CHAPTER 521. CONSUMER INFORMATION AND COMPLAINTS

State Codes and Statutes

Statutes > Texas > Insurance-code > Title-5-protection-of-consumer-interests > Chapter-521-consumer-information-and-complaints

INSURANCE CODE

TITLE 5. PROTECTION OF CONSUMER INTERESTS

SUBTITLE B. CONSUMER SERVICE PROVISIONS

CHAPTER 521. CONSUMER INFORMATION AND COMPLAINTS

SUBCHAPTER A. PUBLIC INTEREST INFORMATION AND COMPLAINT

PROCEDURES

Sec. 521.001. PUBLIC INTEREST INFORMATION. (a) The department

shall prepare information of public interest describing the

department's functions and the procedures by which complaints are

filed with and resolved by the department.

(b) The department shall make the information available to the

public and appropriate state agencies.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.002. COMPLAINT RESOLUTION PROGRAM. The department

shall establish a program to facilitate resolution of

policyholder complaints.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.003. NOTIFICATION OF COMPLAINT STATUS. If a written

complaint is filed with the department, the department, at least

quarterly and until final disposition of the complaint, shall

notify each party to the complaint of the complaint's status

unless the notice would jeopardize an undercover investigation.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.004. RECORDS OF COMPLAINTS. The department shall keep

an information file about each complaint filed with the

department that concerns an activity regulated by the department

or the commissioner.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.005. NOTICE TO ACCOMPANY POLICY. (a) Each insurance

policy delivered or issued for delivery in this state shall

include with the policy a brief written notice that includes:

(1) a suggested procedure to be followed by a policyholder with

a dispute concerning the policyholder's claim or premium;

(2) the department's name and address; and

(3) the department's toll-free telephone number maintained under

Subchapter B.

(b) The commissioner shall adopt appropriate wording for the

notice.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

SUBCHAPTER B. DEPARTMENT TOLL-FREE NUMBER FOR INFORMATION AND

COMPLAINTS

Sec. 521.051. DEPARTMENT TOLL-FREE NUMBER FOR INFORMATION AND

COMPLAINTS. The department shall maintain a toll-free telephone

number to:

(1) provide the information described by Section 521.052; and

(2) receive and aid in resolving complaints against insurers.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.052. INFORMATION PROVIDED. The department shall

provide to the public through the department's toll-free

telephone number only the following information:

(1) information collected or maintained by the department

relating to the number and disposition of complaints received

against an insurer that are justified, verified as accurate, and

documented as valid, expressed as a percentage of the total

number of insurance policies written by the insurer and in force

on December 31 of the preceding year;

(2) the rating of an insurer, if any, as published by a

nationally recognized rating organization;

(3) the kinds of coverage available to a consumer through any

insurer writing insurance in this state;

(4) an insurer's admitted assets-to-liabilities ratio; and

(5) other appropriate information collected and maintained by

the department.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.053. PUBLICITY REQUIREMENTS. The department shall

publicize the department's toll-free telephone number in public

service announcements and publish that number in telephone books

throughout the state, as the department finds appropriate.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.054. RECORD OF INQUIRY OR COMPLAINT REQUIRED. The

department shall maintain a written record of each inquiry and

complaint received through the department's toll-free telephone

number.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.055. COMPLAINT NOTIFICATION SYSTEM. The department

shall establish a system to notify insurers by electronic

transmission to a facsimile machine or other appropriate system

of complaints received by the department through the department's

toll-free telephone number.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.056. INFORMATION BULLETIN TO ACCOMPANY POLICY. Each

insurer that delivers, issues for delivery, or renews an

insurance policy in this state shall include with the policy an

information bulletin that includes:

(1) the department's toll-free telephone number; and

(2) a description of the services available through the

department's toll-free telephone number.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

SUBCHAPTER C. HEALTH MAINTENANCE ORGANIZATION OR INSURER

TOLL-FREE NUMBER FOR INFORMATION AND COMPLAINTS

Sec. 521.101. APPLICABILITY OF SUBCHAPTER. (a) Except as

provided by Subsection (b), this subchapter applies to a health

maintenance organization authorized to engage in the business of

a health maintenance organization in this state or an insurer

authorized to engage in the business of insurance in this state,

including:

(1) a capital stock insurance company;

(2) a mutual insurance company;

(3) a title insurance company;

(4) a fraternal benefit society;

(5) a local mutual aid association;

(6) a statewide mutual assessment company;

(7) a county mutual insurance company;

(8) a Lloyd's plan;

(9) a reciprocal or interinsurance exchange;

(10) a stipulated premium company;

(11) a group hospital service corporation; and

(12) a risk retention group.

(b) This subchapter does not apply to a health maintenance

organization or insurer:

(1) that has gross initial premium receipts collected in this

state of less than $2 million each year; or

(2) with regard to fidelity, surety, or guaranty bonds.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.102. HEALTH MAINTENANCE ORGANIZATION OR INSURER

TOLL-FREE NUMBER FOR INFORMATION AND COMPLAINTS. A health

maintenance organization or insurer shall maintain a toll-free

telephone number to:

(1) provide information concerning evidences of coverage or

policies issued by the health maintenance organization or

insurer; and

(2) receive complaints from enrollees or policyholders.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

Sec. 521.103. INFORMATION INCLUDED IN EVIDENCE OF COVERAGE OR

POLICY. (a) Each health maintenance organization or insurer

that delivers, issues for delivery, or renews an evidence of

coverage or insurance policy in this state shall print on the

evidence of coverage or policy the health maintenance

organization's or insurer's toll-free telephone number.

(b) The commissioner may adopt rules governing the manner in

which the toll-free telephone number appears on the evidence of

coverage or insurance policy.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1,

2005.

SUBCHAPTER D. RACE-BASED INSURANCE REGISTRY

Sec. 521.151. APPLICABILITY OF SUBCHAPTER. This subchapter

applies to any legal entity engaged in the business of insurance

in this state, including:

(1) a capital stock insurance company;

(2) a mutual insurance company;

(3) a title insurance company;

(4) a fraternal benefit society;

(5) a local mutual aid association;

(6) a statewide mutual assessment company;

(7) a county mutual insurance company;

(8) a Lloyd's plan;

(9) a reciprocal or interinsurance exchange;

(10) a stipulated premium company;

(11) a group hospital service corporation;

(12) a farm mutual insurance company;

(13) a risk retention group;

(14) an eligible surplus lines insurer; and

(15) an agent, broker, adjuster, or life and health insurance

counselor.

Added by Acts 2009, 81st Leg., R.S., Ch.

756, Sec. 1, eff. September 1, 2009.

Sec. 521.152. REGISTRY; INTERNET POSTING. (a) The commissioner

shall establish a registry of each legal entity engaged in the

business of insurance in this state that, formally or informally,

has entered into an agreement with the department:

(1) that disposes of allegations of race-based pricing; and

(2) under which all or part of the relief agreed on to make

insureds whole includes a claims-made offer that remains in place

and has not otherwise expired under the terms of the agreement.

(b) The registry must be prominently published on the

department's Internet website, and must:

(1) identify:

(A) each insurance company that has entered into an agreement

described by Subsection (a); and

(B) the eligibility and terms of the insurance company's

claims-made offer; and

(2) include:

(A) a claim form; and

(B) links to the Internet website of the insurance company that

is administrating the claims-made offer.

Added by Acts 2009, 81st Leg., R.S., Ch.

756, Sec. 1, eff. September 1, 2009.

Sec. 521.153. PRESERVATION OF CERTAIN RECORDS REGARDING

RACE-BASED PRICING. (a) Notwithstanding Chapter 441, Government

Code, the department shall preserve all examinations, exhibits to

examinations, and other relevant documents regarding race-based

pricing that the department has gathered or created with respect

to a race-based pricing investigation that is completed or

ongoing on September 1, 2009, other than those for which an

attorney-client or attorney work product privilege can be

claimed, until the time that those documents are eligible for

delivery under Subsection (b).

(b) On the completion of the department's race-based pricing

investigation, but not later than January 15, 2011, the

department shall deliver the records identified under Subsection

(a) or copies of those records to the state archivist.

(1) using best efforts, preserve and catalogue the records

identified under Subsection (a); and

(2) make the records available to the public as soon as

appropriate, but not later than January 15, 2015.

Added by Acts 2009, 81st Leg., R.S., Ch.

756, Sec. 1, eff. September 1, 2009.

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

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