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.
(c) The state archives shall:
(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.