking it, and there are nostate laws which require its release to the state agencies. Statistical information, of course, is avagable to the Occupational Safety Board and others. V.T.C.S. arts. 5182,SS14,15; 9307, S9afnX We conclude you may not divulge any information, other than txmidentifyirg statistical information, in any worker’s compensation file to any of the @rganciesnamed unless the board bs determined that fraud exists with respect to such claims and that the agencies named are the epproprlate ones to prosecute ordiscipline the wrongdoers. SUMMARY The Texas Industrial Accident Board may not divulge any information other than nonidentifying statistical information, in any worker’s compensation claim file to certain federal or state agencig unless the board determines that fraud exists with respect to such claims and that those agencies are the appropriate ate6 to prosecute ordiscipline the wrongdoers.

MARK WHITE Attorney General ofTexas JOHN W.FAINTER, JR. First Assistant Attorney General TZL L.HARTLEY Executive Assistant Attorney General Prepared byBruce Youngblood Assistant Attorney General

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APPROVED: OPINION COMMVTEE C. Robert Heath, Chairman BobGammege SueLowe Bruce Youngblood

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