Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 102 - PRACTICES AND PROCEDURES-GENERAL PROVISIONS › Section 102.4 - General Rules for Non-Division Communications

Current through Reg. 49, No. 28; July 12, 2024
(a) All written communications to a claimant
				(who is either an employee, an employee's legal beneficiary, or a subclaimant)
				must be sent to the most recent address or fax number supplied by the claimant.
				If an address has not been supplied by the claimant, the most recent address
				provided by the employer must be used.
(b) After an insurance carrier, employer, or
				health care provider is notified in writing that a claimant is represented by
				an attorney or other representative, copies of all written communications
				related to the claim or to the claimant must be mailed or delivered to the
				representative as well as the claimant, unless the claimant requests delivery
				to the representative only.
(c)
				Insurance carriers must provide a toll-free telephone number for receipt of
				communication from claimants or their representatives with a sufficient
				quantity of lines to service their volume of business.
(d) Insurance carriers and health care
				providers must provide telephone numbers, fax numbers, and email addresses
				sufficient to service the volume of business for receiving required verbal and
				written communications on workers' compensation claims.
(e) Insurance carriers must ensure effective
				and timely communication with claimants and other parties in the system. If a
				claimant is unable to communicate with an insurance carrier due to a language
				barrier, and the claimant is unable to provide a person that he or she trusts
				to serve as a translator, the insurance carrier must provide a means to
				translate except as needed for a division proceeding. The claimant must not be
				required to contract with or otherwise employ a translator.
(f) When a claimant contacts an insurance
				carrier and requests a response on their claim, the response must be verbally
				provided or sent in writing by the insurance carrier within five working days
				of receiving the request, unless the request is redundant or the response
				duplicates information previously provided.
(g) Insurance carriers must employ or provide
				a sufficient number of personnel, including adjusters appropriately licensed by
				the Texas Department of Insurance, to meet their obligations under the Act and
				this title.
(h) Unless the great
				weight of evidence indicates otherwise, written communications will be deemed
				to have been sent on:
(1) the date received if
				sent by fax, personal delivery, or electronic transmission; or
(2) the date postmarked if sent by mail
				through United States Postal Service regular mail, or, if the postmark date is
				unavailable, the later of the signature date on the written communication or
				the date it was received minus five days. If the date received minus five days
				is a Sunday or legal holiday, the date deemed sent must be the next previous
				day that is not a Sunday or legal holiday.