Texas Insurance Codes 5.58

determining whether rates meet the standards imposed under Section 2, Article 5.55 of this code. If the commissioner determines that any insurer's rates do not meet those standards, the commissioner may order the insurer to adjust its rates to meet those standards. An order of the commissioner under this article may be appealed under Article 1.04 of this code. The commissioner may designate or contract with a qualified organization to serve as the statistical agent for the commissioner under this article as provided by Article 21.69 of this code. The statistical agent may provide to one or more advisory organizations theinformation provided by the statistical agent to the commissioner under this article.

(b) Standards and Procedures. For purposes of Subsection (c) of this article, the commissioner shall establish standards and procedures for categorizing insurance and medical benefits reported on each workers' compensation claim. The commissioner shall consult with the Texas Workers' Compensation Commission and the Research and Oversight Council on Workers' Compensation in establishing these standards to ensure that the data collection methodology will also yield data necessary for research and medical cost containment efforts.

(c) Content of Detailed Claim Information Reports. The following information shall be reported on each workers' compensation claim:

(1) the hazard classification of the affected employee;

(2) the date of injury;

(3) the social security number of the claimant;

(4) the severity classification of the claim, including separate classifications for claims in which death benefits are paid, claims in which lifetime income benefits are paid, claims in which only temporary income benefits are paid, claims in which impairment benefits are paid, claims in which supplemental benefits are paid, and claims in which only medical benefits are paid;

(5) the amount paid in periodic payments;

(6) the amount paid in lump-sum payments;

(7) the amount paid for temporary income benefits;

(8) the amount paid for impairment income benefits;

(9) the amount paid for supplemental income benefits;

(10) the amount paid for death and burial benefits;

(11) the total amount paid for income, death, or burial benefits;

(12) the total amount of incurred losses for income, death, or burial benefits;

(13) the amount paid to doctors and other health care providers;

(14) the amount paid to hospitals and other health care facilities;

(15) the total amount paid for medical benefits;

(16) the total amount of incurred losses for medical benefits; and

(17) other information required by the commissioner.

(d) Information Confidential. A person may not distribute or otherwise disclose a social security number or any other information collected under Subsection (c) of this article which would disclose the identity of any claimant.

(e) Payments Excluded From Rates. In any statistical plan developed by the commissioner, direct expenditures by an insurer to influence public policy and any amounts paid by an insurer as damages in a suit against the insurer for malice or bad faith or as fines or penalties shall be reported separately, and the expenditures and payments shall not be considered as a loss or expense for the calculation of any premium rate modifier or surcharge of an insured.

(f) Transmission of Claims Reports. The claims reports filed under Subsection (c) of this article shall be updated by each insurer and transmitted to the commissioner or the commissioner's statistical agent in accordance with the filing requirements of the commissioner's statistical plan. Each insurer writing at least one-half of one percent of the workers' compensation insurance in this state shall report its data in a compatible electronic format prescribed by the commissioner. The commissioner shall take necessary measures to ensure the accuracy of the data and the adequacy of the format for data reported in an electronic format.

(g) Reports of Aggregate Data. The commissioner may permit the information required by Subsection (c) of this article to be reported in the aggregate for each risk for claims in which benefit payments are less than $5,000. The commissioner may adjust the dollar threshold for aggregate reporting to account for inflationary changes.

(h) Interchange of Rating Plan Data. Reasonable rules and plans may be promulgated by the commissioner after due consideration, requiring the interchange of loss experience necessary for the application of rating plans promulgated by the commissioner under this subchapter.

(i) Consultation with Other States. In order to further uniform administration of rating laws, the commissioner and every insurer may exchange information and experience data with the National Association of Insurance Commissioners, insurance supervisory officials, insurers, and advisory organizations in other states and may consult and cooperate with them with respect to rate-making and the application of rating systems.

Acts 1951, 52nd Leg., p. 868, ch. 491. Amended by Acts 1953, 53rd Leg., p. 64, ch. 50, Sec. 8.

Amended by Acts 1989, 71st Leg., 2nd C.S., ch. 1, Sec. 13.05, eff. Jan. 1, 1991; Subsecs. (a), (e), (f), (g), (i) amended by Acts 1991, 72nd Leg., 2nd C.S., ch. 12, Sec. 18.02, eff. April 1, 1992; Subsec. (j) amended by Acts 1991, 72nd Leg., 2nd C.S., ch. 12, Sec. 18.23(c), eff. Jan. 1, 1992. Amended by Acts 1997, 75th Leg., ch. 810, Sec. 1, eff. June 17, 1997.