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 8 - LOSS CONTROL INFORMATION FOR PROFESSIONAL LIABILITY INSURANCE FOR INSUREDS OTHER THAN HOSPITALS, FOR GENERAL LIABILITY INSURANCE, OR FOR MEDICAL PROFESSIONAL LIABILITY INSURANCE FOR INSUREDS OTHER THAN HOSPITALS › Section 5.1723 - Evaluation and Inspection of Loss Control Information 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 information/services of each
						insurer writing professional liability insurance for insureds other than
						hospitals, of each insurer writing general liability insurance, and of each
						insurer writing medical professional liability insurance for insureds other
						than hospitals in Texas.
(1) Location
					 of evaluations. Evaluations will be conducted in Texas at a company home
					 office, division office, regional office, or office closest to Austin, or as
					 otherwise arranged through mutual consent between a representative of 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
					 Texas company offices or operating locations to the selected evaluation
					 location. All affiliated companies of an insurer shall be evaluated at the same
					 time and location.
(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 the proposed
					 date of the company's evaluation a minimum of 60 days in advance of the
					 evaluation.
(B) List of
					 policyholder accounts. At least 45 days prior to the date set for the
					 evaluation, the company must provide the director of loss control regulation
					 with a list of policyholder accounts, by premium grouping and location. The
					 list shall be separated by affiliated insurance company, including the name and
					 policy number of each policyholder, and arranged in order of descending
					 premium.
(C) Notice of accounts to
					 be evaluated. Upon receipt of this list, the director of loss control
					 regulation 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. 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 the accounts are selected to complete the
					 worksheets. Information on the worksheet may include, but is not limited to,
					 the following:
(i) account identification and
					 location;
(ii) estimated annual
					 premium;
(iii) description of
					 operations;
(iv) date of last loss
					 prevention visit, or direct communication (if any);
(v) loss/accident data;
(vi) loss potential of risk;
(vii) information submitted to policyholders
					 for loss control purposes;
(viii)
					 extent and type of services provided;
(ix) number of employees;
(x) loss ratio;
(xi) effective date of policy; and
(xii) other information as deemed necessary
					 by the director of loss control regulation.
(E) Delivery of information to the board.
					 Five working days prior to the scheduled inspection, the insurer shall deliver
					 the completed worksheets to the Loss Control Regulation Division, State Board
					 of Insurance. Information from account files and other appropriate information
					 and documents shall be made available to the inspectors during the
					 evaluation.
(F) Possible visit by
					 inspector. If considered necessary, the inspector may visit a policyholder to
					 make further evaluation of the loss control information and services provided.
					 If requested by the inspector, a 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.