Texas Administrative Code

The Association is authorized to purchase fidelity bonds in the amounts required by the Governing Committee. The bonds shall reimburse the Association for any pecuniary loss it may sustain by any act or acts of fraud or dishonesty on the part of members of the Governing Committee…

(a) There is no liability on the part of, and no cause of action against insurers, the inspector, the Association, the Governing Committee, their agents or employees, the Association's administrator, the Commissioner or the Commissioner's authorized representatives, with respect …

(a) Any applicant or affected insurer shall have the right to appeal any action or decision of the Association or inspector to the staff of the Association or its administrator. Each denial of insurance to an applicant shall be accompanied by a statement to the applicant and the …

(a) In accordance with the provisions of § 5.9912 (e) of this subchapter (relating to Governing Committee) the Association shall have the following options for servicing Association policies: (1) Contract with one or more member insurers to service some or all of the policies. (2…

(a) An agent must maintain and submit, at the request of FAIR Plan, written documentation that indicates all of the following. (1) At least two insurance companies, not in the same holding company as defined in Insurance Code Chapter 823, concerning Insurance Holding Company Syst…

(a) FAIR Plan must adopt application forms. The forms must be designed to obtain all of the information necessary for underwriting and rating the risk. The forms may also elicit additional information that FAIR Plan may use to revise its rates, underwriting rules, policy forms, a…

(a) The underwriting rules must determine the inspection criteria for risks to be written by FAIR Plan. FAIR Plan may issue a policy of residential property insurance or property owners' association insurance on certain types of risks without an inspection in accordance with the …

(a) The maximum limits of liability for residential property insurance per location through FAIR Plan are $1,000,000 dwelling and $500,000 contents. FAIR Plan is authorized to reinsure some or all risks that are within or at these maximum limits. (b) The maximum limit of liabilit…

(a) Upon request, an agent may assist any property owners' association or owner of residential property in the completion and submission of an application for insurance on forms prescribed by FAIR Plan. (b) Agents may not hold themselves out as agents of FAIR Plan. (c) A commissi…

(a) The Association shall be governed by a Governing Committee. (b) The Governing Committee shall be composed of 11 voting members appointed by the Commissioner as follows: (1) five members who represent the interests of insurers; (2) four public members; and (3) two members who …

The following words and terms, when used in this subchapter, have the following meanings. (1) Agent--Any person licensed by the commissioner as a general lines property and casualty agent under Insurance Code § 4051.051 , concerning License Required. (2) Applicant--Any person app…

The Texas FAIR Plan Association was established by Insurance Code Chapter 2211, concerning FAIR Plan, for the purpose of delivering residential property insurance, and later, property owners' association insurance, to insurable risks in areas determined by the commissioner to be …

(a) A material change includes a change from replacement cost coverage to actual cash value coverage. The change might be to the entire policy, or to any part of it. This section applies only to changes from replacement cost to actual cash value. (b) A notice of material change m…

(a) A notice of material change must be conspicuous, as that term is defined in Business and Commerce Code § 1.201(b)(10) . (b) If the notice of material change is included in a renewal notice, the first page of the renewal notice must include: (1) the notice of material change; …

(a) A notice of material change is not a notice of cancellation or nonrenewal. Instead, it is a notice provided under: (1) Insurance Code § 551.1055 ; (2) Insurance Code § 2002.001 ; or (3) Insurance Code § 2002.102 . (b) This section, § 5.9751 and § 5.9752 of this title (relatin…

(a) All residential property insurance policy declarations pages must list and identify each type of deductible in the policy, including applicable endorsements, and state the exact dollar amount of each deductible. To identify a deductible, the insurer must provide a brief descr…

(a) Purpose and applicability. (1) The purpose of this section is to establish requirements for the reporting of catastrophe-related data by insurers under Insurance Code Chapter 38, Subchapter E and Insurance Code § 38.001 . (2) This section applies to all reports required to be…

(a) Purpose and Applicability. (1) The purpose of this section is to establish requirements for the reporting of premium and loss data by direct commercial lines insurers under Insurance Code Chapter 38, Subchapter E. (2) Under Insurance Code § 38.202 , the commissioner has desig…

The Commissioner of Insurance adopts by reference the forms specified in this section for use in the Residential Property Insurance Market Assistance Program, which is operated pursuant to Article 21.49-12 of the Insurance Code. Specimen copies of these forms are available from t…

The permissible classes for the payment of dividends for the lines of insurance regulated under the Insurance Code, Chapter 5, Subchapter A, are the same as the duly promulgated rating classifications for those lines of insurance. No insurer may declare or pay any dividend on any…

(a) No dividend shall take effect or may be paid until approved by the State Board of Insurance. (b) A dividend may only be paid out of earned surplus. (c) A pro rata earned dividend must be paid on a participating policy which is terminated prior to its expiration date, if a div…

The State Board of Insurance adopts by reference Texas Casualty Dividend Disbursement Application, as applicable to motor vehicle insurance. This form may be obtained from the Deputy Insurance Commissioner, Casualty Group, State Board of Insurance, 1110 San Jacinto Street, Austin…

A certificate of assumption may be attached only to an automobile insurance policy issued for an insurer for which a reinsurance assumption agreement has been approved by a commissioner's order pursuant to 28 Texas Administrative Code § 7.604 . For utilization under this section,…

The permissible classes for the payment of dividends for the lines of insurance regulated under the Insurance Code, Chapter 5, Subchapter B, are the same as the duly approved rating classifications for those lines of insurance. No insurer may declare or pay any dividend on any li…

(a) No dividend shall take effect or may be paid until approved by the State Board of Insurance. (b) A dividend may only be paid out of earned surplus. (c) A pro rata earned dividend must be paid on a participating policy which is terminated prior to its expiration date, if a div…

The State Board of Insurance adopts by reference Texas Casualty Dividend Disbursement Application, as applicable to the Insurance Code, Chapter 5, Subchapter B. This form may be obtained from the Deputy Insurance Commissioner, Casualty Group, State Board of Insurance, 1110 San Ja…

Each insurer covered by the Insurance Code, Article 5.15-1, shall adopt a procedure for reconsideration of the rate or premium charged a physician or health care provider, as defined in §2 of said article, for professional liability insurance coverage. The procedure so adopted mu…

Each insurer shall file its written procedures with the Director of Professional Liability Insurance, Mail Code 012-4, State Board of Insurance, 1110 San Jacinto Boulevard, Austin, Texas 78701-1998, within 60 days after the effective date of this section and, thereafter, when the…

If the insured physician or health care provider is not satisfied with a decision under the procedures established in § 5.1501 and § 5.1502 of this title (relating to Procedure for Reconsideration and Grievance and Hearing Procedures), the insured may appeal to the State Board of…

(a) The following are eight ways to qualify as a field safety representative under the Insurance Code, Article 5.15-2: (1) an individual with a baccalaureate in science or engineering; (2) an individual with a baccalaureate in nursing, pharmacy, or physical therapy; (3) an indivi…

An individual may qualify under the Insurance Code, Article 5.15-2, as a field safety representative with specialty in hospitals, and satisfy § 5.1701 of this title (relating to Qualifications for Designation as Field Safety Representative with Specialty in Hospitals) by completi…

(a) The designation as field safety representative with specialty in hospitals may be made by the State Board of Insurance and may be based on the qualifications in § 5.1701 of this title (relating to Qualifications for Designation as Field Safety Representative with Specialty in…

Any insurer desiring to write professional liability insurance for hospitals in Texas shall have available adequate facilities and field safety representatives to furnish to policyholders the services described in paragraphs (1)-(5) of this section. (1) Surveys. On-site identific…

The insurer shall maintain and make available to its policyholders loss control facilities reasonably commensurate to the loss exposures and experience of the policyholder's business, and each policyholder shall be informed of the type of such services available. The specific met…

At least every two years, the State Board of Insurance will conduct an evaluation of the loss control facilities and services of each insurer writing professional liability insurance for hospitals in the State of Texas. (1) Location of evaluations. Evaluations will be conducted a…

Any insurer desiring to write professional liability insurance for insureds other than hospitals, to write general liability insurance, or to write medical professional liability insurance for insureds other than hospitals in Texas shall provide loss control information to policy…

The insurer shall establish procedures for, and maintain the capability of, providing loss control information to policyholders and may employ various methods of providing such information. Among these are computer products, such as loss summaries and analyses; printed matter, su…

At least every two years, the State Board of Insurance will conduct an evaluation of the loss control information/services of each insurer writing professional liability insurance for insureds other than hospitals, of each insurer writing general liability insurance, and of each …

To provide loss control information and services, an insurer may employ qualified personnel, retain qualified independent contractors, may contract with the policyholder to provide qualified loss prevention personnel and services, or may use a combination of these methods. To be …

These sections implement Insurance Code Article 5.15-4, concerning best practices for risk management and loss control that may be used by for-profit and not-for-profit nursing homes. A nursing home's adoption and implementation of these best practices may be considered by an ins…

(a) A nursing home's adoption and implementation of the best practices for risk management and loss control set forth in this section should focus on the following risk exposure areas, which are exposure areas that appear often in claim lists and claim prevention materials publis…

(a) Words defined in the Insurance Code . Unless the context clearly dictates the contrary, words defined in Insurance Code Chapter 2203 and Insurance Code Article 21.49-3, §2, and not specifically defined in this section have the same definition when used in this subchapter as t…

(a) Membership. The association is governed by Insurance Code Chapter 2203. Any insurer authorized to write and engaged in writing any insurance, the writing of which requires the insurer to become a member of the association under Insurance Code § 2203.055 , will become a member…

(a) Powers of the association. The association is created by the Act and will be governed by the provisions of the Act and this subchapter. (b) Collection and investment of funds. (1) Collection. The treasurer is responsible for the collection of all the premiums received by the …

(a) The policy. (1) Approval. The procedures regarding rates, rating plans, rating rules, rating classifications, territories, and policy forms applicable to insurance written by the association and related statistics must comply with Insurance Code Chapter 2203, Subchapter E. (2…

Amendments to this subchapter may be recommended by the board of directors, subject to the approval of the Commissioner, or may be made at the direction of the Commissioner. Notes 28 Tex. Admin. Code § 5.2005 The provisions of this §5.2005 adopted to be effective January 1, 1976;…

Pursuant to Insurance Code § 2203.151(a)(3) and (4) , the Texas Medical Liability Insurance Underwriting Association may cede and purchase reinsurance. The purpose of this section is to implement Insurance Code § 2203.151(a)(3) and (4) . (1) The association may develop a reinsura…