1. (a) If the department believes that any person conducting independent review is in violation of the Insurance Code Chapters 1305 or 4202 or this chapter, or any provision of the Labor Code Chapters 408, 409, or 413, or Chapters 19, 133, 134, 140, or 180 of this title (relating to Agents' Licensing; General Medical Provisions; Benefits--Guidelines for Medical Services, Charges, and Payments; Dispute Resolution--General Provisions and Monitoring and Enforcement), respectively, the department shall notify the independent review organization of the alleged violation and may compel the production of any and all documents or other information as necessary to determine whether or not such violation has taken place.
2. (b) The department or TDI-DWC may initiate appropriate proceedings under this chapter or the Labor Code Title 5 and TDI-DWC rules.
3. (c) Proceedings under this chapter are a contested case for the purpose of the Government Code, Chapter 2001.

4. (d) If the commissioner or the commissioner's designee determines that an independent review organization or a person conducting independent review has violated or is violating any provision of the Insurance Code Chapter 4202 or this chapter, the commissioner or the commissioner's designee may:

   1. (1) impose sanctions under the Insurance Code Chapter 82;
   2. (2) issue a cease and desist order under the Insurance Code Chapter 83; and/or
   3. (3) assess administrative penalties under the Insurance Code Chapter 84.
5. (e) If the independent review organization has violated or is violating any provisions of the Insurance Code other than Chapter 4202, or applicable rules of the department, sanctions may be imposed under the Insurance Code Chapters 82, 83, or 84.
6. (f) The commission of fraudulent or deceptive acts or omissions in obtaining, attempting to obtain, or use of certification or designation as an independent organization shall be a violation of the Insurance Code Chapter 4202.
7. (g) If the commissioner or the commissioner's designee determines that an independent review organization or a person conducting independent review has violated or is violating any provision of the Labor Code Title 5 or rules adopted pursuant to the Labor Code Title 5, the commissioner or the commissioner's designee may impose sanctions or penalties under the Labor Code Title 5.
8. (h) This chapter does not limit the ability of the Commissioner of Workers' Compensation or TDI-DWC to make inquiries, conduct audits, receive and investigate complaints, and take all actions permitted by the Labor Code against an independent review organization or personnel employed by or under contract with an independent review organization to perform independent review to determine compliance with the Labor Code Title 5 and applicable TDI-DWC rules.

Source Note:The provisions of this §12.302 adopted to be effective November 26, 1997, 22 TexReg 11363; amended to be effective December 26, 2010, 35 TexReg 11281.