reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter C. -1. Request for Claims Information by Certain Officials › Section 542.131. Request by Certain Officials Engaged in Criminal Investigation

Sec. 542.131.  REQUEST BY CERTAIN OFFICIALS ENGAGED IN CRIMINAL INVESTIGATION.  (a)  This section applies only to a claim for a burglary or robbery loss or a death claim seeking life insurance proceeds that is filed with an insurance company on or after September 1, 2001.
(b)  In the course of a criminal investigation and subject to Subsection (c), the state fire marshal, the fire marshal of a political subdivision of this state, the chief of a fire department in this state, a chief of police of a municipality in this state, or a sheriff in this state may request in writing that an insurance company investigating a claimed burglary or robbery loss or a death claim seeking life insurance proceeds release information in the company's possession that relates to that claimed loss.  The company shall release the information to any official authorized to request the information under this subsection if the company has reason to believe that the insurance claim is false or fraudulent.
(c)  An official who requests information under this section may not request anything other than:
(1)  an insurance policy relevant to an insurance claim under investigation and the application for that policy;
(2)  policy premium payment records;
(3)  the history of the insured's previous claims; and
(4)  material relating to the investigation of the insurance claim, including:
(A)  statements of any person;
(B)  proof of loss; or
(C)  other relevant evidence.
(d)  This section does not authorize a public official or agency to adopt or require any form of periodic report by an insurance company.
(e)  In the absence of fraud or malice, an insurance company or a person who releases information on behalf of an insurance company is not liable for damages in a civil action or subject to criminal prosecution for an oral or written statement made, or any other action taken, that relates to the information required to be released under this section.
(f)  An official or department employee receiving information under this section shall maintain the confidentiality of the information until the information is required to be released during a criminal or civil proceeding.
(g)  An insurance company or the company's representative may not intentionally refuse to release to an official described by Subsection (b) the information required to be released to that official under this section.
Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1D.001, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter D. Notice of Settlement of Claim Under Casualty Insurance Policy › Section 542.151. Applicability of Subchapter

Sec. 542.151.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies only to the settlement of a claim under a casualty insurance policy that is delivered, issued for delivery, or renewed in this state, including a policy written by:
(1)  a county mutual insurance company;
(2)  a Lloyd's plan;
(3)  an eligible surplus lines insurer;  or
(4)  a reciprocal or interinsurance exchange.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter D. Notice of Settlement of Claim Under Casualty Insurance Policy › Section 542.152. Exception

Sec. 542.152.  EXCEPTION.  This subchapter does not apply to:
(1)  a casualty insurance policy that requires the insured's consent to settle a claim against the insured;
(2)  fidelity, surety, or guaranty bonds; or
(3)  marine insurance as defined by Section 1807.001.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.010(a), eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2D.010, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter D. Notice of Settlement of Claim Under Casualty Insurance Policy › Section 542.153. Notice Required

Sec. 542.153.  NOTICE REQUIRED.  (a)  Not later than the 10th day after the date an initial offer to settle a claim against a named insured under a casualty insurance policy issued to the insured is made, the insurer shall notify the insured in writing of the offer.
(b)  Not later than the 30th day after the date a claim against a named insured under a casualty insurance policy issued to the insured is settled, the insurer shall notify the insured in writing of the settlement.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter D. Notice of Settlement of Claim Under Casualty Insurance Policy › Section 542.154. Rules

Sec. 542.154.  RULES.  The commissioner may adopt rules to implement this subchapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter E. Recovery of Deductible From Third Parties Under Certain Automobile Insurance Policies › Section 542.201. Purpose

Sec. 542.201.  PURPOSE.  This subchapter is intended to encourage insurers to take appropriate and necessary steps to collect from third parties or the insurers of the third parties.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter E. Recovery of Deductible From Third Parties Under Certain Automobile Insurance Policies › Section 542.202. Definition

Sec. 542.202.  DEFINITION.  In this subchapter, "action" includes taking various actions such as reasonable and diligent collection efforts, mediation, arbitration, and litigation against a responsible third party or the third party's insurer.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter E. Recovery of Deductible From Third Parties Under Certain Automobile Insurance Policies › Section 542.203. Applicability of Subchapter

Sec. 542.203.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to any insurer that delivers, issues for delivery, or renews in this state a private passenger automobile insurance policy, including a reciprocal or interinsurance exchange, mutual insurance company, association, Lloyd's plan, or other insurer.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter E. Recovery of Deductible From Third Parties Under Certain Automobile Insurance Policies › Section 542.204. Action to Recover Deductible

Sec. 542.204.  ACTION TO RECOVER DEDUCTIBLE.  (a)  Notwithstanding any other provision of this code and except as provided by Subsection (b), if an insurer is liable to an insured for a claim that is subject to a deductible payable by the insured and a third party may be liable to the insurer or the insured for the amount of the deductible, the insurer shall:
(1)  take action to recover the deductible against the third party not later than the first anniversary of the date the insured's claim is paid;  or
(2)  pay the amount of the deductible to the insured.
(b)  An insurer is not required to take action or pay the amount of the deductible as required by Subsection (a) if, not later than the earlier of the first anniversary of the date the insured's claim is paid or the 90th day before the date the statute of limitations for a negligence action expires, the insurer:
(1)  notifies the insured in writing that the insurer does not intend to take further collection actions against the third party;  and
(2)  authorizes the insured to take further collection actions.
(c)  This section applies regardless of whether the third party who may be liable for the amount of the deductible is insured or uninsured.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter E. Recovery of Deductible From Third Parties Under Certain Automobile Insurance Policies › Section 542.205. Enforcement; Rules

Sec. 542.205.  ENFORCEMENT;  RULES.  The commissioner may enforce this subchapter and adopt and enforce reasonable rules necessary to accomplish the purposes of this subchapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter F. Water Damage Claims › Section 542.251. Purposes

Sec. 542.251.  PURPOSES.  The purposes of this subchapter are to:
(1)  provide for the prompt, efficient, and effective handling and processing of water damage claims filed under residential property insurance policies, including claims involving losses due to mold;
(2)  reduce the confusion and inconvenience policyholders experience in filing and resolving water damage claims filed under residential property insurance policies, including claims involving losses due to mold; and
(3)  reduce claim costs and premiums for residential property insurance issued in this state.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.011(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter F. Water Damage Claims › Section 542.252. Applicability of Subchapter

Sec. 542.252.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to any insurer that handles or processes water damage claims filed under residential property insurance policies.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.011(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter F. Water Damage Claims › Section 542.253. Rules

Sec. 542.253.  RULES.  (a)  The commissioner may adopt rules that identify the types of water damage claims that require more prompt, efficient, and effective processing and handling than the processing and handling required under Subchapter B.
(b)  The commissioner by rule may regulate the following aspects of water damage claims:
(1)  required notice;
(2)  acceptance and rejection of a claim;
(3)  claim handling and processing procedures and time frames;
(4)  claim investigation requirements, procedures, and time frames;
(5)  settlement of claims; and
(6)  any other area of claim processing, handling, and response determined to be relevant and necessary by the commissioner.
(c)  A rule adopted under this section supersedes the minimum standards described by Subchapter B.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.011(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter G. Insurer's Recovery From Uninsured Third Party › Section 542.301. Applicability of Subchapter

Sec. 542.301.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to any insurer that delivers, issues for delivery, or renews a private passenger automobile insurance policy in this state, including a county mutual, a reciprocal or interinsurance exchange, or a Lloyd's plan.
Added by Acts 2005, 79th Leg., Ch. 1074 (H.B. 1572), Sec. 1, eff. September 1, 2005.
Redesignated from Insurance Code - Not Codified, Art/Sec 21.79H and amended by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.020(a), eff. September 1, 2007.
Redesignated from Insurance Code - Not Codified, Art/Sec 21.79H and amended by Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.020(a), eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542 - Processing and Settlement of Claims › Subchapter G. Insurer's Recovery From Uninsured Third Party › Section 542.302. Recovery in Suit or Other Action

Sec. 542.302.  RECOVERY IN SUIT OR OTHER ACTION.  An insurer that brings suit or takes other action described by Section 542.202 against a responsible third party relating to a loss that is covered under a private passenger automobile insurance policy issued by the insurer and for which the responsible third party is uninsured is entitled to recover, in addition to payments made by the insurer or insured, the costs of bringing the suit or taking the action, including reasonable attorney's fees and court costs.
Added by Acts 2005, 79th Leg., Ch. 1074 (H.B. 1572), Sec. 1, eff. September 1, 2005.
Redesignated from Insurance Code - Not Codified, Art/Sec 21.79H and amended by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.020(a), eff. September 1, 2007.
Redesignated from Insurance Code - Not Codified, Art/Sec 21.79H and amended by Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.020(a), eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542A - Certain Consumer Actions Related to Claims for Property Damage › Section 542A.001. Definitions

Sec. 542A.001.  DEFINITIONS.  In this chapter:
(1)  "Agent" means an employee, agent, representative, or adjuster who performs any act on behalf of an insurer.
(2)  "Claim" means a first-party claim that:
(A)  is made by an insured under an insurance policy providing coverage for real property or improvements to real property;
(B)  must be paid by the insurer directly to the insured; and
(C)  arises from damage to or loss of covered property caused, wholly or partly, by forces of nature, including an earthquake or earth tremor, a wildfire, a flood, a tornado, lightning, a hurricane, hail, wind, a snowstorm, or a rainstorm.
(3)  "Claimant" means a person making a claim.
(4)  "Insurer" means a corporation, association, partnership, or individual, other than the Texas Windstorm Insurance Association, engaged as a principal in the business of insurance and authorized or eligible to write property insurance in this state, including:
(A)  an insurance company;
(B)  a reciprocal or interinsurance exchange;
(C)  a mutual insurance company;
(D)  a capital stock insurance company;
(E)  a county mutual insurance company;
(F)  a farm mutual insurance company;
(G)  a Lloyd's plan;
(H)  an eligible surplus lines insurer; or
(I)  the FAIR Plan Association, unless a claim-related dispute resolution procedure is available to policyholders under Chapter 2211.
(5)  "Person" means a corporation, association, partnership, or other legal entity or individual.
Added by Acts 2017, 85th Leg., R.S., Ch. 151 (H.B. 1774), Sec. 3, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542A - Certain Consumer Actions Related to Claims for Property Damage › Section 542A.002. Applicability of Chapter

Sec. 542A.002.  APPLICABILITY OF CHAPTER.  (a)  Except as provided by Subsection (b), this chapter applies to an action on a claim against an insurer or agent, including:
(1)  an action alleging a breach of contract;
(2)  an action alleging negligence, misrepresentation, fraud, or breach of a common law duty; or
(3)  an action brought under:
(A)  Subchapter D, Chapter 541;
(B)  Subchapter B, Chapter 542; or
(C)  Subchapter E, Chapter 17, Business & Commerce Code.
(b)  This chapter does not apply to an action against the Texas Windstorm Insurance Association or to an action relating to or arising from a policy ceded to an insurer by the Texas Windstorm Insurance Association under Subchapter O, Chapter 2210.  This chapter applies to an action that relates to or arises from a policy renewed under Section 2210.703.
Added by Acts 2017, 85th Leg., R.S., Ch. 151 (H.B. 1774), Sec. 3, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542A - Certain Consumer Actions Related to Claims for Property Damage › Section 542A.003. Notice Required

Sec. 542A.003.  NOTICE REQUIRED.  (a)  In addition to any other notice required by law or the applicable insurance policy, not later than the 61st day before the date a claimant files an action to which this chapter applies in which the claimant seeks damages from any person, the claimant must give written notice to the person in accordance with this section as a prerequisite to filing the action.
(b)  The notice required under this section must provide:
(1)  a statement of the acts or omissions giving rise to the claim;
(2)  the specific amount alleged to be owed by the insurer on the claim for damage to or loss of covered property; and
(3)  the amount of reasonable and necessary attorney's fees incurred by the claimant, calculated by multiplying the number of hours actually worked by the claimant's attorney, as of the date the notice is given and as reflected in contemporaneously kept time records, by an hourly rate that is customary for similar legal services.
(c)  If an attorney or other representative gives the notice required under this section on behalf of a claimant, the attorney or representative shall:
(1)  provide a copy of the notice to the claimant; and
(2)  include in the notice a statement that a copy of the notice was provided to the claimant.
(d)  A presuit notice under Subsection (a) is not required if giving notice is impracticable because:
(1)  the claimant has a reasonable basis for believing there is insufficient time to give the presuit notice before the limitations period will expire; or
(2)  the action is asserted as a counterclaim.
(e)  To ensure that a claimant is not prejudiced by having given the presuit notice required by this chapter, a court shall dismiss without prejudice an action relating to the claim for which notice is given by the claimant and commenced:
(1)  before the 61st day after the date the claimant provides presuit notice under Subsection (a);
(2)  by a person to whom presuit notice is given under Subsection (a); and
(3)  against the claimant giving the notice.
(f)  A claimant who gives notice in accordance with this chapter is not relieved of the obligation to give notice under any other applicable law.  Notice given under this chapter may be combined with notice given under any other law.
(g)  Notice given under this chapter is admissible in evidence in a civil action or alternative dispute resolution proceeding relating to the claim for which the notice is given.
(h)  The giving of a notice under this chapter does not provide a basis for limiting the evidence of attorney's fees, damage, or loss a claimant may offer at trial.
Added by Acts 2017, 85th Leg., R.S., Ch. 151 (H.B. 1774), Sec. 3, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542A - Certain Consumer Actions Related to Claims for Property Damage › Section 542A.004. Inspection

Sec. 542A.004.  INSPECTION.  Not later than the 30th day after receiving a presuit notice given under Section 542A.003(a), a person to whom notice is given may send a written request to the claimant to inspect, photograph, or evaluate, in a reasonable manner and at a reasonable time, the property that is the subject of the claim.  If reasonably possible, the inspection, photography, and evaluation must be completed not later than the 60th day after the date the person receives the presuit notice.
Added by Acts 2017, 85th Leg., R.S., Ch. 151 (H.B. 1774), Sec. 3, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542A - Certain Consumer Actions Related to Claims for Property Damage › Section 542A.005. Abatement

Sec. 542A.005.  ABATEMENT.  (a)  In addition to taking any other act allowed by contract or by any other law, a person against whom an action to which this chapter applies is pending may file a plea in abatement not later than the 30th day after the date the person files an original answer in the court in which the action is pending if the person:
(1)  did not receive a presuit notice complying with Section 542A.003; or
(2)  requested under Section 542A.004 but was not provided a reasonable opportunity to inspect, photograph, or evaluate the property that is the subject of the claim.
(b)  The court shall abate the action if the court finds that the person filing the plea in abatement:
(1)  did not, for any reason, receive a presuit notice complying with Section 542A.003; or
(2)  requested under Section 542A.004 but was not provided a reasonable opportunity to inspect, photograph, or evaluate the property that is the subject of the claim.
(c)  An action is automatically abated without a court order beginning on the 11th day after the date a plea in abatement is filed if the plea:
(1)  is verified and alleges that the person against whom the action is pending:
(A)  did not receive a presuit notice complying with Section 542A.003; or
(B)  requested under Section 542A.004 but was not provided a reasonable opportunity to inspect, photograph, or evaluate the property that is the subject of the claim; and
(2)  is not controverted by an affidavit filed by the claimant before the 11th day after the date the plea in abatement is filed.
(d)  An affidavit described by Subsection (c)(2) controverting whether the person against whom the action is pending received a presuit notice complying with Section 542A.003 must:
(1)  include as an attachment a copy of the document the claimant sent to give notice of the claimant's action; and
(2)  state the date on which the notice was given.
(e)  An abatement under this section continues until the later of:
(1)  the 60th day after the date a notice complying with Section 542A.003 is given; or
(2)  the 15th day after the date of the requested inspection, photographing, or evaluating of the property is completed.
(f)  If an action is abated under this section, a court may not compel participation in an alternative dispute resolution proceeding until after the abatement period provided by Subsection (e) has expired.
Added by Acts 2017, 85th Leg., R.S., Ch. 151 (H.B. 1774), Sec. 3, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 542A - Certain Consumer Actions Related to Claims for Property Damage › Section 542A.007. Award of Attorney's Fees

Sec. 542A.007.  AWARD OF ATTORNEY'S FEES.  (a)  Except as otherwise provided by this section, the amount of attorney's fees that may be awarded to a claimant in an action to which this chapter applies is the lesser of:
(1)  the amount of reasonable and necessary attorney's fees supported at trial by sufficient evidence and determined by the trier of fact to have been incurred by the claimant in bringing the action;
(2)  the amount of attorney's fees that may be awarded to the claimant under other applicable law; or
(3)  the amount calculated by:
(A)  dividing the amount to be awarded in the judgment to the claimant for the claimant's claim under the insurance policy for damage to or loss of covered property by the amount alleged to be owed on the claim for that damage or loss in a notice given under this chapter; and
(B)  multiplying the amount calculated under Paragraph (A) by the total amount of reasonable and necessary attorney's fees supported at trial by sufficient evidence and determined by the trier of fact to have been incurred by the claimant in bringing the action.
(b)  Except as provided by Subsection (d), the court shall award to the claimant the full amount of reasonable and necessary attorney's fees supported at trial by sufficient evidence and determined by the trier of fact to have been incurred by the claimant in bringing the action if the amount calculated under Subsection (a)(3)(A) is:
(1)  greater than or equal to 0.8;
(2)  not limited by this section or another law; and
(3)  otherwise recoverable under law.
(c)  The court may not award attorney's fees to the claimant if the amount calculated under Subsection (a)(3)(A) is less than 0.2.
(d)  If a defendant in an action to which this chapter applies pleads and proves that the defendant was entitled to but was not given a presuit notice stating the specific amount alleged to be owed by the insurer under Section 542A.003(b)(2) at least 61 days before the date the action was filed by the claimant, the court may not award to the claimant any attorney's fees incurred after the date the defendant files the pleading with the court.  A pleading under this subsection must be filed not later than the 30th day after the date the defendant files an original answer in the court in which the action is pending.
Added by Acts 2017, 85th Leg., R.S., Ch. 151 (H.B. 1774), Sec. 3, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 543 - Prohibited Practices Related to Policy or Certificate of Membership › Subchapter A. Prohibitions › Section 543.001. Misrepresentation Prohibited

Sec. 543.001.  MISREPRESENTATION PROHIBITED.  (a)  In this section, "life, health, or casualty insurer" includes a corporation operating on a cooperative or assessment plan, a mutual insurance company, a fraternal benefit society, and any other society or association authorized to issue an insurance policy in this state.
(b)  A life, health, or casualty insurer, an officer, director, agent, or representative of that insurer, or any other person, corporation, or copartnership may not:
(1)  issue, circulate, or cause or permit to be issued or circulated any statement, including an illustration or estimate, that misrepresents:
(A)  the terms of a policy or certificate of membership issued by a life, health, or casualty insurer;
(B)  other benefits or advantages provided by the policy or certificate;  or
(C)  the dividends or share of surplus to be received on the policy or certificate;
(2)  use a name or title of a policy, policy class, certificate of membership, or certificate class that misrepresents the policy, certificate, or class;  or
(3)  make a misleading representation or incomplete comparison of a policy or certificate of membership to an insured or member for the purpose of inducing or tending to induce the insured or member to forfeit, surrender, or allow the lapse of the insurance or membership.
(c)  The commissioner may adopt and enforce reasonable rules as provided by Subchapter I, Chapter 541, to accomplish the purposes of Subsection (b)(1) as those purposes relate to life insurance companies.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 543 - Prohibited Practices Related to Policy or Certificate of Membership › Subchapter A. Prohibitions › Section 543.002. Contract Expressed in Policy Only

Sec. 543.002.  CONTRACT EXPRESSED IN POLICY ONLY.  An insurer or an agent of an insurer may not make an insurance contract or an agreement relating to an insurance contract other than as expressed in the policy issued in connection with the contract.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 543 - Prohibited Practices Related to Policy or Certificate of Membership › Subchapter A. Prohibitions › Section 543.003. Thing of Value Not Specified in Policy

Sec. 543.003.  THING OF VALUE NOT SPECIFIED IN POLICY.  An insurer or an officer, agent, or representative of an insurer may not:
(1)  directly or indirectly pay, allow, or give or offer to pay, allow, or give as an inducement to insurance a thing of value or other inducement that is not specified in the policy, including:
(A)  a rebate of premium payable on the policy;
(B)  a special favor or advantage in the dividends or other benefits to accrue on the policy;  or
(C)  paid employment or a contract for service;  or
(2)  give, sell, or purchase or offer to give, sell, or purchase as an inducement to insurance or in connection with insurance a thing of value that is not specified in the policy, including:
(A)  stocks, bonds, or other securities of an insurer or other corporation, association, or partnership;  or
(B)  dividends or profits to accrue on the stocks, bonds, or other securities of an insurer or other corporation, association, or partnership.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 543 - Prohibited Practices Related to Policy or Certificate of Membership › Subchapter A. Prohibitions › Section 543.004. Sharing of or Participation in Special Fund Prohibited

Sec. 543.004.  SHARING OF OR PARTICIPATION IN SPECIAL FUND PROHIBITED.  An insurer or an officer, agent, or representative of an insurer may not issue a policy that contains a special or board contract or similar provision by the terms of which the policy will share or participate in a special fund derived from a tax or a charge against any portion of the premium on another policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 543 - Prohibited Practices Related to Policy or Certificate of Membership › Subchapter B. Enforcement; Penalty › Section 543.051. Suspension or Revocation of Certificate, Charter, Permit, or License

Sec. 543.051.  SUSPENSION OR REVOCATION OF CERTIFICATE, CHARTER, PERMIT, OR LICENSE.  (a)  On a hearing, the commissioner may suspend or revoke the certificate, charter, permit, or license to engage in the business of insurance of A society, association, corporation, or person that violates Subchapter A.
(b)  The commissioner must give 10 days' notice of the hearing by certified mail to the society, association, corporation, or person.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 543 - Prohibited Practices Related to Policy or Certificate of Membership › Subchapter B. Enforcement; Penalty › Section 543.052. Criminal Penalty

Sec. 543.052.  CRIMINAL PENALTY.  (a)  A person commits an offense if the person violates Subchapter A.
(b)  An offense under this section is a Class A misdemeanor.
(c)  The penalty provided by this section is in addition to any other penalty specifically provided by law.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter A. General Prohibitions Against Discrimination by an Insurer or Health Maintenance Organization › Section 544.001. Applicability of Subchapter

Sec. 544.001.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to:
(1)  any legal entity engaged in the business of insurance in this state, including:
(A)  a capital stock insurance company;
(B)  a mutual insurance company;
(C)  a title insurance company;
(D)  a fraternal benefit society;
(E)  a local mutual aid association;
(F)  a statewide mutual assessment company;
(G)  a county mutual insurance company;
(H)  a Lloyd's plan;
(I)  a reciprocal or interinsurance exchange;
(J)  a stipulated premium company;
(K)  a group hospital service corporation;
(L)  a farm mutual insurance company;
(M)  a risk retention group;
(N)  an eligible surplus lines insurer; and
(O)  an agent, broker, or adjuster; and
(2)  a health maintenance organization.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2021, 87th Leg., R.S., Ch. 355 (H.B. 4030), Sec. 4, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter A. General Prohibitions Against Discrimination by an Insurer or Health Maintenance Organization › Section 544.002. Unfair Discrimination

Sec. 544.002.  UNFAIR DISCRIMINATION.  (a)  A person may not refuse to insure or provide coverage to an individual, refuse to continue to insure or provide coverage to an individual, limit the amount, extent, or kind of coverage available for an individual, or charge an individual a rate that is different from the rate charged to other individuals for the same coverage because of the individual's:
(1)  race, color, religion, or national origin;
(2)  age, gender, marital status, or geographic location;  or
(3)  disability or partial disability.
(b)  Subsection (a)(2) does not prohibit an insurer or health maintenance organization from considering marital status in defining persons eligible for dependent benefits.
(c)  Subsection (a) does not prevent requirements to provide title insurance coverage relating to possible community, homestead, or other marital rights in land.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter A. General Prohibitions Against Discrimination by an Insurer or Health Maintenance Organization › Section 544.003. Exceptions

Sec. 544.003.  EXCEPTIONS.  (a)  A person does not violate Section 544.002 by providing coverage only to persons who are required to obtain or maintain membership or qualification for membership in a club, group, or organization to be eligible for coverage if:
(1)  the requirements are uniform requirements of the insurer or health maintenance organization as a condition of providing coverage and are applied uniformly throughout this state;  and
(2)  the person does not engage in an act prohibited under Section 544.002 against a qualified member, except as provided by this section.
(b)  A person does not violate Section 544.002(a)(2) or (3) if the refusal, limitation, or charge is based on sound underwriting or actuarial principles reasonably related to actual or anticipated loss experience.  For the purposes of this subsection, a refusal, limitation, or charge relating to title insurance is based on sound actuarial principles if the action is based on an examination of title or on closing the transaction.
(c)  A person does not violate Section 544.002 if the refusal, limitation, or charge is required or authorized by law or a regulatory mandate.
(d)  A person does not violate Section 544.002 if policyholders or enrollees with similar expense factors but different loss exposures are charged different premiums or rates under a mass marketing plan.  The commissioner by rule shall define selected groups eligible for issuance of policies or evidences of coverage under a mass marketing plan.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter A. General Prohibitions Against Discrimination by an Insurer or Health Maintenance Organization › Section 544.004. Enforcement Actions

Sec. 544.004.  ENFORCEMENT ACTIONS.  (a)  A health maintenance organization or legal entity engaged in the business of insurance that is found to be in violation of or to have failed to comply with this subchapter is subject to the sanctions provided by Chapter 82 or administrative penalties authorized under Chapter 84.
(b)  In addition to the procedures provided by Subsection (a), the commissioner may use the cease and desist procedures authorized by Chapter 83.
(c)  It is not a defense to an action of the commissioner under this section that the contract giving rise to the alleged violation was entered into before August 28, 1995.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.012(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter B. Other General Prohibitions Against Discrimination by Insurers › Section 544.051. Applicability of Subchapter

Sec. 544.051.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to any individual, corporation, association, partnership, or other legal entity engaged in the business of insurance, including:
(1)  a fraternal benefit society;
(2)  a county mutual insurance company;
(3)  a Lloyd's plan;
(4)  a reciprocal or interinsurance exchange;
(5)  a farm mutual insurance company; and
(6)  an agent, broker, or adjuster.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2021, 87th Leg., R.S., Ch. 355 (H.B. 4030), Sec. 5, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter B. Other General Prohibitions Against Discrimination by Insurers › Section 544.052. Unfair Discrimination

Sec. 544.052.  UNFAIR DISCRIMINATION.  A person may not in any manner engage in unfair discrimination or permit unfair discrimination between individuals of the same class and of essentially the same hazard, including unfair discrimination in:
(1)  the amount of premium, policy fees, or rates charged for a policy or contract of insurance;
(2)  the benefits payable under a policy or contract of insurance;  or
(3)  any of the terms or conditions of a policy or contract of insurance.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter B. Other General Prohibitions Against Discrimination by Insurers › Section 544.053. Exceptions

Sec. 544.053.  EXCEPTIONS.  (a)  A person does not violate Section 544.052 if the refusal to insure or to continue to insure, the limiting of the amount, extent, or kind of coverage, or the charging of an individual a rate that is different from the rate charged another individual for the same coverage is based on sound actuarial principles.
(b)  A person does not violate Section 544.052 by providing insurance coverage only to persons who are required to obtain or maintain membership or qualification for membership in a club, group, or organization to be eligible for coverage if:
(1)  the requirements are uniform requirements of the insurer as a condition of providing insurance and are applied uniformly throughout this state;  and
(2)  the person does not engage in an act prohibited under Section 544.052 against a qualified member, except as provided by this section.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter B. Other General Prohibitions Against Discrimination by Insurers › Section 544.054. Judicial Action; Award by Court

Sec. 544.054.  JUDICIAL ACTION;  AWARD BY COURT.  (a)  A person who has sustained economic damages as the result of a violation of Section 544.052 may maintain only in a Travis County district court an action against the person who violated that section.
(b)  An action under this section must be commenced on or before the second anniversary of:
(1)  the date on which the plaintiff was denied insurance or the unfair act occurred; or
(2)  the date the plaintiff, in the exercise of reasonable diligence, should have discovered the occurrence of the unfair act.
(c)  A plaintiff who prevails in an action under this section may obtain:
(1)  the amount of economic damages, court costs, and attorney's fees;  and
(2)  an order enjoining the violation.
(d)  Court costs under Subsection (c) may include any reasonable and necessary expert witness fees.
(e)  If the trier of fact finds that the defendant knowingly committed an act prohibited by Section 544.052, the court may award a civil penalty in an amount of not more than $25,000 for each claimant.
(f)  The court shall award the defendant reasonable and necessary attorney's fees if the court finds that an action under this section was:
(1)  groundless;  and
(2)  brought in bad faith or for the purpose of harassment.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.013(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter C. English Fluency › Section 544.101. Definitions

Sec. 544.101.  DEFINITIONS.  In this subchapter:
(1)  "Health benefit plan issuer" means an insurance company, association, organization, group hospital service corporation, or health maintenance organization that delivers or issues for delivery an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an evidence of coverage that provides health insurance or health care benefits.  The term includes:
(A)  a life, health, and accident insurance company operating under Chapter 841 or 982;
(B)  a general casualty insurance company operating under Chapter 861;
(C)  a fraternal benefit society operating under Chapter 885;
(D)  a mutual life insurance company operating under Chapter 882;
(E)  a local mutual aid association operating under Chapter 886;
(F)  a statewide mutual assessment company operating under Chapter 881;
(G)  a mutual assessment company or mutual assessment life, health, and accident association operating under Chapter 887;
(H)  a mutual insurance company operating under Chapter 883 that writes coverage other than life insurance;
(I)  a Lloyd's plan operating under Chapter 941;
(J)  a reciprocal exchange operating under Chapter 942;  and
(K)  a stipulated premium company operating under Chapter 884.
(2)  "Underwriting guideline" means a written, electronic, or oral rule, standard, marketing decision, or practice that is used by a health benefit plan issuer or an agent of a health benefit plan issuer to examine, bind, accept, reject, renew or refuse to renew, cancel, or limit coverages available to classes of consumers or charge a different rate for the same coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter C. English Fluency › Section 544.102. Applicability of Subchapter

Sec. 544.102.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to any health insurance policy, agreement, contract, or evidence of coverage delivered or issued for delivery by a health benefit plan issuer.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter C. English Fluency › Section 544.103. Prohibition on Use of Certain Guidelines

Sec. 544.103.  PROHIBITION ON USE OF CERTAIN GUIDELINES.  (a)  A health benefit plan issuer may not use an underwriting guideline that is based on:
(1)  the ability of an insured or enrollee or an applicant for insurance coverage or health care benefits to speak English fluently;  or
(2)  the literacy in English of the insured, enrollee, or applicant.
(b)  An applicant has the burden of proof to establish a violation of this subchapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle C - Deceptive, Unfair, and Prohibited Practices › Chapter 544 - Prohibited Discrimination › Subchapter D. Family Violence › Section 544.151. Definition

Sec. 544.151.  DEFINITION.  In this subchapter, "family violence" means an act between individuals who reside together or resided together in which one individual:
(1)  wilfully attempts to cause bodily injury, or wilfully or wantonly causes bodily injury, to another;
(2)  wilfully by physical threat places another in fear of imminent bodily injury;
(3)  engages in the act of sexual intercourse with a minor under 16 years of age who is not the spouse of the individual;  or
(4)  engages, with the intent to arouse or to satisfy the sexual desires of the individual, a minor under 16 years of age who is not the spouse of the individual, or both the individual and the minor, in any lewd fondling or touching of the individual or the minor.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.