Section 415.002 - Administrative Violation By Insurance Carrier(a) An insurance carrier or its representative commits an administrative violation if that person:(1) misrepresents a provision of this subtitle to an employee, an employer, a health care provider, or a legal beneficiary;(2) terminates or reduces benefits without substantiating evidence that the action is reasonable and authorized by law;(3) instructs an employer not to file a document required to be filed with the division;(4) instructs or encourages an employer to violate a claimant's right to medical benefits under this subtitle;(5) fails to tender promptly full death benefits if a legitimate dispute does not exist as to the liability of the insurance carrier;(6) allows an employer, other than a self-insured employer, to dictate the methods by which and the terms on which a claim is handled and settled;(7) fails to confirm medical benefits coverage to a person or facility providing medical treatment to a claimant if a legitimate dispute does not exist as to the liability of the insurance carrier;(8) fails, without good cause, to attend a dispute resolution proceeding within the division;(9) attends a dispute resolution proceeding within the division without complete authority or fails to exercise authority to effectuate agreement or settlement;(10) adjusts a workers' compensation claim in a manner contrary to license requirements for an insurance adjuster, including the requirements of Chapter 4101, Insurance Code, or the rules of the commissioner of insurance;(11) fails to process claims promptly in a reasonable and prudent manner;(12) fails to initiate or reinstate benefits when due if a legitimate dispute does not exist as to the liability of the insurance carrier;(13) misrepresents the reason for not paying benefits or terminating or reducing the payment of benefits;(14) dates documents to misrepresent the actual date of the initiation of benefits;(15) makes a notation on a draft or other instrument indicating that the draft or instrument represents a final settlement of a claim if the claim is still open and pending before the division;(16) fails or refuses to pay benefits from week to week as and when due directly to the person entitled to the benefits;(17) fails to pay an order awarding benefits;(18) controverts a claim if the evidence clearly indicates liability;(19) unreasonably disputes the reasonableness and necessity of health care;(20) violates a commissioner rule;(21) makes a statement denying all future medical care for a compensable injury; or(22) fails to comply with a provision of this subtitle.(b) An insurance carrier or its representative does not commit an administrative violation under Subsection (a)(6) by allowing an employer to:(1) freely discuss a claim;(2) assist in the investigation and evaluation of a claim; or(3) attend a proceeding of the division and participate at the proceeding in accordance with this subtitle.Amended By Acts 2005, 79th Leg., Ch. 265, Sec. 3.266, eff. 9/1/2005.Amended by Acts 1995, 74th Leg., ch. 980, Sec. 1.45, eff. 9/1/1995. Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. 9/1/1993.