reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter D. Assessments in General › Section 462.163. Payment of Assessment

Sec. 462.163.  PAYMENT OF ASSESSMENT.  An insurer shall pay the amount of an assessment under Section 462.160 or 462.162(b) to the association not later than the 30th day after the date the association gives notice of the assessment.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter D. Assessments in General › Section 462.164. Participation Receipts

Sec. 462.164.  PARTICIPATION RECEIPTS.  (a)  On receipt from a member insurer of payment of an assessment or partial assessment under Section 462.160 or 462.162(b), the association shall provide the insurer with a participation receipt.  A participation receipt creates liability against the account described by Section 462.105 for the line or lines of business for which the assessment was made.
(b)  The account from which an advance is made to an impaired insurer for the payment of covered claims is a general creditor of the impaired insurer for the money advanced.  With reference to the remaining balance of an advance not used to pay covered claims, the claim of the account has preference over other general creditors.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter D. Assessments in General › Section 462.165. Accounting; Reports; Refund

Sec. 462.165.  ACCOUNTING; REPORTS; REFUND.  (a)  The association, with respect to an impaired insurer, shall adopt accounting procedures that reflect the use of all money and shall make a final report of the use of the money to the commissioner.  The final report must state any remaining balance from the money advanced to an impaired insurer for the payment of covered claims.
(b)  The association shall make interim accounting reports as required by the commissioner or requested by the conservator.
(c)  As soon as practicable after completion of the final report, the association shall refund by line of business the remaining balance of those advances to the association's accounts.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter D. Assessments in General › Section 462.166. Use of Excess Money in Account

Sec. 462.166.  USE OF EXCESS MONEY IN ACCOUNT.  (a)  If the association determines that money in the account described by Section 462.164(b) for a line of business exceeds the amount reasonably necessary for efficient future operation under this chapter, the association shall, after deducting any premium tax credit taken under Section 462.157, return the excess money pro rata to the holders of participation receipts:
(1)  on which an outstanding balance exists; and
(2)  that were issued for an assessment on the same line of business as the line for which the excess money is found to exist.
(b)  The association shall transfer an excess amount that exists in the account described by Section 462.164(b) to the comptroller to be deposited to the credit of the general revenue fund if:
(1)  after a distribution under this section the association finds that an excess amount still exists; or
(2)  participation receipts on which there is an outstanding balance do not exist.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter D. Assessments in General › Section 462.167. Collection of Assessments

Sec. 462.167.  COLLECTION OF ASSESSMENTS.  (a)  The commissioner may collect an assessment on behalf of the association through a suit brought for that purpose.
(b)  Venue for a suit under this section is in Travis County.
(c)  Either party to the suit may appeal to an appellate court.  The appeal is at once returnable to the appellate court.  The appeal has precedence in the appellate court over all causes of a different character pending before the court.
(d)  The commissioner is not required to give an appeal bond in any cause of action arising under this section.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter D. Assessments in General › Section 462.168. Exemption for Impaired Insurer

Sec. 462.168.  EXEMPTION FOR IMPAIRED INSURER.  An impaired insurer is exempt from assessment from the date the insurer is designated an impaired insurer until the date the commissioner determines that the insurer is no longer an impaired insurer.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.201. Covered Claims in General

Sec. 462.201.  COVERED CLAIMS IN GENERAL.  A claim is a covered claim if:
(1)  the claim is an unpaid claim;
(2)  the claim is made under an insurance policy to which this chapter applies that is:
(A)  issued by an insurer authorized to engage in business in this state; or
(B)  assumed by an insurer authorized to engage in business in this state that issues an assumption certificate to the insured;
(3)  the claim arises out of the policy and is within the coverage and applicable limits of the policy;
(4)  the insurer that issued the policy or assumed the policy under an assumption certificate issued to the insured is an impaired insurer; and
(5)  the claim:
(A)  is made by a liability claimant or insured who is a resident of this state at the time of the insured event; or
(B)  is a first-party claim for damage to property that is permanently located in this state.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.202. Claim for Unearned Premiums

Sec. 462.202.  CLAIM FOR UNEARNED PREMIUMS.  (a)  A claim for unearned premiums is a covered claim.  A covered claim for unearned premiums may not exceed $25,000.
(b)  With respect to a covered claim for unearned premiums, a person has a covered claim under this chapter if the person is a resident of this state at the time:
(1)  the policy is issued; or
(2)  the insurer is determined to be an impaired insurer.
(c)  A person has a covered claim under this chapter if the person holds a valid assignment of a covered claim for unearned premiums under Subsections (a) and (b).
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1188 (S.B. 1227), Sec. 1, eff. June 19, 2015.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.203. Certain Expenses of Receivership or Conservatorship Estate Covered

Sec. 462.203.  CERTAIN EXPENSES OF RECEIVERSHIP OR CONSERVATORSHIP ESTATE COVERED.  An administration expense incurred in processing or paying a claim against a receivership or conservatorship estate is a covered claim if the impaired insurer has insufficient assets to pay the expenses of administering the estate.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.204. Affiliate May Not Be Claimant

Sec. 462.204.  AFFILIATE MAY NOT BE CLAIMANT.  A person who is an affiliate of an impaired insurer may not be a claimant of the insurer.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.205. Determination of Residence of Entities

Sec. 462.205.  DETERMINATION OF RESIDENCE OF ENTITIES.  A corporation or other entity that is not an individual is considered to be a resident of the state in which the entity's principal place of business is located.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.206. Claims Not Covered: Premium Under Retrospective Rating Plan

Sec. 462.206.  CLAIMS NOT COVERED: PREMIUM UNDER RETROSPECTIVE RATING PLAN.  An amount sought as a return of premium under a retrospective rating plan is not a covered claim.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.207. Claims Not Covered: Amounts Due Certain Entities

Sec. 462.207.  CLAIMS NOT COVERED: AMOUNTS DUE CERTAIN ENTITIES.  (a)  Any amount directly or indirectly due any reinsurer, insurer, self-insurer, insurance pool, or underwriting association, as a subrogation recovery, reinsurance recovery, contribution, or indemnification, or otherwise, is not a covered claim.
(b)  An impaired insurer's insured is not liable, and the reinsurer, insurer, self-insurer, insurance pool, or underwriting association is not entitled to sue or continue a suit against the insured, for a subrogation recovery, reinsurance recovery, contribution, indemnification, or any other claim asserted directly or indirectly by a reinsurer, insurer, self-insurer, insurance pool, or underwriting association to the extent of the applicable liability limits of the insurance policy written and issued to the insured by the insolvent insurer.
(c)  The association is entitled to recover the association's costs, expenses, and reasonable attorney's fees incurred in defending the association or an impaired insurer's insured against a claim brought in violation of this subsection by a reinsurer, insurer, self-insurer, insurance pool, or underwriting association, on that entity's own behalf or on behalf of the entity's insured, after the date on which the entity is provided notice by the association or otherwise of the provisions of this section applicable to the entity's suit.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.006(a), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.006(a), eff. September 1, 2007.
Acts 2019, 86th Leg., R.S., Ch. 343 (S.B. 1063), Sec. 4, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.208. Claims Not Covered: Supplementary Payment Obligations

Sec. 462.208.  CLAIMS NOT COVERED: SUPPLEMENTARY PAYMENT OBLIGATIONS.  A  supplementary payment obligation, including an adjustment fee or expense, attorney's fee or expense, court cost, interest or penalty, or interest or bond premium, incurred before an insurer is determined to be an impaired insurer is not a covered claim.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.209. Claims Not Covered: Prejudgment or Postjudgment Interest

Sec. 462.209.  CLAIMS NOT COVERED: PREJUDGMENT OR POSTJUDGMENT INTEREST.  Prejudgment or postjudgment interest that accrues after an insurer is determined to be an impaired insurer is not a covered claim.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.210. Claims Not Covered: Certain Damages

Sec. 462.210.  CLAIMS NOT COVERED: CERTAIN DAMAGES.  A claim against the insured, insurer, guaranty association, receiver, special deputy receiver, or commissioner for recovery of punitive, exemplary, extracontractual, or bad-faith damages awarded in a court judgment against an insured or insurer is not a covered claim.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.211. Claims Not Covered: Late Filed Claims

Sec. 462.211.  CLAIMS NOT COVERED:  LATE FILED CLAIMS.  (a)  Notwithstanding any other provision of this chapter or any other law to the contrary, and subject to Subsection (b), a claim that is filed with the association on a date that is later than 18 months after the date of the order of liquidation or that is unknown  and unreported as of the date is not a covered claim.
(b)  This section does not apply to a claim for workers' compensation benefits governed by Title 5, Labor Code, and the applicable rules of the commissioner of workers' compensation.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.007(a), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.007(a), eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.213. Amount of Individual Covered Claim; Limit

Sec. 462.213.  AMOUNT OF INDIVIDUAL COVERED CLAIM; LIMIT.  (a)  Except as provided by Subsection (b) and Section 462.252, an individual covered claim may not exceed $300,000.
(b)  The association shall pay the full amount of a covered claim arising out of a workers' compensation claim made under a workers' compensation insurance policy.
(c)  For purposes of this section, an individual covered claim includes any derivative claims by more than one person that arise from the same occurrence.  The claims shall be considered collectively as a single claim under this chapter.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter E. Covered Claims; Claimants › Section 462.214. Certain Shareholders' Claims: Limit

Sec. 462.214.  CERTAIN SHAREHOLDERS' CLAIMS: LIMIT.  Notwithstanding any other provision of this chapter, the association's liability for shareholder derivative actions or other claims for economic loss incurred by a claimant in the claimant's capacity as a shareholder under an insurance policy placed in force on or after January 1, 1992, is limited to $300,000 for each policy, including defense costs, regardless of the number of claimants under each policy.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter F. Nonduplication of Recovery › Section 462.251. Exhaustion of Rights Under Other Policy Required

Sec. 462.251.  EXHAUSTION OF RIGHTS UNDER OTHER POLICY REQUIRED.  (a)  Any person who has a claim under an insurance policy, other than an impaired insurer's policy, and whose claim arises from the same facts, injury, or loss giving rise to a claim against an impaired insurer or the insurer's insured, must first exhaust the person's rights under the insurance policy, including:
(1)  a claim for benefits under a workers' compensation insurance policy or a claim for indemnity or medical benefits under a health, disability, uninsured motorist, personal injury protection, medical payment, liability, or other insurance policy; and
(2)  the right to defense under the insurance policy.
(b)  Subsection (a) applies without regard to whether the insurance policy is issued by a member insurer.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter F. Nonduplication of Recovery › Section 462.252. Reduction in Amount of Covered Claim for Other Policy

Sec. 462.252.  REDUCTION IN AMOUNT OF COVERED CLAIM FOR OTHER POLICY.  (a)  Except as provided by Subsection (b), an amount payable as a covered claim under this chapter is reduced by the full applicable limits of another insurance policy described by Section 462.251, and the association shall receive a full credit in the amount of the full applicable limits of the other policy.
(b)  A covered claim for workers' compensation benefits is subject to reduction only by a third-party liability recovery under Section 417.002, Labor Code.
(c)  Subject to Section 462.255, the maximum amount payable by the association is the damages incurred by the claimant, less the association's credit or offset under this section, except that the association's liability may not exceed the lesser of:
(1)  $300,000; or
(2)  the limits of the insurance policy under which the claim is made.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter F. Nonduplication of Recovery › Section 462.253. Effect on Insured of Reduction in Amount of Covered Claim

Sec. 462.253.  EFFECT ON INSURED OF REDUCTION IN AMOUNT OF COVERED CLAIM.  To the extent that the association's obligation is reduced by the application of Sections 462.251 and 462.252, the liability of the person insured by the impaired insurer's policy for the claim is reduced in the same amount.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter F. Nonduplication of Recovery › Section 462.254. Recovery From More Than One Guaranty Association

Sec. 462.254.  RECOVERY FROM MORE THAN ONE GUARANTY ASSOCIATION.  (a)  Except as provided by Subsections (b) and (c), a person who has a claim that may be recovered from more than one insurance guaranty association or the equivalent shall seek recovery first from the association of the insured's residence.
(b)  A claimant shall seek recovery of a first-party claim for damage to property with a permanent location first from the association of the location of the property.
(c)  A claimant shall seek recovery of a workers' compensation claim first from the association of the claimant's residence.
(d)  The association has a credit or offset against the benefits under this chapter in the amount of the claimant's recovery under this section.
(e)  Subject to Section 462.255, the maximum amount payable by the association is the amount of damages incurred by the claimant, less the credit or offset, except that the association's liability may not exceed $300,000.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter F. Nonduplication of Recovery › Section 462.255. Certain Claims Subject to Lien or Subrogation; Limit on Total Recovery

Sec. 462.255.  CERTAIN CLAIMS SUBJECT TO LIEN OR SUBROGATION; LIMIT ON TOTAL RECOVERY.  (a)  Notwithstanding Sections 462.252(c) and 462.254(e), if a claimant is seeking recovery of insurance policy benefits that, had the impaired insurer not been insolvent, would be subject to lien or subrogation by any other insurer, including a workers' compensation insurer or health insurer, regardless of whether the other insurer is impaired, the association's credit or offset is deducted from the lesser of the damages incurred by the claimant or the limits of the policy under which the claim is made.
(b)  A claimant's recovery under this chapter may not result in a total recovery to the claimant that is greater than the recovery that would have resulted had the impaired insurer not been insolvent.
(c)  Subject to Sections 462.201-462.203, 462.205-462.210, 462.213, 462.214, and 462.305 of this code and Title 5, Labor Code, a claim for workers' compensation benefits under this chapter may not result in a recovery to the claimant that is less than the recovery that would have resulted had the impaired insurer not been insolvent.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.301. General Powers and Duties of Association in Connection With Payment of Covered Claims

Sec. 462.301.  GENERAL POWERS AND DUTIES OF ASSOCIATION IN CONNECTION WITH PAYMENT OF COVERED CLAIMS.  (a)  The association shall investigate and adjust, compromise, settle, and pay covered claims to the extent of the association's obligation and deny all other claims.
(b)  The association may review a settlement, release, or judgment to which an impaired insurer or the impaired insurer's insured was a party to determine the extent to which the settlement, release, or judgment may be properly contested.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.302. Payment of Covered Claims

Sec. 462.302.  PAYMENT OF COVERED CLAIMS.  (a)  The association shall pay covered claims that exist before the designation of impairment or that arise:
(1)  not later than the 30th day after the date of the designation of impairment;
(2)  before the insurance policy expiration date, if that date is not later than the 30th day after the date of the designation of impairment; or
(3)  before the insured replaces the insurance policy or causes the policy's cancellation, if the insured does so not later than the 30th day after the date of the designation of impairment.
(b)  The association satisfies the obligation to pay a covered claim by paying the claimant the full amount of a covered claim for benefits.
(c)  The association's liability is limited to the payment of covered claims.  The association is not liable for any other claim or damages against the insured, an impaired insurer, the association, the receiver, the special deputy receiver, the commissioner, or the liquidator, including a claim for:
(1)  recovery of attorney's fees, prejudgment or postjudgment interest, or penalties;
(2)  extracontractual damages, multiple damages, or exemplary damages; or
(3)  any other amount sought in connection with the assertion or prosecution of a claim, without regard to whether the claim is a covered claim, by or on behalf of:
(A)  an insured or claimant; or
(B)  a provider of goods or services retained by an insured or claimant.
(d)  The association shall pay claims in the order the association considers reasonable, including paying as claims are received from the claimants or in groups or categories of claims.
(e)  This section does not exclude the payment of workers' compensation benefits or other liabilities or penalties authorized by Title 5, Labor Code, arising from the association's processing and paying workers' compensation benefits after the designation of impairment.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.303. Certain Determinations Not Binding

Sec. 462.303.  CERTAIN DETERMINATIONS NOT BINDING.  (a)  The association is not bound by:
(1)  a judgment taken before the designation of impairment in which an insured under a liability insurance policy or the insurer failed to exhaust all appeals;
(2)  a judgment taken by default or consent against an insured or the impaired insurer; or
(3)  a judgment, settlement, or release entered into by the insured or the impaired insurer.
(b)  A judgment, settlement, or release described by Subsection (a) is not evidence of liability or of damages in connection with a claim brought against the association, an impaired insurer's insured, or another party under this chapter.
(c)  The association is entitled to recover the association's costs, expenses, and reasonable attorney's fees incurred in contesting a claim based on a judgment, settlement, or release described by Subsection (a) on the association's behalf or on behalf of an impaired insurer's insured after the date on which the party asserting the claim is provided notice by the association or otherwise of the provisions of this section applicable to the judgment, settlement, or release.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 343 (S.B. 1063), Sec. 6, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.304. Servicing Facility

Sec. 462.304.  SERVICING FACILITY.  (a)  The association shall handle claims through:
(1)  the association's employees or contract claims adjusters; or
(2)  subject to the approval of the commissioner, one or more insurers designated as a servicing facility under a servicing agreement or loss portfolio transfer agreement.
(b)  A member insurer may decline designation as a servicing facility.
(c)  The association shall reimburse a servicing facility for obligations of the association paid by the facility and expenses incurred by the facility in handling claims for the association.  The association shall reimburse a servicing facility under this subsection in a manner that is consistent with the applicable servicing agreement or loss portfolio agreement.
(d)  The commissioner may revoke the designation of a servicing facility if the commissioner finds that servicing facility is handling claims unsatisfactorily.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 343 (S.B. 1063), Sec. 7, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.305. Limitation of Association's Liability

Sec. 462.305.  LIMITATION OF ASSOCIATION'S LIABILITY.  The association is not liable to an insured or liability claimant for the association's failure to settle a liability claim within the limits of a covered claim under this chapter.  A claim described by this section for failure to settle a liability claim is not a covered claim.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.306. Discharge of Policy Obligation

Sec. 462.306.  DISCHARGE OF POLICY OBLIGATION.  (a)  The association shall discharge an impaired insurer's policy obligations, including the duty to defend insureds under a liability insurance policy, to the extent that the policy obligation is a covered claim under this chapter.
(b)  In performing the association's statutory obligations, the association may also enforce a duty imposed on the insured or beneficiary under the terms of an insurance policy within the scope of this chapter.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.307. Assignment of Rights

Sec. 462.307.  ASSIGNMENT OF RIGHTS.  (a)  A person recovering under this chapter assigns to the association the person's rights:
(1)  under the insurance policy; and
(2)  to recover for the occurrence that is the basis of the claim under this chapter under an insurance policy issued by an unimpaired insurer to the extent of the person's recovery from the association.
(b)  The association may pursue a claim to which the association is subrogated under Subsection (a) in the association's own name or in the name of the person recovering under this chapter.
(c)  An insured or claimant seeking the protection of this chapter shall cooperate with the association to the same extent as that person would have been required to cooperate with the impaired insurer.
(d)  Except as provided by Section 462.308 or 462.212, the association does not have a cause of action against the impaired insurer's insured for money the association has paid, other than a cause of action that the impaired insurer would have had if the money had been paid by the impaired insurer.
(e)  In the case of an impaired insurer operating on a plan with assessment liability, the payment of a claim of the association does not reduce the liability of the insured to the receiver or statutory successor for an unpaid assessment.
(f)  To the extent the association has a right to recover proceeds from the sale of salvage property related to a covered claim, the association's right to recover the proceeds may not be reduced in the amount of any pre-impairment costs, fees, or expenses related to the salvage property that are not part of a covered claim under Subchapter E.  A person or entity in possession of salvage property subject to the association's right of recovery may not seek recovery from the association for any pre-impairment costs, fees, or expenses related to the salvage property that are not a covered claim under Subchapter E.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 343 (S.B. 1063), Sec. 8, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.308. Recovery From Certain Persons

Sec. 462.308.  RECOVERY FROM CERTAIN PERSONS.  (a)  The association is entitled to recover:
(1)  the amount of a covered claim and the cost of defense paid on behalf of a person:
(A)  who is an affiliate of the impaired insurer; and
(B)  whose liability obligations to other persons are satisfied wholly or partly by payment made under this chapter; and
(2)  the amount of a covered claim for workers' compensation insurance benefits and the costs of administration and defense of the claim paid under this chapter from an insured employer or any successor entity to the insured employer under state, federal, or international law whose net worth on December 31 of the year preceding the date the insurer becomes an impaired insurer exceeds $50 million.
(b)  The association is not entitled to recover under Subsection (a)(2) against an insured who is exempt from federal income tax under Section 501(a), Internal Revenue Code of 1986, by being described by Section 501(c)(3) of that code.
(c)  For purposes of Subsection (a)(2), an insured's net worth is deemed to include the aggregate net worth of the insured and of the insured's parent, subsidiary, and affiliated companies computed on a consolidated basis.
(d)  A court shall award the association the association's costs, expenses, and reasonable attorney's fees incurred in seeking recovery under this section.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.009(a), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.009(a), eff. September 1, 2007.
Acts 2019, 86th Leg., R.S., Ch. 343 (S.B. 1063), Sec. 9, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.309. Stay of Proceedings; Certain Decisions Not Binding

Sec. 462.309.  STAY OF PROCEEDINGS; CERTAIN DECISIONS NOT BINDING.  (a)  To permit the association to properly defend a pending cause of action, a proceeding in which an impaired insurer is a party or is obligated to defend a party in a court in this state, other than a proceeding directly related to the receivership or instituted by the receiver, is stayed for:
(1)  a six-month period beginning on the later of the date of the designation of impairment or the date an ancillary proceeding is brought in this state; and
(2)  a subsequent period as determined by the court, if any.
(b)  The stay applies to each party to the proceeding and the proceeding is stayed for all purposes.
(c)  A deadline imposed under the Texas Rules of Civil Procedure or the Texas Rules of Appellate Procedure is tolled during the stay.  Statutes of limitation or repose are not tolled during the stay, and any action filed during the stay is stayed upon the filing of the action.
(d)  The court in which the delinquency proceeding is pending has exclusive jurisdiction regarding the application, enforcement, and extension of the stay and may issue an injunction or another similar order to enforce the stay.
(e)  The commissioner may bring an ancillary conservation proceeding under Section 443.401 for the purpose of determining the application, enforcement, and extension of the stay to an impaired insurer that is not domiciled in this state.
(f)  With respect to a covered claim arising from a judgment, order, decision, verdict, or finding based on the default of an impaired insurer or an impaired insurer's failure to defend the insured, the association, on the association's own behalf or on behalf of an insured and on application, shall be entitled to:
(1)  have the court or administrator that made the judgment, order, decision, verdict, or finding set aside the judgment, order, decision, verdict, or finding; and
(2)  defend the claim on the merits.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.011(a), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.011(a), eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.310. Settlement by Association Binding; Priority of Claim and Expenses

Sec. 462.310.  SETTLEMENT BY ASSOCIATION BINDING;  PRIORITY OF CLAIM AND EXPENSES.  (a)  The settlement of a covered claim by the association or a similar organization in another state binds the receiver or statutory successor of an impaired insurer.
(b)  The court having jurisdiction shall give the covered claim the same priority against assets of the impaired insurer that the claim would have had in the absence of this chapter.
(c)  The expenses of the association or a similar organization in another state in handling claims have the same priority as the receiver's expenses.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter G. Association Powers and Duties Relating to Covered Claims › Section 462.311. Report to Receiver

Sec. 462.311.  REPORT TO RECEIVER.  The association shall periodically file with the receiver of an impaired insurer a statement of covered claims paid by the association and an estimate of claims anticipated against the association.  The statement preserves the rights of the association against the assets of the impaired insurer.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 462 - Texas Property and Casualty Insurance Guaranty Association › Subchapter H. Release From Receivership › Section 462.351. Issuance of Policies After Release From Receivership

Sec. 462.351.  ISSUANCE OF POLICIES AFTER RELEASE FROM RECEIVERSHIP.  (a)  Except as provided by Subsection (b), an impaired insurer placed in receivership for which money has been advanced under this chapter may not be authorized, on release from receivership, to issue new or renewal insurance policies until the insurer repays the advances to the association.
(b)  On application of the association and after hearing, the commissioner may permit the insurer to issue new insurance policies in accordance with the insurer's plan of operation for repayment of advances.
(c)  The commissioner, in approving the plan of operation, may place restrictions on the issuance of new or renewal insurance policies as the commissioner considers necessary to implement the plan.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 463 - Texas Life and Health Insurance Guaranty Association › Subchapter A. General Provisions › Section 463.001. Short Title

Sec. 463.001.  SHORT TITLE.  This chapter may be cited as the Texas Life and Health Insurance Guaranty Association Act.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.012(b), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.012(b), eff. September 1, 2007.
Acts 2011, 82nd Leg., R.S., Ch. 14 (S.B. 567), Sec. 2, eff. September 1, 2011.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 463 - Texas Life and Health Insurance Guaranty Association › Subchapter A. General Provisions › Section 463.002. Purpose

Sec. 463.002.  PURPOSE.  The purpose of this chapter is to protect, subject to certain limitations, a person specified by Section 463.201 against failure in the performance of a contractual obligation under a life, accident, health, or annuity policy, plan, or contract with respect to which this chapter provides coverage as determined under Subchapter E, because of the impairment or insolvency of the member insurer that issued the policy, plan, or contract.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 432 (S.B. 1153), Sec. 1, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 463 - Texas Life and Health Insurance Guaranty Association › Subchapter A. General Provisions › Section 463.0031. Definition of Principal Place of Business of Plan Sponsor or Other Person

Sec. 463.0031.  DEFINITION OF PRINCIPAL PLACE OF BUSINESS OF PLAN SPONSOR OR OTHER PERSON.  (a)  Except as otherwise provided by this section, in this chapter, the "principal place of business" of a plan sponsor or a person other than an individual means the single state in which the individuals who establish policy for the direction, control, and coordination of the operations of the plan sponsor or person as a whole primarily exercise that function, as determined by the association in its reasonable judgment by considering the following factors:
(1)  the state in which the primary executive and administrative headquarters of the plan sponsor or person is located;
(2)  the state in which the principal office of the chief executive officer of the plan sponsor or person is located;
(3)  the state in which the board of directors, or similar governing person or persons, of the plan sponsor or person conduct the majority of their meetings;
(4)  the state in which the executive or management committee of the board of directors, or similar governing person or persons, of the plan sponsor or person conduct the majority of their meetings;
(5)  the state from which the management of the overall operations of the plan sponsor or person is directed; and
(6)  in the case of a benefit plan sponsored by affiliated companies comprising a consolidated corporation, the state in which the holding company or controlling affiliate has its principal place of business as determined using the factors described by Subdivisions (1)-(5).
(b)  In the case of a plan sponsor, if more than 50 percent of the participants in the benefit plan are employed in a single state, that state is the principal place of business of the plan sponsor.
(c)  The principal place of business of a plan sponsor of a benefit plan described in Section 463.003(8-a)(C) is the principal place of business of the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan that, in lieu of a specific or clear designation of a principal place of business, shall be deemed to be the principal place of business of the employer or employee organization that has the largest investment in that benefit plan.
Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.013(b), eff. September 1, 2007.
Added by Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.013(b), eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 463 - Texas Life and Health Insurance Guaranty Association › Subchapter A. General Provisions › Section 463.0032. Use of Terms Policy and Contract

Sec. 463.0032.  USE OF TERMS POLICY AND CONTRACT.  For purposes of this chapter, "policy" and "contract" have the same meaning.
Added by Acts 2019, 86th Leg., R.S., Ch. 432 (S.B. 1153), Sec. 3, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 463 - Texas Life and Health Insurance Guaranty Association › Subchapter A. General Provisions › Section 463.004. Construction

Sec. 463.004.  CONSTRUCTION.  This chapter shall be liberally construed to implement the purpose of this chapter described by Section 463.002. Section 463.002 shall be used to aid and guide interpretation of this chapter.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 463 - Texas Life and Health Insurance Guaranty Association › Subchapter A. General Provisions › Section 463.005. Immunity

Sec. 463.005.  IMMUNITY.  (a)  The following persons are not liable, and a cause of action does not arise against any of the following persons, for a good faith act or omission in exercising powers and performing duties under this chapter:
(1)  the commissioner or the commissioner's representative;
(2)  the association or the association's agent or employee;
(3)  a member insurer or the insurer's agent or employee;
(4)  a board member;
(5)  the receiver; and
(6)  a special deputy receiver or the special deputy receiver's agent or employee.
(b)  Immunity under Subsection (a) extends to participation in an organization of one or more state associations that have similar purposes and to a similar organization and the organization's agent or employee.
(c)  The attorney general shall defend any action to which this section applies that is brought against the commissioner or the commissioner's representative, the association or the association's agent or employee, a member insurer or the insurer's agent or employee, a board member, or a special deputy receiver or the special deputy receiver's agent or employee, including an action brought after the defendant's service with the association, commissioner, or department has terminated.  This subsection does not require the attorney general to defend a person with respect to an issue other than the applicability or effect of the immunity created by this section.  The attorney general is not required to defend the association or the association's agent or employee, a member insurer or the insurer's agent or employee, a board member, or a special deputy receiver or the special deputy receiver's agent or employee against an action regarding the disposition of a claim filed with the association under this chapter or any issue other than the applicability or effect of the immunity created by this section.  The association may contract with the attorney general under Chapter 771, Government Code, for legal services not covered by this subsection.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 463 - Texas Life and Health Insurance Guaranty Association › Subchapter A. General Provisions › Section 463.006. Rules

Sec. 463.006.  RULES.  The commissioner shall adopt reasonable rules as necessary to carry out and supplement this chapter and the purposes of this chapter.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.