TITLE 28.INSURANCE

Part 1. TEXAS DEPARTMENT OF INSURANCE

Chapter 5. PROPERTY AND CASUALTY INSURANCE

Subchapter E. TEXAS WINDSTORM INSURANCE ASSOCIATION

7. INSPECTIONS FOR WINDSTORM AND HAIL INSURANCE

28 TAC §5.4607

The Commissioner of Insurance adopts new §5.4607, concerning the procedures for the appointment by the Commissioner, based on demonstrated need, of temporary qualified inspectors to conduct windstorm inspections in designated catastrophe areas pursuant to the Insurance Code Article 21.49 §6A. The section is adopted without change to the proposed text as published in the June 9, 2006, issue of the Texas Register (31 TexReg 4696).

The purpose of the Texas Windstorm Insurance Association (Association) is to provide windstorm and hail insurance coverage to residents and businesses in the designated catastrophe areas along the Texas coast that are unable to obtain such coverage in the voluntary market. In order to obtain or maintain windstorm and hail insurance through the Association after an insured's property has been damaged by a windstorm, a property owner must ensure that the rebuilding or repair of the property is done in conformance with the applicable windstorm building code. The purpose of the windstorm building code standards is to minimize windstorm damage to structures and to thereby minimize loss of life, property and economic losses caused by catastrophic windstorms.

This new section is necessary to establish procedures for the appointment of temporary qualified windstorm inspectors in the designated catastrophe areas, following a natural disaster that results in major windstorm and/or hail damage, to inspect damaged structures as soon as possible in order that the repairs or rebuilding may be completed in a timely manner. The Department in adopting this rule is seeking to prevent potential adverse impact to residents and business owners who are trying to rebuild or to repair their properties to meet the windstorm building code requirements following a catastrophe and to minimize negative economic consequences to the affected catastrophe areas. The rule will assist in ensuring that an adequate number of temporary qualified inspectors are available in designated catastrophe areas for windstorm inspections when the need arises. This rule will enable the Commissioner to make these inspector appointments in an expedited manner without having to adopt separate rules for each designated catastrophe area that requires additional inspectors following a major catastrophe.

To determine if repairs or rebuilding of damaged structures are in compliance with the applicable building code, a windstorm inspection is conducted before the final work is completed so that the inspector is able to observe the contractor's adherence to the applicable building code. A certificate of compliance that is evidence of insurability by the Association is issued if the rebuilding or repair is determined to be in compliance with the applicable building code; this certificate of compliance enables the building owner to obtain or retain insurance through the Association. It is necessary to have enough inspectors available in the catastrophe areas so that all damaged structures can be inspected and repaired or rebuilt as quickly as possible. Insurance Code Article 21.49 §6A provides that a windstorm inspection may only be performed by a qualified inspector who must be approved and appointed or employed by the Department to perform building inspections.

As a result of Hurricane Rita in 2005, the Department found that in the aftermath of a hurricane or other catastrophe, residents and business owners in the affected catastrophe areas faced delays in the completion of the rebuilding or repair of structures because of the overwhelming demand for windstorm inspections and the lack of qualified inspectors to meet this demand. The delay in completion of the rebuilding and repair of structures had a negative influence in the economic stability of the affected area. In the past, the Department has used various measures to increase the number of windstorm inspectors. Following Hurricane Rita, the Department temporarily assigned its inspectors from other areas of the coast to the affected areas, provided by rule for the temporary appointment of inspectors in the most needed areas, and in cooperation with the Association, provided additional inspection assistance through independent contract inspectors. Even with these measures, the Department discovered that the time required to complete the procedures to appoint temporary inspectors imposed negative influences in the catastrophe areas. There is a need for the Department to act earlier and more quickly following any future catastrophe to address the overwhelming demand for windstorm inspections and the lack of qualified inspectors to meet this demand.

The adopted rule provides for procedures, qualifications, and requirements for the appointment of temporary qualified windstorm inspectors on an as-needed basis. Under the rule, the Commissioner may make appointments of temporary inspectors if the Commissioner, following notice and a public hearing, determines that the appointment of additional inspectors is necessary to alleviate or prevent long delays for inspections of windstorm damaged structures and that qualified inspectors are not reasonably available. The rule provides that the issuance of a temporary appointment to a qualified inspector only authorizes the appointee to inspect structures for the purposes of determining whether windstorm and hail insurance may be provided by the Association and provides that no other types of inspections by temporary appointees will be valid for purposes of the Insurance Code Article 21.49. The rule provides that temporary appointees will be subject to the provisions of the Department's current rule §5.4604 relating to the appointment of engineers as qualified inspectors, including oversight by the Department, and will also be subject to the emergency cease and desist provisions of the Insurance Code Chapter 83. This is necessary to ensure that improper inspections are halted as quickly as possible to prevent and deter approval of faulty or inadequate building, re-building, adding to, or repairing of structures, which could result in certification of structures that do not meet windstorm building code requirements and also to prevent additional harm to the property of residents and business owners.

The proposed new section was considered in a public hearing on June 21, 2006, under Docket Number 2642. No comments on the proposal were submitted either during the comment period or at the hearing.

New §5.4607(a) specifies that the purpose of the section is the establishment of the procedures for the appointment of temporary inspectors for a limited period on an as-needed basis, the qualifications of temporary inspectors, and the requirements for the appointment of persons to perform such inspections. Subsection (b) provides that temporary inspector appointments may be made only upon a determination by the Commissioner after notice and a hearing that qualified inspectors are not reasonably available in the first tier coastal counties specified in the Insurance Code Article 21.49 and/or in designated catastrophe areas as defined by Article 21.49 §3(h), and further provides that an order by the Commissioner shall specify the reasons for the temporary appointments, the designated catastrophe areas in which the temporary inspector appointments are authorized, the types of inspections the temporary inspectors are authorized to perform, the period of time for which the appointments are effective, and any other requirements necessary to properly ensure the availability of qualified inspectors as needed in the designated catastrophe areas. Subsection (c) specifies the qualifications, including necessary experience and training, of persons eligible to apply for a temporary appointment. It provides that the following persons are eligible to apply for an appointment as a temporary qualified inspector: a certified coastal inspector who has at least two years of construction, design or inspection experience on building or structures located in high wind areas; a Texas registered architect with construction, design or inspection experience on buildings or structures located in high wind areas; and any person with experience, education or training in programs at an accredited university which shall include at a minimum successful completion of at least two years of technical or university training in the field of civil or architectural engineering, the field of architecture, or the field of construction technology or construction science and at least two years of construction, design or inspection experience on buildings or structures located in high wind areas. Subsection (c) also specifies the necessary forms, affidavits and other documents needed for application. Subsection (d) defines terms used throughout the section. Subsection (e) outlines the application process for an appointment. Subsection (f) specifies the training an appointee must undergo, which is a two-hour orientation and training session provided by the Department at one of its field offices or in Austin, Texas. Subsection (g) specifies prohibited financial interests for applicants and temporary appointees. Subsection (h) requires that temporary appointees comply and utilize certain specified windstorm inspection forms. Subsection (i) provides that temporary appointees will be subject to the provisions of the Department's current §5.4604 relating to the appointment of engineers as qualified inspectors, including oversight by the Department. Subsection (j) prohibits temporary appointees from delegating any duties that are part of the authorization of their temporary appointment. Subsection (k) provides that the issuance of a temporary appointment to a qualified inspector only authorizes the appointee to inspect structures for the purposes of determining whether windstorm and hail insurance may be provided by the Association and provides that no other types of inspections by temporary appointees will be valid for purposes of the Insurance Code Article 21.49. It further provides that a temporary appointment issued under this section shall be valid only for the areas and period of time specified by the Commissioner in the order of temporary appointment; at the end of such period or upon action by the Department, the appointment will expire. Subsection (l) provides that temporary appointees will be subject to the provisions of the Department's current §5.4604, relating to the appointment of engineers as qualified inspectors, including oversight by the Department, and will also be subject to the emergency cease and desist provisions of the Insurance Code Chapter 83. Subsection (m) contains a severability clause which provides for the continuation of non-affected provisions of the rules if any provisions are declared invalid.

The Department did not receive any comments on the published proposal.

The new section is adopted pursuant to the Insurance Code Article 21.49 §6A and §36.001. Article 21.49 §6A(d) provides that a windstorm inspection may only be performed by a qualified inspector who must be approved and appointed or employed by the Department to perform building inspections. Section 6A(d) also provides that a qualified inspector includes a person determined by the Department to be qualified to perform building inspections because of training or experience and/or an inspector who is certified by the International Code Council, the Building Officials and Code Administrators International, Inc., the International Conference of Building Officials, or the Southern Building Code Congress International, Inc. (all now known as the International Code Council) who has certifications as a buildings inspector and coastal construction inspector, and who also complies with other requirements specified by rule by the Commissioner. Section 36.001 provides that the Commissioner of Insurance may adopt any rules necessary and appropriate to implement the powers and duties of the Texas Department of Insurance under the Insurance Code and other laws of this state.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 1, 2006.

TRD-200603995

Brenda Caldwell

Assistant General Counsel

Texas Department of Insurance

Effective date: August 21, 2006

Proposal publication date: June 9, 2006

For further information, please call: (512) 463-6327


Part 6. OFFICE OF INJURED EMPLOYEE COUNSEL

Chapter 276. GENERAL ADMINISTRATION

Subchapter B. OMBUDSMAN PROGRAM

The Office of Injured Employee Counsel (OIEC) adopts the repeal of §276.10 and §276.11, new §276.10, and amendments to §276.12, concerning ombudsman training and education and private meetings with unrepresented injured employees. The adopted repeal of §276.10 and §276.11, new §276.10, and amendments to §276.12 are necessary to implement OIEC's ombudsman education and training program pursuant to Labor Code §404.152 as amended by House Bill (HB) 7, 79th Texas Legislature, Regular Session, 2005. The repeal of §276.10 and §276.11 is adopted without changes, and new §276.10 and the amendments to §276.12 are adopted with changes to the proposed text as published in the June 23, 2006, issue of the Texas Register (31 TexReg 5053).

The adopted repeal of §276.10 is necessary to reduce confusion as necessary definitions are adopted in new §276.10(a). The repeal of §276.10 provides for future OIEC rulemaking initiatives, particularly in providing a single location for Chapter 276 definitions.

The adopted repeal of §276.11 and adopted new §276.10 are needed to provide an extensive ombudsman education and training program for an ombudsman's assistance to an unrepresented injured employee in the Texas Workers' Compensation System. The adopted repeal of §276.11 and new §276.10 are necessary to implement a detailed process and procedure to deliver workers' compensation education to ombudsmen, provide a system for continuing education for ombudsmen, and to assure that injured employees of Texas are provided with assistance in both informal and formal dispute resolution proceedings in the workers' compensation system.

The adopted amendments to §276.12 are necessary to complete the transfer of the ombudsmen education and training program from the former Texas Workers' Compensation Commission to OIEC. The adopted amendments to §276.12 are necessary to provide clarity to ombudsmen and injured employees in preparing for informal and formal proceedings.

Section 276.10(a) provides for definitions for the section. Subsections (b) provides for OIEC to establish and maintain an education and training program that ensures consistent, quality, and thorough training of ombudsman staff. Subsection (c) delineates between the Injured Employee Services and ombudsmen training and education responsibilities. The amendments to §276.12 establishes requirements for ombudsmen to meet privately with unrepresented injured employees for a minimum of 15 minutes prior to a proceeding. Subsection (c) has been changed from proposal to clarify that an ombudsman shall request a recess from the proceeding if an ombudsman becomes aware that the unrepresented injured employee has not met with an ombudsman for a minimum of 15 minutes prior to the proceeding. Subsection (d) establishes ombudsman procedures for when an unrepresented injured employee refuses ombudsman assistance.

The public benefits anticipated as a result of the adoption shall be a more comprehensive ombudsman education and training program. Injured employees shall benefit from an ombudsman program where ombudsmen provide assistance to injured employees in both informal and formal workers' compensation proceedings. Both injured employees and ombudsmen will benefit from the existence of regional staff attorneys who will provide legal research and advice to ombudsmen assisting injured employees.

It is anticipated that all system participants will benefit from a workers' compensation system where unrepresented injured employees receive a higher level of assistance in benefit review conferences and contested case hearings. An increased level of ombudsmen education and training is likely to result in a workers' compensation system that provides increased access to assistance, narrows the information disparity in proceedings where an injured employee's right to benefits is at stake, and provides additional information and education on the injured employee's rights and responsibilities in the workers' compensation system. Further, an increased ombudsmen education and training program is anticipated to provide ombudsmen with the skill set and resources to provide a more efficient level of assistance for Texas' injured employees.

The following is a summary of the public comment received during the comment period and OIEC's response to the comment:

Comment: One commenter suggested prescribing additional procedures in §276.12(d) regarding the meeting between an injured employee and ombudsman prior to a proceeding. The commenter requested a procedure to resume the proceeding in situations when an injured employee chose not to meet with an ombudsman prior to a proceeding, unless the ombudsman did not have sufficient material to go forward with the proceeding.

Agency Response: OIEC appreciates the commenter's suggestion but declines to make the requested change. OIEC's ombudsmen are charged with assisting unrepresented injured employees to protect their rights in the workers' compensation system pursuant to Labor Code §404.101(b)(2)(C) and §404.151(b)(4). The ombudsman's role is to assist, not represent (ie. serve as an attorney), injured employees at the administrative level of the workers' compensation system. As such, an ombudsman cannot proceed at a benefit review conference or a contested case hearing without the injured employee, who is considered the party in the proceeding, because the ombudsman is not representing the injured employee. Further, Labor Code §404.151(b)(5) requires ombudsman to meet with unrepresented claimants privately for a minimum of 15 minutes prior to any informal or formal hearing. OIEC does not have the statutory authority to either provide exceptions or waive this requirement.

The following are the names of those who submitted public comment:

For, with changes: The Boeing Company

28 TAC §276.10, §276.11

The repeal of §276.10 and §276.11 is adopted pursuant to Texas Labor Code §§404.151, 404.152, 404.154, 404.103, 404.105 and 404.006. Section 404.151 provides for the maintenance of an ombudsman program; the assistance of unrepresented injured employees and the protection of their rights in the workers' compensation system; and the meeting of an ombudsman with an unrepresented injured employee privately for a minimum of 15 minutes prior to any informal or formal hearing. Section 404.152 provides for the designation, education and training, and continuing education requirements to be an ombudsman. Section 404.152(c) provides that the public counsel shall by rule adopt training guidelines and continuing education requirements for ombudsmen, which must include: education on the workers' compensation laws, rules, and appeals panel decisions; require ombudsmen undergoing training to be observed and monitored by an experienced ombudsman during daily activities; and assign staff attorneys, as the public counsel considers appropriate, to supervise the work of the ombudsman program and advise ombudsmen in providing assistance to claimants and preparing for informal and formal hearings. Section 404.154 requires the office to widely disseminate information about the ombudsman program. Section 404.103 provides for the operation of the ombudsman program and requires the public counsel to assign staff attorneys, as appropriate, to supervise the work of the ombudsman program and advise ombudsmen in providing assistance to claimants and preparing for informal and formal hearings. Section 404.105 provides that the office, through the ombudsman program, may appear before the commissioner or division on behalf of an individual injured employee during an administrative dispute resolution process. Section 404.006 requires the public counsel to adopt rules to implement Chapter 404 of the Labor Code.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 3, 2006.

TRD-200604024

Brian M. White

Counsel for Policy Development

Office of Injured Employee Counsel

Effective date: August 23, 2006

Proposal publication date: June 23, 2006

For further information, please call: (512) 804-4186


28 TAC §276.10, §276.12

The new section and amendments are adopted pursuant to Texas Labor Code §§404.151, 404.152, 404.154, 404.103, 404.105, and 404.006. Section 404.151 provides for the maintenance of an ombudsman program; the assistance of unrepresented injured employees and the protection of their rights in the workers' compensation system; and the meeting of an ombudsman with an unrepresented injured employee privately for a minimum of 15 minutes prior to any informal or formal hearing. Section 404.152 provides for the designation, education and training, and continuing education requirements to be an ombudsman. Section 404.152(c) provides that the public counsel shall by rule adopt training guidelines and continuing education requirements for ombudsmen, which must include: education on the workers' compensation laws, rules, and appeals panel decisions; require ombudsmen undergoing training to be observed and monitored by an experienced ombudsman during daily activities; and assign staff attorneys, as the public counsel considers appropriate, to supervise the work of the ombudsman program and advise ombudsmen in providing assistance to claimants and preparing for informal and formal hearings. Section 404.154 requires the office to widely disseminate information about the ombudsman program. Section 404.103 provides for the operation of the ombudsman program and requires the public counsel to assign staff attorneys, as appropriate, to supervise the work of the ombudsman program and advise ombudsmen in providing assistance to claimants and preparing for informal and formal hearings. Section 404.105 provides that the office, through the ombudsman program, may appear before the commissioner or division on behalf of an individual injured employee during an administrative dispute resolution process. Section 404.006 requires the public counsel to adopt rules to implement Chapter 404 of the Labor Code.

§276.10.Ombudsmen Training Program and Continuing Education.

(a) Definitions. The following words and phrases shall have the following meaning in this section unless the context clearly indicates otherwise:

(1) Adjuster's license: A workers' compensation license issued by the Texas Department of Insurance.

(2) Continuing education: A formal training program required for all ombudsmen in this state that includes continuing education for obtaining and retaining an adjuster's license.

(3) Ombudsman education and training program: The training required by the Office of Injured Employee Counsel (OIEC) to serve as an ombudsman, which results in certification upon completion.

(b) Purpose. OIEC shall establish and maintain the ombudsmen education and training program to ensure consistent, quality, and thorough training of ombudsmen staff. The ombudsmen education and training program applies to every ombudsman, regardless of hire date. The ombudsmen education and training program shall include, but is not limited to:

(1) formal classroom training conducted by OIEC staff;

(2) on-the-job training monitored by a supervising ombudsman, senior ombudsman, and regional staff attorneys;

(3) observations of ombudsmen by supervising ombudsman, senior ombudsman, and regional staff attorneys;

(4) professional skill development and legal education on workers' compensation laws, rules, advisories, and appeals panel decisions by the regional attorneys; and

(5) resource meetings with OIEC's central staff to discuss current and pending issues instrumental to providing assistance to injured employees in informal and formal proceedings.

(c) OIEC staff's responsibilities regarding education and training. OIEC staff shall maintain the knowledge and skills needed to properly assist unrepresented injured employees in the workers' compensation system.

(1) Injured Employee Services is the division within OIEC that is responsible for the overall management of the ombudsmen education and training program. Injured Employee Services' responsibilities include, but are not limited to:

(A) educating ombudsmen about the workers' compensation laws, rules, advisories, appeals panel decisions, dispute resolution, OIEC policies and procedures, and application of such information to specific cases or factual situations;

(B) selecting team lead supervisors, training ombudsmen, and senior ombudsmen to observe, supervise, train, and provide feedback to ombudsmen on a daily basis;

(C) notifying regional staff attorneys if guidance, instruction, or legal research on technical areas is needed;

(D) establishing on-going training schedules for ombudsmen and evaluating the performance of ombudsmen's progress through the education and training program;

(E) maintaining documentation to monitor the effectiveness of the ombudsman program and coordinating with OIEC's Legal Services division to develop education and training materials to address systematic issues to enhance ombudsmen's effectiveness;

(F) examining the proficiency and competency of each ombudsman by conducting technical observations and identifying areas for professional improvement;

(G) providing targeted training to individual ombudsman for professional development and incorporating the technical observations and evaluations into the performance evaluation process;

(H) providing continuing education and training, at least annually, to ombudsmen on workers' compensation laws, rules, advisories, appeals panel decisions, dispute resolution, OIEC policies and procedures; and

(I) assigning a staff attorney to each ombudsman who will advise the ombudsman on providing assistance to injured employees and preparing for informal and formal proceedings.

(2) An ombudsman's responsibilities shall include, but is not limited to:

(A) obtaining and maintaining a valid workers' compensation adjusters' license issued by the Texas Department of Insurance and submitting a copy of the license to OIEC's central office;

(B) completing the ombudsman education and training program;

(C) participating in OIEC conferences;

(D) completing all continuing education requirements;

(E) maintaining the technical and professional skills to perform all the duties of an ombudsman; and

(F) assisting and serving as an advocate for injured employees throughout the workers' compensation system.

§276.12.Procedures for Private Meetings with Unrepresented Injured Employees Prior to a Workers' Compensation Proceeding.

(a) An ombudsman shall meet privately with an unrepresented injured employee for a minimum of 15 minutes prior to each benefit review conference and benefit contested case hearing.

(b) The 15-minute private meeting shall include:

(1) an overview of the dispute resolution process, and

(2) a review of the injured employee's disputed issues and applicable workers' compensation laws, rules, and appeals panel decisions.

(c) The ombudsman shall request the benefit review officer or contested case hearing officer to recess the proceeding to allow for the private meeting pursuant to Labor Code §404.151(b)(5) if the ombudsman becomes aware that the unrepresented injured employee has not met with an ombudsman for a minimum of 15 minutes prior to the proceeding.

(d) If the injured employee refuses to attend the required meeting prior to a benefit review conference or a contested case hearing, the injured employee shall acknowledge such refusal in writing. If the injured employee refuses to sign the acknowledgement, the ombudsman shall request that:

(1) the injured employee receive a copy of Texas Labor Code §404.151, and

(2) the benefit review officer make a notation of the injured employee's refusal in the claim file or that the contested case hearing officer note such refusal in the hearing record.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on August 3, 2006.

TRD-200604023

Brian M. White

Counsel for Policy Development

Office of Injured Employee Counsel

Effective date: August 23, 2006

Proposal publication date: June 23, 2006

For further information, please call: (512) 804-4186