reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 3 - LOSS FUNDING, INCLUDING CATASTROPHE RESERVE TRUST FUND, FINANCING ARRANGEMENTS, AND PUBLIC SECURITIES › Section 5.4188 - Association Surcharges not Subject to Commissions or Premium Taxes; Contingent Surcharges Not Subject to Commissions

Current through Reg. 49, No. 28; July 12, 2024
(a) As provided by Insurance Code
					 §§
											2210.612(d),
					 2210.613(d)
					 and
					 2210.6131(d),
					 association surcharges are not subject to either premium taxes or agents'
					 commissions.
(b) The association
					 may not increase association surcharges for premium taxes or commissions, and
					 agents may not collect or charge commissions for association
					 surcharges.
(c) Insurers may not
					 increase contingent surcharges for commissions, and agents, including a surplus
					 lines agent, may not collect or charge commissions for contingent
					 surcharges.
(d) Insurers may
					 increase contingent surcharges in an amount equal to any premium or maintenance
					 tax attributable to the contingent surcharge and owed to the
					 comptroller.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 3 - LOSS FUNDING, INCLUDING CATASTROPHE RESERVE TRUST FUND, FINANCING ARRANGEMENTS, AND PUBLIC SECURITIES › Section 5.4189 - Notification Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Insurers
					 must provide written notice to policyholders receiving a contingent surcharge
					 that their policy contains a surcharge and the dollar amount of the surcharge.
					 The notice must read: "Texas Insurance Code Section
					 2210.6132
					 authorizes a premium surcharge to be added to certain property and casualty
					 insurance policies providing coverage in the catastrophe area to pay the debt
					 service on public securities issued to pay Texas Windstorm Insurance
					 Association claims resulting from a catastrophic event. A premium surcharge {in
					 the amount of $_____} has been added to your premium. Should your policy be
					 canceled by you or the insurer prior to its expiration date, a proportionate
					 amount of the premium surcharge will be refunded to you."
(b) The association must provide written
					 notice to policyholders receiving an association surcharge that their policy
					 contains a surcharge and the dollar amount of the surcharge. The notice must
					 read: "Texas Insurance Code Sections
					 2210.612,
					 2210.613,
					 and
					 2210.6131
					 require a premium surcharge be added to Texas Windstorm Insurance Association
					 policies to pay the debt service on public securities issued to pay association
					 claims resulting from a catastrophic event. A premium surcharge {in the amount
					 of $_____} has been added to your premium. Should your policy be canceled by
					 you or the association prior to its expiration date, the premium surcharge will
					 not be refunded to you. Failure to pay the surcharge is grounds for
					 cancellation of your policy."
(c)
					 Except as provided in subsection (e) of this section, notices required under
					 subsection (a) of this section must:
(1) be
					 provided at the time the policy is issued, in the case of new
					 business;
(2) be provided with the
					 renewal notice, in the case of renewal business;
(3) be provided within 20 days of the date of
					 the transaction for any midterm change in the premium surcharge; and
(4) use at least 12-point font and either be
					 contained on a separate page or shown in a conspicuous location on the
					 declarations page.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 3 - LOSS FUNDING, INCLUDING CATASTROPHE RESERVE TRUST FUND, FINANCING ARRANGEMENTS, AND PUBLIC SECURITIES › Section 5.4191 - Premium Surcharge Reconciliation Report

Current through Reg. 49, No. 28; July 12, 2024
(a) This section applies to an insurer that,
					 during an applicable calendar year, wrote any or all of the following types of
					 insurance: commercial fire; commercial allied lines; farm and ranch owners;
					 residential property insurance; commercial multiple peril (nonliability
					 portion); private passenger automobile no fault (personal injury protection
					 (PIP)); other private passenger automobile liability; private passenger
					 automobile physical damage; commercial automobile no fault (PIP); other
					 commercial automobile liability; or commercial automobile physical
					 damage.
(b) On a written request
					 from the department, an insurer must provide the department with a premium
					 surcharge reconciliation report for the year specified by the department in its
					 request.
(c) Reconciliation reports
					 must be provided to the department within 15 working days after the date the
					 request is received by the insurer.
(d) Reconciliation reports must consist of
					 information concerning premiums written and surcharges collected, separately
					 for each applicable surcharge period, including periods in which no premium
					 surcharges were in effect, within the specified year for:
(1) premium written at policy issuance for
					 policies effective within the year, including anniversary dates within the year
					 on multiyear policies, separately for:
(A)
					 premium on policies subject to a premium surcharge, including premium
					 attributable to insured property located both in and outside of the catastrophe
					 area; and
(B) premium on policies
					 not subject to a premium surcharge, including premium attributable to insured
					 property located both in and outside of the catastrophe area;
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 3 - LOSS FUNDING, INCLUDING CATASTROPHE RESERVE TRUST FUND, FINANCING ARRANGEMENTS, AND PUBLIC SECURITIES › Section 5.4192 - Data Collection

Current through Reg. 49, No. 28; July 12, 2024
(a) The department
					 may request from each insurer the information necessary to enable the
					 department to determine the premium surcharge percentage applicable to
					 policyholders with insured property located in the catastrophe area.
(b) For lines of insurance subject to this
					 division for policies in force on or after October 1, 2011, each insurer must
					 maintain sufficient records to report, for policies where the premium surcharge
					 was, or would be determined under this division, the total written premium
					 attributable to insured property located in the catastrophe area.
(c) When possible, and practical, the
					 department will obtain information from the Texas Surplus Lines Stamping Office
					 prior to requesting information from affiliated surplus lines
					 insurers.
(d) Nothing in subsection
					 (c) of this section should be read to mean that subsections (a) and (b) of this
					 section do not apply to affiliated surplus lines insurers.
(e) Nothing in this section limits the
					 department's authority to obtain information from insurers under the Insurance
					 Code.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4200 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following definitions apply to this division:
(1) Appraiser--A person who is qualified to
					 be an appraiser under §
											5.4212
					 of this title (relating to Appraisal Process - Appraiser Qualifications and
					 Conflicts of Interest) and is selected by the association or a claimant to
					 participate in the appraisal process.
(2) Association--Texas Windstorm Insurance
					 Association. "Association" includes any authorized representative of the Texas
					 Windstorm Insurance Association.
(3) Claimant--A person who makes a claim
					 under an association policy.
(4)
					 Department or TDI--The Texas Department of Insurance.
(5) Good cause--Section 5.4202 of this title
					 (relating to Good Cause Extensions Under Insurance Code § 2210.205)
					 defines good cause for purposes of Insurance Code § 2210.205.
(6) Mediator--A person who is qualified to be
					 a mediator under §
											5.4232
					 of this title (relating to Mediation Process - Mediator Qualifications and
					 Conflicts of Interest).
(7)
					 Mediator roster--The roster of mediators maintained by the
					 department.
(8) Mediator selection
					 panel--A short list of potential mediators from the mediator roster from which
					 the department will select a mediator.
(9) Party--The association or the claimant.
					 "Party" includes employees and other representatives of a party.
(10) Umpire--A person who is qualified to be
					 an appraisal umpire under §
											5.4214
					 of this title (relating to Appraisal Process - Umpire Qualifications and
					 Conflicts of Interest) and is selected by the appraisers or the department to
					 participate in the appraisal process.
(11) Umpire roster--The roster of umpires
					 maintained by the department.
(12)
					 Umpire selection panel--A short list of potential umpires from the umpire
					 roster from which the department will select an umpire.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4201 - Coastal Outreach and Assistance Services Team (COAST) Program

Current through Reg. 49, No. 28; July 12, 2024
(a) Establishment. The Texas Department of
					 Insurance (department) establishes the Coastal Outreach and Assistance Services
					 Team (COAST) Program to provide information and educational programs to assist
					 persons insured under Chapter 2210 of the Insurance Code with the claim
					 processes prescribed under Subchapter L-1, Chapter 2210 of the Insurance
					 Code.
(b) Administration. The COAST
					 Program is administratively attached to the department and will be administered
					 by the department.
(c) Staffing.
					 The COAST Program will include an ombudsman familiar with the claim processes
					 prescribed under Subchapter L-1, Chapter 2210, of the Insurance Code, as well
					 as sufficient staff to support its purpose. If a catastrophic event occurs, the
					 COAST Program may expand as necessary to support the increased number of
					 policyholders requiring assistance.
(d) Funding. The COAST Program will be funded
					 by the Texas Windstorm Insurance Association (the Association).
(1) Annual budget.
(A) The funding year shall be from May 1 of
					 each year to April 30 of the following year.
(B) Not later than March 1 of each year, the
					 department shall prepare and submit to the Commissioner of Insurance
					 (commissioner) a budget for the COAST Program, including approval of all
					 expenditures incurred to administer and operate the COAST Program. The
					 department may include ongoing ombudsman activities related to a prior
					 catastrophic event in the annual budget request. The commissioner will adopt or
					 modify and adopt the budget not later than April 1 of each year.
(C) Not later than May 1 of each year, the
					 Association shall transfer the budgeted amount adopted by the commissioner to
					 the department for the COAST Program.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4202 - Good Cause Extensions Under Insurance Code Section 2210.205

Current through Reg. 49, No. 28; July 12, 2024
(a) For purposes of Insurance Code §
					 2210.205 and this section, good cause means objective facts beyond the
					 insured's control that reasonably caused the insured to fail to file a claim
					 under the policy within the one-year claim-filing deadline.
(b) If an insured shows good cause, the
					 commissioner may extend the one-year claim-filing period set by Insurance Code
					 § 2210.205(b). An extension granted under this section is effective on the
					 date the one-year claim-filing period expires and may not exceed 180 days. The
					 extension is limited to the claim for which it is granted.
(c) A request for an extension under this
					 section must:
(1) be sent in writing to the
					 department, under §
												5.4251
					 of this title (relating to Requests and Submissions to the Department);
(2) describe the good cause that
					 caused the insured to miss the one-year claim-filing deadline; and
(3) be signed by the insured or the insured's
					 legal representative.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4203 - Good Cause Extensions for Insurance Code Section 2210.573(b) and (d) and Section 2210.5741(b)

Current through Reg. 49, No. 28; July 12, 2024
(a) This
					 section defines "good cause" for the purpose of extending the deadlines in
					 Insurance Code §
											2210.573(b) and
					 (d) and §2210.5741(b). In this section,
					 "good cause" means objective facts beyond the association's control that
					 reasonably caused or may cause the association to fail to meet a deadline in
					 Insurance Code §
											2210.573(b) or
					 (d) or §2210.5741(b).
(b) If the association shows good cause in a
					 request for an extension, or in the absence of a request, if the Commissioner
					 determines good cause exists, the Commissioner may, consistent with subsection
					 (e) of this section, extend the deadlines established under Insurance Code
					 §
											2210.573(b) and
					 (d) and §2210.5741(b). An extension
					 granted under this section is effective on the date of the deadline for which
					 it is granted. An extension is limited to the claims for which it is
					 granted.
(c) A request for an
					 extension under this section must:
(1) be sent
					 in writing to the department, under §
												5.4251
					 of this title (relating to Requests and Submissions to the
					 Department);
(2) specify the
					 deadline or deadlines for which an extension is requested;
(3) identify the claims for which an
					 extension is requested by:
(A) the type of
					 policy; and
(B) the time period
					 during which the event occurred and a description of the event that gave rise
					 to the claims;
(4)
					 specify the association's estimated total number of claims arising from the
					 event that gave rise to the claims for which an extension is
					 requested;
(5) describe the good
					 cause for which the association cannot meet the deadlines in Insurance Code
					 §
												2210.573(b) and
					 (d) and §2210.5741(b); and
(6) if the association requests a specific
					 amount of time, provide an explanation for the time requested.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4204 - Supplemental Payments

Current through Reg. 49, No. 28; July 12, 2024
A claimant who timely demands appraisal under Insurance
						Code §
											2210.574
						or §
											2210.5741
						may request a supplemental payment on the accepted claim or accepted portion of
						the claim at any time. A claimant who does not timely demand appraisal may not
						request a supplemental payment after the deadlines for demanding appraisal
						under Insurance Code §
											2210.574
						or §
											2210.5741.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4211 - Appraisal Process

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability.
					 This section and §§
											5.4212-
					 5.4222 of this title describe the
					 appraisal process and apply when:
(1) the
					 association has accepted coverage for a claim, in full or in part;
					 and
(2) the claimant disputes the
					 amount of loss the association will pay for the accepted portion of the claim
					 within the time allowed by Insurance Code §
												2210.574, concerning
					 Disputes Concerning Amount of Accepted Coverage, or §2210.5741, concerning
					 Replacement Cost Coverage Claim Processing.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4212 - Appraisal Process - Appraiser Qualifications and Conflicts of Interest

Current through Reg. 49, No. 28; July 12, 2024
(a) Qualifications. To qualify as an
					 appraiser, a person must be one of the following:
(1) an engineer or architect with experience
					 and training in building construction, repair, estimating, or investigation of
					 property damage;
(2) an adjuster or
					 public adjuster with experience and training in estimating property damage;
					 or
(3) a general contractor with
					 experience and training in building construction, repair, or estimating
					 property damage.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4213 - Appraisal Process - Appraiser Obligations

Current through Reg. 49, No. 28; July 12, 2024
(a) Conflicts. An appraiser must disclose to
					 both parties any potential conflicts of interest no later than the fifth day
					 after being hired, and before the appraiser begins work on the appraisal.
					 Potential conflicts of interest are listed in §
											5.4212
					 of this title (relating to Appraisal Process - Appraiser Qualifications and
					 Conflicts of Interest).
(b)
					 Withdrawal prohibited. After an appraiser has accepted the responsibility for
					 an appraisal, the appraiser may not withdraw or abandon the appraisal unless
					 compelled to do so by unanticipated circumstances that would render it
					 impossible or impractical to continue. The appraiser may not charge a fee for
					 services if the appraiser withdraws or abandons the appraisal.
(c) Postponement. An appraiser must postpone
					 the appraisal for a reasonable amount of time if a party shows good cause for a
					 postponement.
(d) Duties. An
					 appraiser must:
(1) consider all information
					 provided by the parties and any other reasonably available evidence material to
					 the claim;
(2) follow the
					 association insurance policy when making the appraisal decision;
(3) carefully decide all issues submitted for
					 determination regarding the amount of loss; and
(4) give the parties and the other appraiser
					 an itemized written appraisal.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4214 - Appraisal Process - Umpire Qualifications and Conflicts of Interest

Current through Reg. 49, No. 28; July 12, 2024
(a) Required qualifications. To qualify as an
					 umpire, a person must:
(1) be one of the
					 following:
(A) an engineer or architect with
					 experience and training in building construction, repair, estimating, or
					 investigation of property damage;
(B) an adjuster or public adjuster with
					 experience and training in estimating property damage;
(C) a general contractor with experience and
					 training in building construction, repair, or estimating property
					 damage;
(D) a licensed attorney;
					 or
(E) a current or former judge of
					 any Texas court of record or the State Office of Administrative Hearings;
					 and
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4215 - Appraisal Process - Umpire Roster

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Eligibility. To be placed on the umpire roster, a person must register with the
					 department and must meet the qualifications in §
											5.4214
					 of this title (relating to Appraisal Process - Umpire Qualifications and
					 Conflicts of Interest).
(b)
					 Registration. The registration must include contact information and details
					 about:
(1) the person's training and
					 experience related to building construction, repair, estimating, or
					 investigating property damage;
(2)
					 any training and experience related to estimating property damage
					 claims;
(3) whether the person's
					 experience is with residential or commercial property damage;
(4) any relevant licenses or
					 certifications;
(5) a general
					 description of the approximate number, type of policies, and value and
					 complexity of property damage claims on which the applicant worked over the
					 previous three years;
(6) the
					 counties in which the person is willing to work;
(7) the type of policies, and value and
					 complexity of claims on which the person is willing to work;
(8) potential conflicts of interest, under
					 §
												5.4214
					 of this title;
(9) any professional
					 disciplinary actions or criminal convictions; and
(10) an up-to-date biography, resume, or
					 curriculum vitae.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4216 - Appraisal Process - Removal of Umpire from Roster

Current through Reg. 49, No. 28; July 12, 2024
(a) Voluntary removal. An umpire may request
					 removal from the roster at any time. The umpire must submit the request under
					 §
											5.4251
					 of this title (relating to Requests and Submissions to the
					 Department).
(b) Removal by
					 department. The department may, in its sole discretion, remove an umpire from
					 the umpire roster for:
(1) alleged dishonest,
					 incompetent, fraudulent, or unethical behavior;
(2) alleged failure to respond promptly and
					 completely to requests from the department and where the actions or failure to
					 act are counter to the purpose of the appraisal;
(3) a disciplinary action by any other agency
					 or disciplinary authority against the umpire, regardless of whether the agency
					 or disciplinary authority's regulation relates to the appraisal;
(4) conviction of, or accepting deferred
					 adjudication for, a crime under state or federal law;
(5) a disqualifying conflict of interest
					 listed in §
												5.4214
					 of this title (relating to Appraisal Process - Umpire Qualifications and
					 Conflicts of Interest);
(6) failure
					 to comply with any requirement of this title; or
(7) other factors relevant to the umpire's
					 qualifications, conflicts of interest, or performance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4217 - Appraisal Process - Umpire Selection by Department

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability. This section applies when
					 the appraisers are unable to agree on an umpire and a party requests the
					 department to select an umpire.
(b)
					 Notice. The department will notify at least five umpires of possible inclusion
					 on an umpire selection panel.
(c)
					 Factors. When selecting an umpire for the umpire selection panel, the
					 department may consider:
(1) the umpire's
					 preferred geographic locations and types of claims;
(2) the proximity of the claimant and the
					 umpire;
(3) the umpire's areas of
					 training and expertise;
(4) the
					 extent of the umpire's experience with appraisal and with property damage
					 claims;
(5) the subject of the
					 dispute;
(6) the type of
					 policy;
(7) the value and
					 complexity of the claim;
(8) any
					 conflicts of interest; and
(9)
					 other factors relevant to the dispute.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4219 - Appraisal Process - Additional Obligations for Department-Selected Umpires

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability.
					 The following umpire obligations apply only when the department selects an
					 umpire under §
											5.4217
					 of this title (relating to Appraisal Process - Umpire Selection by
					 Department).
(b) Notices. No later
					 than the seventh day after receiving notice of being selected for an appraisal,
					 the umpire must send a notice to the parties and to the appraisers. This
					 deadline may not be extended. The notice must:
(1) be in writing;
(2) inform the parties and appraisers that
					 the umpire has been selected;
(3)
					 state whether the umpire is insured by the association; and
(4) inform the parties of their right to
					 object to the umpire under §
												5.4252 of
					 this title (relating to Objections).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4220 - Appraisal Process - Prohibited Communications

Current through Reg. 49, No. 28; July 12, 2024
(a) Ex parte communications. After an umpire
					 is selected and before the appraisal is completely resolved:
(1) The umpire may not communicate separately
					 with either party or either party's appraiser regarding the pending appraisal
					 unless the umpire notifies the other party and gives the other party the
					 opportunity to participate.
(2) No
					 party or appraiser may communicate with the umpire regarding the pending
					 appraisal without including the other party or appraiser, except that:
(A) an appraiser may identify the parties'
					 counsel or experts;
(B) an
					 appraiser may discuss logistical matters, such as setting the time and place of
					 meetings or making other arrangements for the conduct of the proceedings. The
					 appraiser initiating this contact with the umpire must promptly inform the
					 other appraiser; or
(C) if an
					 appraiser fails to attend a meeting or conference call after receiving notice,
					 or if both parties agree in writing, the opposing appraiser may discuss the
					 claim with the umpire who is present.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4221 - Appraisal Process - Costs

Current through Reg. 49, No. 28; July 12, 2024
(a) One-half
					 per party. Each party must pay one-half of all reasonable and necessary costs
					 incurred or charged in connection with the appraisal, including:
(1) appraisers' fees;
(2) umpire's fee; and
(3) umpire's travel costs.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4222 - Appraisal Process - Extension of Deadlines

Current through Reg. 49, No. 28; July 12, 2024
(a) Extensions. For good cause, the
					 Commissioner may extend any deadline related to appraisal, except the deadline
					 for the umpire to notify the parties that the umpire is insured by the
					 association, under §
											5.4218
					 of this title (relating to Appraisal Process - Umpire Obligations).
(b) Good cause. This section defines "good
					 cause" for the purpose of extending the deadlines related to appraisal. In this
					 section, "good cause" means objective facts beyond a party's, appraiser's, or
					 umpire's control that reasonably caused or may cause the party, appraiser, or
					 umpire to fail to meet a deadline related to appraisal.
(c) Request for extension. To ask the
					 Commissioner to extend a deadline, a party, appraiser, or umpire must send the
					 request in writing to the department, under §
											5.4251
					 of this title (relating to Requests and Submissions to the Department). The
					 request must explain the good cause for the extension. Good cause includes
					 military deployment of the claimant. In the absence of a request, the
					 Commissioner may extend a deadline if the Commissioner determines good cause
					 exists.
(d) Extension limit. For
					 purposes of Insurance Code §
											2210.581(b),
					 all deadlines related to appraisal--including those for appraisers and
					 umpires--are considered applicable to the claimant or to both the claimant and
					 the association. The deadlines are not subject to an extension limit.
(e) The Commissioner may extend deadlines for
					 a single claim or a group of claims.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4231 - Mediation Process

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability.
					 Sections 5.4231-
					 5.4241
					 of this title are the mediation process and apply when:
(1) the association has denied coverage for a
					 claim, in full or in part;
(2) the
					 claimant disputes the denial and gives the association a notice of intent to
					 file suit; and
(3) the association
					 has requested mediation under the association policy within the time frame
					 allowed under Insurance Code §
												2210.575.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4232 - Mediation Process - Mediator Qualifications and Conflicts of Interest

Current through Reg. 49, No. 28; July 12, 2024
(a) Required qualifications. To qualify as a
					 mediator, a person must:
(1) have completed a
					 40-hour basic mediation course:
(A) conducted
					 by an alternative dispute resolution system described in Texas Civil Practice
					 and Remedies Code §
													154.021(a)(1);
					 or
(B) that complies with the
					 mediation training standards established by the Texas Mediation Trainers
					 Roundtable; and
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4233 - Mediation Process - Mediator Roster

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Eligibility. To be placed on the mediator roster, a mediator must register with
					 the department and must meet the qualifications in §
											5.4232
					 of this title (relating to Mediation Process - Mediator Qualifications and
					 Conflicts of Interest).
(b)
					 Registration. The registration must include contact information and details
					 about:
(1) the mediator's mediation
					 training;
(2) any mediation
					 certification;
(3) any other
					 relevant licenses or certifications;
(4) any training or experience relating to
					 property damage claims;
(5) a
					 general description of the approximate number, value, complexity, and nature of
					 disputes mediated over the previous three years;
(6) the counties in which the mediator is
					 willing to mediate;
(7) the types
					 of policies, and value and complexity of claims the mediator is willing to
					 mediate;
(8) potential conflicts of
					 interest, under §
												5.4232
					 of this title;
(9) any professional
					 disciplinary actions or criminal convictions;
(10) whether the mediator is insured by the
					 association; and
(11) an up-to-date
					 biography, resume, or curriculum vitae.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4234 - Mediation Process - Removal of Mediator from Roster

Current through Reg. 49, No. 28; July 12, 2024
(a) Voluntary removal. A mediator may request
					 removal from the roster at any time. The mediator must submit the request under
					 §
											5.4251
					 of this title (relating to Requests and Submissions to the
					 Department).
(b) Removal by
					 department. The department may, in its sole discretion, remove a mediator from
					 the mediator roster for:
(1) alleged
					 dishonest, incompetent, fraudulent, or unethical behavior;
(2) alleged failure to respond promptly and
					 completely to requests from the department and where the actions or failure to
					 act are counter to the purpose of mediation;
(3) a disciplinary action by any other agency
					 or disciplinary authority against the mediator, regardless of whether the
					 agency or disciplinary authority's regulation relates to mediation;
(4) conviction of, or accepting deferred
					 adjudication for, a crime under state or federal law;
(5) a disqualifying conflict of interest
					 listed in §
												5.4232
					 of this title (relating to Mediation Process - Mediator Qualifications and
					 Conflicts of Interest);
(6) failure
					 to comply with any requirement of this title; or
(7) other factors relevant to the mediator's
					 qualifications, conflicts of interest, or performance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4235 - Mediation Process - Mediator Selection by Department

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability. This section applies when
					 the parties are unable to agree on a mediator and a party requests the
					 department to select a mediator.
(b) Notice. The department will notify at
					 least five mediators of possible inclusion on a mediator selection
					 panel.
(c) Factors. When selecting
					 a mediator for the mediator selection panel, the department may consider:
(1) the mediator's preferred geographic
					 locations and types of claims;
(2)
					 the proximity of the claimant and the mediator;
(3) the mediator's areas of training and
					 expertise;
(4) the extent of the
					 mediator's experience with mediation and with property damage claims;
(5) the subject of the dispute;
(6) the type of policy;
(7) the value and complexity of the
					 claim;
(8) any conflicts of
					 interest; and
(9) other factors
					 relevant to the dispute.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4237 - Mediation Process - Additional Obligations for Department-Selected Mediators

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability.
					 The following mediator obligations apply when the department selects a
					 mediator, under §
											5.4235
					 of this title (relating to Mediation Process - Mediator Selection by
					 Department).
(b) Notices. No later
					 than the seventh day after receiving notice of selection to mediate a dispute,
					 the mediator must send a notice to the parties. This deadline may not be
					 extended. The notice must:
(1) be in
					 writing;
(2) inform the parties
					 that the mediator has been selected;
(3) state whether the mediator is insured by
					 the association; and
(4) inform the
					 parties of their right to object to the mediator under §
												5.4235
					 and §
												5.4252 of
					 this title (relating to Objections).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4238 - Mediation Process - Association Obligations

Current through Reg. 49, No. 28; July 12, 2024
(a) Mediation explanation. At the same time
					 the association requests mediation, the association must give the claimant a
					 notice explaining the mediation process.
(b) Representative. The association must send
					 an authorized representative to participate in the mediation. The association's
					 representative must know the facts of the dispute and must be authorized to
					 make an agreement to resolve the claim. The association must come prepared to
					 present any relevant documents, such as insurance policies, payment receipts,
					 adjuster reports, repair estimates, claim files, or other documents.
(c) Assistance. In addition to its primary
					 representative, the association may bring other people to the mediation to help
					 the primary representative. This may include contractors, adjusters, engineers,
					 and interpreters.
(d) Association
					 participants. No later than the seventh day before the mediation, the
					 association must tell the claimant who will be attending the mediation for the
					 association. The association may be represented by an attorney in the mediation
					 only if the claimant is represented by an attorney.
(e) Rescheduling or canceling. No later than
					 24 hours before the scheduled mediation, the association must tell the mediator
					 if the association wants to cancel or reschedule the mediation.
(f) Failure to appear.
(1) If the association has good cause for a
					 failure to appear, the mediator may reschedule one time. Rescheduling does not
					 relieve the association from the obligation to pay the rescheduling
					 fee.
(2) The association will be
					 deemed to have failed to appear if the association's representative lacks
					 authority to settle the full amount of the claim or lacks the ability to
					 disburse the settlement amount within a reasonable time following the
					 mediation.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4239 - Mediation Process - Claimant Obligations and Privileges

Current through Reg. 49, No. 28; July 12, 2024
(a) Participation. The claimant must
					 participate in the mediation. A claimant who participates in mediation must
					 know the facts of the dispute and must be authorized to make an agreement to
					 resolve the claim. The claimant must come prepared to present any relevant
					 documents, such as insurance policies, payment receipts, adjuster reports,
					 repair estimates, claim files, or other documents.
(b) Assistance. The claimant may bring other
					 people to help in presenting the claim. This may include contractors,
					 adjusters, engineers, and interpreters.
(c) Attorney. The claimant may, but is not
					 required to, be represented by an attorney in the mediation.
(d) Claimant participants. No later than the
					 seventh day before the mediation, the claimant must tell the association if the
					 claimant's attorney will be participating in the mediation. At the same time,
					 the claimant must also tell the association who else will be attending the
					 mediation with the claimant.
(e)
					 Rescheduling. No later than 24 hours before the scheduled mediation, the
					 claimant must tell the mediator if the claimant wants to reschedule the
					 mediation.
(f) Failure to appear.
					 If the claimant fails to appear for a scheduled mediation for which the
					 association appears, but the claimant has good cause for a failure to appear,
					 the mediator may reschedule one time. Rescheduling does not relieve the
					 claimant from the obligation to pay the rescheduling fee.
(g) Contract. If the department selects the
					 mediator, then before mediation begins, the claimant must sign the mediation
					 contract under §
											5.4237
					 of this title (relating to Mediation Process - Additional Obligations for
					 Department-Selected Mediators).
(h)
					 Good faith. The claimant must negotiate in good faith to attempt to resolve the
					 dispute. However, there is no requirement that the dispute must be resolved in
					 mediation.
(i) Rescission. The
					 claimant has three days from the date of an agreement to rescind the mediation
					 agreement if the claimant has not accepted payment from the association by:
(1) cashing or depositing any check or
					 payment; or
(2) agreeing in writing
					 to accept an electronic funds transfer.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4240 - Mediation Process - Costs

Current through Reg. 49, No. 28; July 12, 2024
(a) One-half
					 per party. Each party must pay one-half of all reasonable and necessary costs
					 incurred or charged in connection with the mediation, including:
(1) mediator's fee;
(2) mediator's travel costs;
(3) cost of renting space for the mediation;
					 and
(4) food or beverages provided
					 during the mediation.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4241 - Mediation Process - Deadlines and Extensions

Current through Reg. 49, No. 28; July 12, 2024
(a) Deadline. Mediation must be completed by
					 the 60th day after the association notifies the claimant that the association
					 is requesting mediation, unless the deadline is extended. If the association
					 does not ask the department to select a mediator before the 60-day deadline, or
					 any extension of that deadline, the association waives its right to require
					 mediation under Insurance Code §
											2210.575
					 and this division.
(b) Good cause.
					 This section defines "good cause" for the purpose of extending the deadlines
					 related to mediation. In this section, "good cause" means objective facts
					 beyond a party's or mediator's control that reasonably caused or may cause the
					 party or mediator to fail to meet a deadline related to mediation.
(c) Extensions.
(1) The association and the claimant may
					 agree to extend the 60-day deadline for mediation in subsection (a) of this
					 section.
(2) For good cause, the
					 Commissioner may extend any deadline related to mediation, except the deadline
					 for the mediator to notify the parties that the mediator is insured by the
					 association, under §
												5.4236
					 of this title (relating to Mediation Process - Mediator Obligations).
(3) The Commissioner may extend deadlines for
					 a single claim or a group of claims.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4251 - Requests and Submissions to the Department

Current through Reg. 49, No. 28; July 12, 2024
(a) Items submitted under this section must
					 be submitted in writing to the chief clerk, Texas Department of Insurance. They
					 may be:
(1) hand delivered;
(2) mailed; or
(3) sent in a manner that is otherwise
					 acceptable to the department.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4252 - Objections

Current through Reg. 49, No. 28; July 12, 2024
(a) Objections. A party or appraiser may
					 object to an umpire or a mediator as follows:
(1) for good cause:
(A) no later than the third day after the
					 party or appraiser receives the selection panel, based on the information
					 provided with the selection panel, or based on other information not provided
					 with the selection panel that is known to the party or the appraiser at the
					 time the selection panel is received; and
(B) at any time no later than 30 days after
					 the mediation or appraisal is complete based on other information not provided
					 with the selection panel and discovered after the selection of the umpire or
					 mediator; or
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4253 - Contract Administrator

Current through Reg. 49, No. 28; July 12, 2024
The department may contract with one or more entities to
						administer the umpire roster, the mediator roster, or any of the department's
						or the commissioner's functions in this division.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4260 - Composition of the Expert Panel

Current through Reg. 49, No. 28; July 12, 2024
(a) The
					 expert panel must have a minimum of three and a maximum of seven
					 members.
(b) The commissioner or
					 the commissioner's designee must appoint one member as the presiding officer of
					 the expert panel.
(c) Panel members
					 may be individuals, firms, institutions, or governmental bodies.
(d) Panel members that are firms,
					 institutions, or governmental bodies must designate an individual to represent
					 the panel member and inform the commissioner of the individual representing the
					 panel member.
(e) Collectively, the
					 expert panel must have professional expertise in, and be knowledgeable
					 concerning, the geography and meteorology of the Texas seacoast territory, as
					 well as the scientific basis for determining the extent to which property
					 damage is caused by wind, waves, tidal surges, or rising waters not caused by
					 waves or surges.