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 751.003. Definitions

Sec. 751.003.  DEFINITIONS.  (a)  In this chapter:
(1)  "Complaint" means a written or documented oral communication, the primary intent of which is to express a grievance or an expression of dissatisfaction.
(2)  "Desk examination" means a targeted examination conducted by an examiner at a location other than an insurer's premises.  The term includes an examination performed at the department's offices during which the insurer provides requested documents for department review by hard copy or by microfiche, disk, or other electronic media.
(3)  "Market analysis" means a process under which market conduct surveillance personnel collect and analyze information from filed schedules, surveys, required reports, and other sources as necessary to:
(A)  develop a baseline understanding of the marketplace; and
(B)  identify insurer patterns or practices that:
(i)  deviate significantly from the norm; or
(ii)  pose a potential risk to the insurance consumer.
(4)  "Market analysis handbook" means the outline of the elements and objectives of market analysis as developed and adopted by the National Association of Insurance Commissioners, and used to establish a uniform process by which states may establish and implement market analysis programs.
(5)  "Market conduct action" means any activity that the commissioner may initiate to assess and address insurer market practices before conducting a targeted examination.  The term does not include a commissioner action taken to resolve:
(A)  an individual consumer complaint; or
(B)  another report relating to a specific instance of insurer misconduct.
(6)  "Market conduct examination" means a review of one or more lines of business of an insurer domiciled in this state that is not conducted for cause.  The term includes a review of rating, tier classification, underwriting, policyholder service, claims, marketing and sales, producer licensing, complaint handling practices, or compliance procedures and policies.
(7)  "Market conduct examiners handbook" means the set of guidelines, developed and adopted by the National Association of Insurance Commissioners, that document established practices to be used by market conduct surveillance personnel in developing and executing an examination under this chapter.
(8)  "Market conduct surveillance personnel" means those individuals employed by or under contract with the department who collect, analyze, review, or act on information regarding insurer patterns or practices.
(9)  "Market conduct uniform examination procedures" means the set of guidelines developed and adopted by the National Association of Insurance Commissioners designed to be used by market conduct surveillance personnel in conducting an examination under this chapter.
(10)  "On-site examination" means a targeted examination that is conducted at:
(A)  the insurer's home office; or
(B)  another location at which the records under review are stored.
(11)  "Qualified contract examiner" means a person qualified by education, experience, and any applicable professional designations who is under contract with the commissioner to perform market conduct actions.
(12)  "Standard data request" means the set of field names and descriptions developed and adopted by the National Association of Insurance Commissioners for use by market conduct surveillance personnel in an examination.
(13)  "Targeted examination" means a limited review and analysis, conducted through a desk examination or an on-site examination and in accordance with the market conduct uniform examination procedures, of specific insurer conduct, practices, or risks identified through market analysis that have not been remedied by the insurer, including:
(A)  underwriting and rating;
(B)  marketing and sales;
(C)  complaint handling operations and management;
(D)  advertising materials;
(E)  licensing;
(F)  policyholder services;
(G)  claims handling;
(H)  policy forms and filings; or
(I)  tier classification.
(14)  "Third-party model or product" means a model or product provided by an entity that is separate from and not under direct or indirect corporate control of the insurer using the model or product.
(b)  In this chapter, "affiliate" and "subsidiary" have the meanings described by Section 823.003.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.