Sec. 415.021. ASSESSMENT OF ADMINISTRATIVE PENALTIES. (a) In addition to any other provisions in this subtitle relating to violations, a person commits an administrative violation if the person violates, fails to comply with, or refuses to comply with this subtitle or a rule, order, or decision of the commissioner, including an emergency cease and desist order issued under Section 415.0211 . In addition to any sanctions, administrative penalty, or other remedy authorized by this subtitle, the commissioner may assess an administrative penalty against a person who commits an administrative violation. The administrative penalty shall not exceed $25,000 per day per occurrence. Each day of noncompliance constitutes a separate violation. The commissioner's authority under this chapter is in addition to any other authority to enforce a sanction, penalty, fine, forfeiture, denial, suspension, or revocation otherwise authorized by law. (b) The commissioner may enter a cease and desist order against a person who: (1) commits repeated administrative violations; (2) allows, as a business practice, the commission of repeated administrative violations; or (3) violates an order or decision of the commissioner. (c) In assessing an administrative penalty: (1) the commissioner shall consider: (A) the seriousness of the violation, including the nature, circumstances, consequences, extent, and gravity of the prohibited act; (B) the history and extent of previous administrative violations; (C) the demonstrated good faith of the violator, including actions taken to rectify the consequences of the prohibited act; (D) the penalty necessary to deter future violations; (E) whether the administrative violation has negative impact on the delivery of benefits to an injured employee; (F) the history of compliance with electronic data interchange requirements; and (G) other matters that justice may require; and (2) the commissioner shall, to the extent reasonable, consider the economic benefit resulting from the prohibited act. (c-1) The commissioner shall adopt rules that require the division, in the assessment of an administrative penalty against a person, to communicate to the person information about the penalty, including: (1) the relevant statute or rule violated; (2) the conduct that gave rise to the violation; and (3) the factors considered in determining the penalty. (c-2) In determining whether to assess an administrative penalty involving a claim in which the insurance carrier provided notice under Section 409.021 (a-3), the commissioner shall consider whether: (1) the employee cooperated with the insurance carrier's investigation of the claim; (2) the employee timely authorized access to the applicable medical records before the insurance carrier's deadline to: (A) begin payment of benefits; or (B) notify the division and the employee of the insurance carrier's refusal to pay benefits; and (3) the insurance carrier conducted an investigation of the claim, applied the statutory presumptions under Subchapter B , Chapter 607 , Government Code, and expedited medical benefits under Section 504.055 or 504.057 . (d) A penalty may be assessed only after the person charged with an administrative violation has been given an opportunity for a hearing under Subchapter C.
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