Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter B - INSURANCE CODE, CHAPTER 5, SUBCHAPTER B › Division 7 - STANDARDS FOR PROVIDING LOSS CONTROL SERVICES FOR PROFESSIONAL LIABILITY INSURANCE FOR HOSPITALS › Section 5.1713 - Evaluation and Inspection of Loss Control Facilities and Services

Current through Reg. 49, No. 28; July 12, 2024
At least every two years, the State Board of Insurance
						will conduct an evaluation of the loss control facilities and services of each
						insurer writing professional liability insurance for hospitals in the State of
						Texas.
(1) Location of evaluations.
					 Evaluations will be conducted at the insurer's home office, division office,
					 regional office, or office closest to Austin, unless otherwise arranged through
					 mutual consent between the director of loss control regulation for the State
					 Board of Insurance and a representative of the insurer. Companies out of state
					 with no office in Texas will be required to bring necessary files to Austin.
					 The insurer shall bring all account files selected by the director of loss
					 control regulation from all company offices to the selected evaluation
					 location. All affiliated companies of an insurer shall be evaluated at the same
					 time and place.
(2) Notification
					 and preparation. Notification and preparation for evaluations shall occur in
					 accordance with subparagraphs (A)-(F) of this paragraph.
(A) Notice of date of evaluation. The
					 director of loss control regulation will notify each company of a proposed date
					 60 days in advance of the evaluation for that company.
(B) List of policyholder accounts. At least
					 45 days prior to the date set for the evaluation, the insurer must provide the
					 director of loss control regulation with a list of policyholder accounts, by
					 premium, based on the individual company's most current data processing records
					 or other comparable records if data processing records are not available. The
					 list must be separated by affiliated insurance companies and include the name,
					 location, and policy number of each insured and must be arranged in order of
					 descending premium. The Insurance Code, Article 5.15-2(h), provides that loss
					 control information provided by an insurer to an insured is not discoverable or
					 admissible in any civil proceeding as evidence. Such information, when provided
					 to this agency under these rules, shall be deemed confidential and proprietary
					 information, and shall be restricted to State Board of Insurance
					 personnel.
(C) Notice of accounts
					 to be evaluated. Upon receipt of this list, the director of loss control
					 regulation or a State Board of Insurance inspector will select those accounts
					 to be evaluated, notify the company, and specify each account for which an
					 evaluation worksheet must be prepared by the company. At that time, the
					 director shall return such list to the company with instructions on completing
					 the required evaluation worksheets. Worksheet forms will be provided to the
					 company at the time the accounts to be evaluated are identified.
(D) Information required. The company will
					 have at least 30 days from the time notification is received to complete the
					 worksheets. Information on the worksheet may include, but is not limited to,
					 the following:
(i) identification of account
					 and location;
(ii) type of hospital
					 (government, proprietary, etc.); number of employees;
(iii) estimated annual premium;
(iv) description of operations and services
					 provided;
(v) date of last visit or
					 direct communications;
(vi) types
					 of patient care services provided;
(vii) number of physicians;
(viii) loss occurrence data;
(ix) loss potential of risk;
(x) loss ratio;
(xi) recommendations submitted for loss
					 control;
(xii) training program
					 information;
(xiii) number of beds;
					 and
(xiv) number of patient visits
					 (inpatient and outpatient).
(E) Availability of information. The insurer
					 must make the completed worksheets available to the inspector at least five
					 working days in advance of the inspection. At the time of the evaluation, the
					 account files and other data deemed necessary shall be available to verify
					 evaluation worksheets prepared by the insurer.
(F) Possible visit by inspector. If
					 considered necessary, the inspector may visit a hospital to make further
					 evaluation of the loss control services provided. If requested by the
					 inspector, the representative of the insurer shall make the necessary
					 notifications and arrangements and shall be afforded the opportunity to
					 accompany the inspector. If the director of loss control regulation for the
					 State Board of Insurance considers it appropriate, the inspector will make the
					 visit without notifying the insurer.