reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter C. Investigations › Section 701.104. Department Investigators

Sec. 701.104.  DEPARTMENT INVESTIGATORS.  (a)  The commissioner may:
(1)  employ investigators as necessary to enforce this chapter;  and
(2)  commission those investigators as peace officers.
(b)  If the commissioner commissions investigators as peace officers, the commissioner shall appoint a chief investigator who:
(1)  is commissioned as a peace officer;  and
(2)  is qualified by training and experience in law enforcement to supervise, direct, and administer the activities of the commissioned investigators.
(c)  An investigator employed by the department as a peace officer must meet the requirements for a peace officer under Chapter 1701, Occupations Code.
(d)  The commissioner shall ensure that a peace officer commissioned under Subsection (a) is compensated according to Schedule C of the position classification salary schedule prescribed by the General Appropriations Act.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1143 (H.B. 2816), Sec. 3, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter C. Investigations › Section 701.105. Assistance From Law Enforcement

Sec. 701.105.  ASSISTANCE FROM LAW ENFORCEMENT.  An investigator employed by the department may request assistance from local law enforcement officers in conducting an investigation authorized by this chapter.
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 F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter C. Investigations › Section 701.106. Subpoena Authority

Sec. 701.106.  SUBPOENA AUTHORITY.  (a)  The commissioner may issue a subpoena to compel the attendance and testimony of a witness or, except as provided by Subsection (b), the production of materials relevant to an investigation under this chapter.
(b)  A person is not required to produce an item subpoenaed under Subsection (a) if the item can only be identified by writing and executing a special computer program for that purpose.
(c)  A person possessing materials located outside this state that are requested by the commissioner may make the materials available to the commissioner or a representative of the commissioner for examination at the place where the materials are located.  The commissioner may designate a representative, including an official of the state in which the materials are located, to examine the materials.  The commissioner may respond to a similar request from an official of another state or the United States.
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 F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter C. Investigations › Section 701.107. Certain Agencies' Duty to Provide Information

Sec. 701.107.  CERTAIN AGENCIES' DUTY TO PROVIDE INFORMATION.  (a)  On the insurance fraud unit's request, an authorized governmental agency or a state licensing agency shall provide material, documents, reports, complaints, or other evidence to the insurance fraud unit.
(b)  Compliance with Subsection (a) by an authorized governmental agency or a state licensing agency does not constitute waiver of any otherwise applicable privilege or confidentiality requirement.
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 F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter C. Investigations › Section 701.108. Insurer's Duty to Provide Information

Sec. 701.108.  INSURER'S DUTY TO PROVIDE INFORMATION.  (a)  On the written request of an authorized governmental agency, an insurer shall provide to the agency any relevant information or material relating to a matter under investigation.
(b)  An insurer must respond to a request under Subsection (a) from the department not later than the 15th day after the date the request is received.  On written request of the insurer, the department shall extend the period 10 days.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 82 (S.B. 411), Sec. 1, eff. September 1, 2013.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter C. Investigations › Section 701.109. Request for Investigation by Insurer

Sec. 701.109.  REQUEST FOR INVESTIGATION BY INSURER.  (a)  An insurer who conducts an independent investigation of suspected insurance fraud is not required to complete that investigation before requesting that the commissioner conduct an investigation.
(b)  When requesting the commissioner to conduct an investigation, the insurer shall draft a report of the insurer's findings and submit the report and any related investigation file to the commissioner as soon as practicable on the conclusion of the insurer's independent investigation.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 1282 (H.B. 2388), Sec. 2, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter D. Insurance Fraud Information; Confidentiality › Section 701.151. Confidentiality of Department Information

Sec. 701.151.  CONFIDENTIALITY OF DEPARTMENT INFORMATION.  (a)  Information or material acquired by the department that is relevant to an investigation by the insurance fraud unit is not a public record for the period the commissioner considers reasonably necessary to:
(1)  complete the investigation;
(2)  protect the person under investigation from unwarranted injury;  or
(3)  serve the public interest.
(b)  The information or material is not subject to a subpoena by another governmental entity, other than a grand jury subpoena, until:
(1)  the information or material is released for public inspection by the commissioner;  or
(2)  after notice and a hearing a district court determines that obeying the subpoena would not jeopardize the public interest and any investigation by the commissioner.
(c)  This section does not affect the conduct of a contested case under Chapter 2001, Government Code.
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 F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter D. Insurance Fraud Information; Confidentiality › Section 701.152. Confidentiality of Authorized Governmental Agency Information

Sec. 701.152.  CONFIDENTIALITY OF AUTHORIZED GOVERNMENTAL AGENCY INFORMATION.  Information or material acquired under this chapter by an authorized governmental agency is privileged and is not a public record.  The information or material is not subject to a subpoena, other than a grand jury subpoena, unless, after reasonable notice to the insurer and agency and a hearing, a district court determines that obeying the subpoena would not jeopardize the public interest and any investigation by the agency.
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 F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter D. Insurance Fraud Information; Confidentiality › Section 701.153. Disclosure of Information to Certain Agencies

Sec. 701.153.  DISCLOSURE OF INFORMATION TO CERTAIN AGENCIES.  An authorized governmental agency may release to another authorized governmental agency or the department and the department may release to an authorized governmental agency information or material provided under this chapter.
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 F - Insurance Fraud and Identity Theft › Chapter 701 - Insurance Fraud Investigations › Subchapter D. Insurance Fraud Information; Confidentiality › Section 701.154. Disclosure of Information to Public

Sec. 701.154.  DISCLOSURE OF INFORMATION TO PUBLIC.  (a)  Except as otherwise provided by law, an authorized governmental agency or an insurer that possesses or receives information or material under this chapter may not release that information or material to the public.
(b)  Information provided under this chapter by an insurer to the insurance fraud unit or an authorized governmental agency is not subject to public disclosure.  The information may be used by the insurance fraud unit or authorized governmental agency only in performing duties described by this chapter.
(c)  Notwithstanding Section 701.151, the commissioner may not release evidence obtained under Section 701.107 for public inspection if releasing the evidence would violate a privilege held by or a confidentiality requirement imposed on the agency from which the evidence was obtained.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter A. General Provisions › Section 703.001. Definition

Sec. 703.001.  DEFINITION.  In this chapter, "covered entity" means a health maintenance organization or insurer regulated by the department, including:
(1)  a stock life, health, or accident insurance company;
(2)  a mutual life, health, or accident insurance company;
(3)  a stock fire or casualty insurance company;
(4)  a mutual fire or casualty insurance company;
(5)  a Mexican casualty insurance company;
(6)  a Lloyd's plan;
(7)  a reciprocal or interinsurance exchange;
(8)  a fraternal benefit society;
(9)  a title insurance company;
(10)  a stipulated premium company;
(11)  a nonprofit legal services corporation;
(12)  a statewide mutual assessment company;
(13)  a local mutual aid association;
(14)  a local mutual burial association;
(15)  an association exempt under Section 887.102;
(16)  a nonprofit hospital, medical, or dental service corporation, including a corporation subject to Chapter 842;
(17)  a county mutual insurance company; and
(18)  a farm mutual insurance company.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 967 (S.B. 2065), Sec. 5.005, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter A. General Provisions › Section 703.002. Right of Intervention

Sec. 703.002.  RIGHT OF INTERVENTION.  This chapter does not affect the right of any person, including a state agency, to intervene in an antifraud action brought under this chapter.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter B. Antifraud Action; Certification › Section 703.051. Antifraud Action Authorized

Sec. 703.051.  ANTIFRAUD ACTION AUTHORIZED.  (a)  A covered entity acting alone or through a person, corporation, or legal entity affiliated with the covered entity may bring an action in a court, including a counter-action or cross-action, to:
(1)  prevent a person from fraudulently engaging in the business of insurance or the business of a health maintenance organization in this state;  or
(2)  redress the effects of a person who has fraudulently engaged in the business of insurance or the business of a health maintenance organization in this state.
(b)  An action may be brought under this section if:
(1)  the acts of the person may adversely affect or have adversely affected at least 10 residents of this state;  and
(2)  the department has not brought an antifraud action in a court against the person.
(c)  An action may be brought under this section regardless of whether the covered entity is directly affected by the person's acts.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter B. Antifraud Action; Certification › Section 703.052. Request for Certification

Sec. 703.052.  REQUEST FOR CERTIFICATION.  A covered entity may request the court to certify that the action is an antifraud action under this chapter.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter B. Antifraud Action; Certification › Section 703.053. Notice of Request for Certification

Sec. 703.053.  NOTICE OF REQUEST FOR CERTIFICATION.  (a)  When a covered entity files a request for certification, the covered entity shall provide at least 10 days' notice of the request to the department and the attorney general by serving each with a copy of the request in the manner provided for service of notice under Rule 21a, Texas Rules of Civil Procedure.
(b)  The covered entity shall provide the notice regardless of whether the department or the state is a party to the action.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter B. Antifraud Action; Certification › Section 703.054. Hearing on Request for Certification

Sec. 703.054.  HEARING ON REQUEST FOR CERTIFICATION.  As soon as practicable after a covered entity files a request for certification, the court shall hold a hearing to determine whether the action is an antifraud action under this chapter.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter B. Antifraud Action; Certification › Section 703.055. Certification

Sec. 703.055.  CERTIFICATION.  The court shall certify that the action is an antifraud action if the court determines that:
(1)  the requirements of Section 703.051 are met;  and
(2)  the pleadings and evidence demonstrate that the covered entity has a probable right of recovery.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter C. Expenses of Antifraud Action › Section 703.101. Determination of Expenses

Sec. 703.101.  DETERMINATION OF EXPENSES.  (a)  The court that certifies an action as an antifraud action by order may determine the amount of reasonable and necessary expenses incurred in bringing the action, including court costs, reasonable attorney's fees, witness fees, fees of experts, and deposition expenses.
(b)  In making the determination, the court may consider the contribution to the action of any person, including a state agency, that has intervened in the action.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter C. Expenses of Antifraud Action › Section 703.102. Deduction or Offset for Expenses; Reimbursement

Sec. 703.102.  DEDUCTION OR OFFSET FOR EXPENSES;  REIMBURSEMENT.  (a)  Subject to Subsection (b), a covered entity has a deduction or offset against any obligation, assessment, or debt owed by the covered entity to this state in the amount of the reasonable and necessary expenses determined by the court order.
(b)  The covered entity shall reimburse the state the amount of any expenses actually recovered from the parties to the private antifraud action under a final judgment awarding, wholly or partly, expenses to or for the covered entity's benefit.  The amount of reimbursement may not exceed the actual amount of deductions or offsets taken by the covered entity.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter C. Expenses of Antifraud Action › Section 703.103. Assignment of Deduction or Offset

Sec. 703.103.  ASSIGNMENT OF DEDUCTION OR OFFSET.  The covered entity may assign the covered entity's deduction or offset to any other covered entity or reinsurer.
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 F - Insurance Fraud and Identity Theft › Chapter 703 - Covered Entity's Antifraud Action › Subchapter C. Expenses of Antifraud Action › Section 703.104. Treatment of Deduction or Offset as Admitted Asset

Sec. 703.104.  TREATMENT OF DEDUCTION OR OFFSET AS ADMITTED ASSET.  A covered entity or a covered entity's assignee entitled to an offset or deduction that has not been used may show, in the covered entity's or assignee's books and records, the balance of the deduction or offset as an admitted asset for any purpose.
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 F - Insurance Fraud and Identity Theft › Chapter 704 - Antifraud Programs › Subchapter A. General Provisions › Section 704.001. Definition

Sec. 704.001.  DEFINITION.  In this chapter, "plan issuer" means:
(1)  a health insurer, including a life, health, and accident insurer, a health and accident insurer, a health maintenance organization, and any other person operating under Chapter 841, 842, 843, 884, 885, 982, or 1501 who is authorized to issue, issue for delivery, or deliver insurance policies, certificates, contracts, or evidences of coverage in this state;
(2)  an approved nonprofit health corporation that holds a certificate of authority issued under Chapter 844;  or
(3)  an insurer authorized by the department to write workers' compensation insurance in this state.
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 F - Insurance Fraud and Identity Theft › Chapter 704 - Antifraud Programs › Subchapter A. General Provisions › Section 704.002. Notice Relating to False or Fraudulent Claims Required

Sec. 704.002.  NOTICE RELATING TO FALSE OR FRAUDULENT CLAIMS REQUIRED.  (a)  A plan issuer who provides a form for a person to make a claim against or to give notice of the person's intent to make a claim against a policy, certificate, contract, or evidence of coverage issued by the issuer must include on the form, in comparative prominence with the other content on the form, a statement that is substantially similar to the following:  "Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison."
(b)  This section does not apply to a form provided to make a claim against a policy issued by a reinsurer.
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 F - Insurance Fraud and Identity Theft › Chapter 704 - Antifraud Programs › Subchapter B. Antifraud Plans › Section 704.051. Antifraud Plan Required for Certain Plan Issuers

Sec. 704.051.  ANTIFRAUD PLAN REQUIRED FOR CERTAIN PLAN ISSUERS.  A plan issuer who collects direct written premium shall adopt an antifraud plan under 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 F - Insurance Fraud and Identity Theft › Chapter 704 - Antifraud Programs › Subchapter B. Antifraud Plans › Section 704.052. Antifraud Plan Requirements

Sec. 704.052.  ANTIFRAUD PLAN REQUIREMENTS.  An antifraud plan adopted by a plan issuer under this subchapter must include a description of the issuer's procedures for:
(1)  detecting and investigating possible fraudulent insurance acts;  and
(2)  reporting possible fraudulent insurance acts to the insurance fraud unit.
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 F - Insurance Fraud and Identity Theft › Chapter 704 - Antifraud Programs › Subchapter B. Antifraud Plans › Section 704.053. Filing of Antifraud Plan

Sec. 704.053.  FILING OF ANTIFRAUD PLAN.  A plan issuer may annually file the issuer's antifraud plan adopted under this subchapter with the insurance fraud unit.
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 F - Insurance Fraud and Identity Theft › Chapter 704 - Antifraud Programs › Subchapter B. Antifraud Plans › Section 704.054. Fraud and Abuse Plans Under Certain State Programs; Enforcement

Sec. 704.054.  FRAUD AND ABUSE PLANS UNDER CERTAIN STATE PROGRAMS;  ENFORCEMENT.  (a)  A fraud and abuse plan put in place by a plan issuer participating in the Medicaid STAR or STAR + Plus program or the child health plan program under Chapter 62, Health and Safety Code, and approved by a health and human services agency meets the requirements of this subchapter.
(b)  If a plan issuer described by Subsection (a) is required by law to report possible fraudulent insurance acts to a health and human services agency or the office of the attorney general, the issuer is not required to report those acts to the insurance fraud unit.
(c)  The insurance fraud unit, the office of the attorney general, and the health and human services agencies shall coordinate enforcement efforts with respect to fraudulent insurance acts covered by this chapter relating to the Medicaid program or the child health plan program.
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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter A. General Provisions › Section 705.001. Definition

Sec. 705.001.  DEFINITION.  In this subchapter, "insurance policy" means a contract or policy 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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter A. General Provisions › Section 705.002. Applicability of Subchapter

Sec. 705.002.  APPLICABILITY OF SUBCHAPTER.  Except as provided by Section 705.005, this subchapter applies to each insurance policy issued or contracted for in this state.
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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter A. General Provisions › Section 705.003. Policy Provision: Misrepresentation in Proof of Loss or Death

Sec. 705.003.  POLICY PROVISION:  MISREPRESENTATION IN PROOF OF LOSS OR DEATH.  (a)  An insurance policy provision that states that a misrepresentation, including a false statement, made in a proof of loss or death makes the policy void or voidable:
(1)  has no effect;  and
(2)  is not a defense in a suit brought on the policy.
(b)  Subsection (a) does not apply if it is shown at trial that the misrepresentation:
(1)  was fraudulently made;
(2)  misrepresented a fact material to the question of the insurer's liability under the policy;  and
(3)  misled the insurer and caused the insurer to waive or lose a valid defense to the 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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter A. General Provisions › Section 705.004. Policy Provision: Misrepresentation in Policy Application

Sec. 705.004.  POLICY PROVISION:  MISREPRESENTATION IN POLICY APPLICATION.  (a)  An insurance policy provision that states that false statements made in the application for the policy or in the policy make the policy void or voidable:
(1)  has no effect;  and
(2)  is not a defense in a suit brought on the policy.
(b)  Subsection (a) does not apply if it is shown at trial that the matter misrepresented:
(1)  was material to the risk;  or
(2)  contributed to the contingency or event on which the policy became due and payable.
(c)  It is a question of fact whether a misrepresentation made in the application for the policy or in the policy itself was material to the risk or contributed to the contingency or event on which the policy became due and payable.
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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter A. General Provisions › Section 705.005. Notice to Insured of Misrepresentations

Sec. 705.005.  NOTICE TO INSURED OF MISREPRESENTATIONS.  (a)  This section applies to any suit brought on an insurance policy issued or contracted for after June 29, 1903.
(b)  A defendant may use as a defense a misrepresentation made in the application for or in obtaining an insurance policy only if the defendant shows at trial that before the 91st day after the date the defendant discovered the falsity of the representation, the defendant gave notice that the defendant refused to be bound by the policy:
(1)  to the insured, if living;  or
(2)  to the owners or beneficiaries of the insurance policy, if the insured was deceased.
(c)  This section does not:
(1)  make available as a defense an immaterial misrepresentation;  or
(2)  affect the provisions of Section 705.004.
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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter B. Special Provisions Related to Life, Accident, and Health Insurance Policies › Section 705.051. Immaterial Misrepresentation in Life, Accident, or Health Insurance Application

Sec. 705.051.  IMMATERIAL MISREPRESENTATION IN LIFE, ACCIDENT, OR HEALTH INSURANCE APPLICATION.  A misrepresentation in an application for a life, accident, or health insurance policy does not defeat recovery under the policy unless the misrepresentation:
(1)  is of a material fact;  and
(2)  affects the risks assumed.
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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter C. Special Provisions Related to Life Insurance Policies › Section 705.101. Definition

Sec. 705.101.  DEFINITION.  In this subchapter, "insurance policy" means a contract or policy 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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter C. Special Provisions Related to Life Insurance Policies › Section 705.102. Applicability of Subchapter

Sec. 705.102.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to any insurance policy issued or contracted for in this state.
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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter C. Special Provisions Related to Life Insurance Policies › Section 705.103. Documents to Accompany Policy

Sec. 705.103.  DOCUMENTS TO ACCOMPANY POLICY.  Except as otherwise provided by this code, a life insurance policy must be accompanied by a copy of:
(1)  the policy application;  and
(2)  any questions and answers given in connection with the application.
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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter C. Special Provisions Related to Life Insurance Policies › Section 705.104. Misrepresentation in Application for Life Insurance

Sec. 705.104.  MISREPRESENTATION IN APPLICATION FOR LIFE INSURANCE.  A defense based on a misrepresentation in the application for, or in obtaining, a life insurance policy on the life of a person in or residing in this state is not valid or enforceable in a suit brought on the policy on or after the second anniversary of the date of issuance of the policy if premiums due on the policy during the two years have been paid to and received by the insurer, unless:
(1)  the insurer has notified the insured of the insurer's intention to rescind the policy because of the misrepresentation;  or
(2)  it is shown at the trial that the misrepresentation was:
(A)  material to the risk;  and
(B)  intentionally made.
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 F - Insurance Fraud and Identity Theft › Chapter 705 - Misrepresentations by Policyholders › Subchapter C. Special Provisions Related to Life Insurance Policies › Section 705.105. Applicability of Other Law

Sec. 705.105.  APPLICABILITY OF OTHER LAW.  Subchapter A does not apply to a life insurance policy:
(1)  that contains a provision making the policy incontestable after two years or less;  and
(2)  on which premiums have been duly paid.
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 F - Insurance Fraud and Identity Theft › Chapter 706 - Identity Theft Insurance › Section 706.001. Definitions

Sec. 706.001.  DEFINITIONS.  (a)  The definitions adopted under Sections 2251.002 and 2301.002 and the terms described by Sections 2251.003 and 2301.003  apply to this chapter.
(b)  In this chapter, "identity theft" means a criminal offense described by Section 32.51, Penal Code, or a substantially similar federal law or law in another state.
Added by Acts 2005, 79th Leg., Ch. 102 (S.B. 99), Sec. 3, eff. September 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2D.017, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 706 - Identity Theft Insurance › Section 706.002. Coverage Authorized

Sec. 706.002.  COVERAGE AUTHORIZED.  (a)  An insurer authorized to write property and casualty insurance in this state may offer and issue insurance coverage for a loss suffered by a policyholder as a result of the policyholders' being a victim of identity theft or attempted identity theft.
(b)  Coverage authorized by Subsection (a) may be:
(1)  offered as a separate insurance policy or as a rider or endorsement to:
(A)  a residential and commercial property insurance policy; or
(B)  a personal or commercial casualty insurance policy; and
(2)  underwritten and issued as an individual or group insurance policy.
Added by Acts 2005, 79th Leg., Ch. 102 (S.B. 99), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 706 - Identity Theft Insurance › Section 706.003. Eligible Policyholders

Sec. 706.003.  ELIGIBLE POLICYHOLDERS.  (a)  An insurer may issue coverage authorized under Section 706.002 to:
(1)  an individual; or
(2)  a group, business, employer, association, trustee, or other entity for the benefit of its members, customers, employees, members, or beneficiaries.
(b)  An entity described by Subsection (a)(2) may be a group that:
(1)  is formed solely for the purpose of obtaining insurance coverage under this chapter; or
(2)  has already been formed for a purpose other than for obtaining insurance coverage under this chapter and that is described by Subsection (a)(2).
Added by Acts 2005, 79th Leg., Ch. 102 (S.B. 99), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 706 - Identity Theft Insurance › Section 706.004. Rates and Forms

Sec. 706.004.  RATES AND FORMS.  Notwithstanding any other law, rates and forms for insurance coverage issued under this chapter are governed by:
(1)  Subchapters A-E, Chapter 2251;
(2)  Subchapter A, Chapter 2301; and
(3)  Article 5.13-2.
Added by Acts 2005, 79th Leg., Ch. 102 (S.B. 99), Sec. 3, eff. September 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2D.018, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 706 - Identity Theft Insurance › Section 706.005. Rules

Sec. 706.005.  RULES.  The commissioner may adopt rules as necessary to implement this chapter.
Added by Acts 2005, 79th Leg., Ch. 102 (S.B. 99), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 707 - Payment of Insurance Deductible › Section 707.001. Definitions

Sec. 707.001.  DEFINITIONS.  In this chapter:
(1)  "Person" means an individual, corporation, association, partnership, limited liability company, or other legal entity.
(2)  "Property insurance policy" means an insurance policy issued by an insurer, including a county mutual insurance company, farm mutual insurance company, Lloyd's plan, or reciprocal or interinsurance exchange, that provides first-party coverage for loss of or damage to real property.
Added by Acts 2019, 86th Leg., R.S., Ch. 1099 (H.B. 2102), Sec. 1, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 707 - Payment of Insurance Deductible › Section 707.002. Payment of Deductible Required

Sec. 707.002.  PAYMENT OF DEDUCTIBLE REQUIRED.  A person insured under a property insurance policy shall pay any deductible applicable to a first-party claim made under the policy.
Added by Acts 2019, 86th Leg., R.S., Ch. 1099 (H.B. 2102), Sec. 1, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 707 - Payment of Insurance Deductible › Section 707.003. Consumer Education

Sec. 707.003.  CONSUMER EDUCATION.  The department, in coordination with other state agencies and stakeholders as necessary, shall develop and implement an education program related to the payment of property insurance policy deductibles.  The program must:
(1)  provide reasonable methods to educate insurance consumers and providers of goods or services that are regularly paid for from proceeds of property insurance claims; and
(2)  include information regarding:
(A)  the requirements of this chapter and Section 27.02, Business & Commerce Code; and
(B)  the conduct prohibited by Section 27.02, Business & Commerce Code.
Added by Acts 2019, 86th Leg., R.S., Ch. 1099 (H.B. 2102), Sec. 1, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 707 - Payment of Insurance Deductible › Section 707.004. Reasonable Proof of Payment

Sec. 707.004.  REASONABLE PROOF OF PAYMENT.  An insurer that issues a property insurance policy with replacement cost coverage may refuse to pay a claim for withheld recoverable depreciation or a replacement cost holdback under the policy until the insurer receives reasonable proof of payment by the policyholder of any deductible applicable to the claim.  Reasonable proof of payment includes a canceled check, money order receipt, credit card statement, or copy of an executed installment plan contract or other financing arrangement that requires full payment of the deductible over time.
Added by Acts 2019, 86th Leg., R.S., Ch. 1099 (H.B. 2102), Sec. 1, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle F - Insurance Fraud and Identity Theft › Chapter 707 - Payment of Insurance Deductible › Section 707.005. Rulemaking

Sec. 707.005.  RULEMAKING.  The commissioner may adopt rules as necessary to implement this chapter. Section 2001.0045, Government Code, does not apply to rules adopted under this section.
Added by Acts 2019, 86th Leg., R.S., Ch. 1099 (H.B. 2102), Sec. 1, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter A. General Provisions › Section 751.001. Short Title

Sec. 751.001.  SHORT TITLE.  This chapter may be cited as the Insurance Market Conduct Surveillance Act.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter A. General Provisions › Section 751.002. Purpose and Scope

Sec. 751.002.  PURPOSE AND SCOPE.  (a)  The purpose of this chapter is to establish a framework for department market conduct actions, including:
(1)  processes and systems for identifying, assessing, and prioritizing market conduct problems that have a substantial adverse impact on consumers, policyholders, and claimants;
(2)  development of appropriate market conduct actions by the commissioner as required to:
(A)  substantiate market conduct problems; and
(B)  remedy significant market conduct problems; and
(3)  procedures to communicate and coordinate market conduct actions with other states to foster the most efficient and effective use of resources.
(b)  Notwithstanding any other law of this state, the department or commissioner, as applicable, may undertake market analysis or market conduct action only as provided by this chapter.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter A. General Provisions › Section 751.004. Immunity

Sec. 751.004.  IMMUNITY.  (a)  A cause of action does not arise, and liability may not be imposed, for any statements made or conduct performed in good faith while implementing this chapter, against:
(1)  the commissioner;
(2)  an authorized representative of the commissioner; or
(3)  an examiner appointed by the commissioner.
(b)  A cause of action does not arise, and liability may not be imposed, against any person for the act of communicating or delivering information or data to the commissioner or the commissioner's authorized representative or examiner under an examination made under this chapter, if the act of communication or delivery was performed in good faith and without fraudulent intent or the intent to deceive.
(c)  A person identified in Subsection (a) is entitled to attorney's fees and costs if the person is the prevailing party in a civil cause of action for libel, slander, or any other relevant tort arising out of activities conducted in implementing this chapter, and the party bringing the action was not substantially justified in doing so.  For purposes of this subsection, an action is "substantially justified" if the action had a reasonable basis in law or fact at the time that it was initiated.
(d)  This section does not abrogate or modify any common law or statutory privilege or immunity.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter B. General Powers and Duties of Commissioner › Section 751.051. Participation in National Market Conduct Databases

Sec. 751.051.  PARTICIPATION IN NATIONAL MARKET CONDUCT DATABASES.  (a)  The commissioner shall collect and report market data to the National Association of Insurance Commissioners' market information systems, including the complaint database system, the examination tracking system, the regulatory information retrieval system, or other successor systems of that association, as determined by the commissioner.
(b)  Information collected and maintained by the department shall be compiled in a manner that meets the requirements of the National Association of Insurance Commissioners.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter B. General Powers and Duties of Commissioner › Section 751.052. Coordination With Other States; Registration of Contract Examiner

Sec. 751.052.  COORDINATION WITH OTHER STATES; REGISTRATION OF CONTRACT EXAMINER.  (a)  The commissioner shall coordinate the department's market analysis and examination efforts with other states through the National Association of Insurance Commissioners.
(b)  A person with whom another state contracts to perform any market analysis or examination initiated by the other state of an insurer domiciled in this state shall register with and provide the following information to the department's chief examiner:
(1)  the person's name;
(2)  if the person is not an individual, the identity of each examiner or other person who will perform any part of the market analysis or examination;
(3)  the name of the state that contracted with the person;
(4)  the identity of the insurer to be examined;
(5)  a description of each issue that the person has been contracted to examine;
(6)  an estimate of the examination costs to be charged to the insurer to be examined;
(7)  a copy of any contract between the person and the state regulatory body that initiated the examination and the letter authorizing the examination; and
(8)  a list of the previous examinations conducted on the same insurer on behalf of any state within the last three years.
(b-1)  On accepting a person's registration under Subsection (b), the department shall send written confirmation of the acceptance to:
(1)  the person;
(2)  the insurer to be examined; and
(3)  the state regulatory body that initiated the examination.
(c)  It is a violation of this code for a person to accept compensation from multiple states for the same examination, if doing so results in duplicative costs to the insurer being examined.  It is not a violation of this code for:
(1)  an examiner to conduct an examination of an insurer for the benefit of multiple states in a coordinated examination; and
(2)  the examiner to accept compensation from the states participating in the coordinated examination to reduce the examination costs to the insurer being examined.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1030 (H.B. 4359), Sec. 1, eff. June 19, 2009.
Acts 2011, 82nd Leg., R.S., Ch. 185 (S.B. 1229), Sec. 2, eff. May 28, 2011.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter B. General Powers and Duties of Commissioner › Section 751.053. Information From Commissioner

Sec. 751.053.  INFORMATION FROM COMMISSIONER.  (a)  At least once annually or more frequently if determined necessary by the commissioner, the commissioner shall provide in an appropriate manner to insurers and other entities subject to this code information regarding new laws and rules, enforcement actions, and other information the commissioner considers relevant to ensure compliance with market conduct requirements.
(b)  The commissioner may provide the notice required under Subsection (a) in an electronic format that is designed to give insurers and other entities adequate notice.
(c)  Failure by the commissioner to provide the information described by Subsection (a) does not constitute a defense for an insurer who fails to comply with an insurance law of this state.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter B. General Powers and Duties of Commissioner › Section 751.054. Report of Violations

Sec. 751.054.  REPORT OF VIOLATIONS.  (a)  The commissioner shall designate an individual within the department whose responsibilities shall include the receipt of information from employees of insurers and other entities regulated by the department regarding violations of laws or rules by their employers.  The commissioner's designee shall be properly trained in the handling of that information.
(b)  Information received under this section is a confidential communication and is not public information.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter B. General Powers and Duties of Commissioner › Section 751.055. Exercise of Subpoena Authority

Sec. 751.055.  EXERCISE OF SUBPOENA AUTHORITY.  The commissioner has the subpoena power authorized by Subchapter C, Chapter 36, for the production of documents under this chapter and enforcement of this subtitle.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.