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Review Requirements Checklist Employers Indemnity

Employers Indemnity (Including Employers Liability) for Non-Subscribers to Workers Compensation Act that Self Insure ERISA Obligations

Updated 10/3/2016 - Return to Index

Indicates new addition since last update.Indicates new addition since last update.

Employers Indemnity Checklist
REVIEW REQUIREMENTS REFERENCE COMMENTS
FORMS
Filing Standards - Policy forms and endorsements may not be unjust, unfair, inequitable, misleading or deceptive.
Prior Approval of Policy Forms and Endorsements Chapter 2301, Texas Insurance Code An insurance policy form or endorsement may not be delivered or issued for delivery in this state unless the form has been filed with and approved by the commissioner. Each filing shall be made not later than the 60th day before the date of any use or delivery for use.
Large Risk Exemption §2301.004, Texas Insurance Code Policy forms for use with large risks are exempt from filing for prior approval if the forms are to be used with a "large risk". "Large Risk" is defined as an insured that has total insured property values of $5 million or more; an insured that has total annual gross revenues of $10 million or more; or an insured that has a total premium of $25,000 or more for property insurance, $25,000 or more for general liability insurance, or $50,000 or more for multiperil insurance.
Disapproval of Forms; Withdrawal of Approval §2301.007, Texas Insurance Code The commissioner may disapprove a form filed under §2301.006 or withdraw approval of a form if the form (1) violates any law, including a rule adopted under the Texas Insurance Code, or (2) contains a provision or has a title or heading that is unjust or deceptive, encourages misrepresentation, or violates public policy.
Applications
Not Required to be Filed For Approval Unless Being Made a Part of the Policy
Arbitration
Arbitration Chapter 2301, Texas Insurance Code Language used in arbitration agreements is to be consistent with that of the policy: to wit, don't use the word "parties" when you actually mean insured(s) and insurer. Binding arbitration is okay. Arbitration agreements may be mandatory. Arbitration must be held in Texas for Texas policyholders unless mutually agree on an alternate. In general, arbitration language cannot be unjust, misleading or deceptive.
Cancellation & Nonrenewal
Cancellation & Nonrenewal of Certain Liability Insurance Coverage §§551.051-551.055 and §551.004, Texas Insurance Code Cancellation and nonrenewal of certain liability insurance policies.
Elected Officials §§551.151 & 551.152, Texas Insurance Code An insurer may not cancel or refuse to renew an insurance policy based solely on the fact that the policyholder is an elected official.
Insured's Right to Cancel Chapter 2301, Texas Insurance Code Insurance company cannot limit or restrict the insured's right to cancel a policy.
Voiding Coverage Chapter 705, Texas Insurance Code "Void Coverage" language must comply with Chapter 705, Subchapter A, and the misrepresentation must be material.
Choice of Law
Texas Laws Govern Policies Article 21.42, Texas Insurance Code Texas must be choice if filing contains choice of law provision.
Claims Made Coverage
Disclosure Required Chapter 2301, Texas Insurance Code If the policy is a claims made policy a disclosure to that effect must be prominently displayed on either or both the declaration sheet or the first page of the policy. The disclosure must be plainly readable bold type.
30-Day Extended Reporting Period Required Chapter 2301, Texas Insurance Code The insured must be given at least an automatic 30-day extended reporting period to report claims becoming known too late to report before the end of the policy period.
Policy Provision Required Chapter 2301, Texas Insurance Code A policy provision advising the insureds of a right to purchase an extended reporting endorsement. The policy must give the insured a minimum of thirty days to purchase the extended reporting endorsement and the minimum term of the extended reporting period must be at least one year. An extended reporting period unlimited in time must be available.
Claims Settlement
Prompt Payment of Claims §§542.051 - 542.061, Texas Insurance Code Prompt payment of claims. (1st Party Coverage - "Pay to," "indemnify," or "reimburse" the insured. Not "pay on behalf of".)
Notice of Settlement of Liability Claims §§542.151 - 542.154, Texas Insurance Code Notice of settlement of claim under casualty insurance policy. EXCEPTION - This article does not apply to a casualty policy that requires the insured's consent to settlement of a claim against the insured; or to fidelity, surety, or guaranty bonds.
Contractual Limitations Period - Suits §16.070, Civil Practice & Remedies Except as provided by Subsection (b), a person may not enter a stipulation, contract, or agreement that purports to limit the time in which to bring suit on the stipulation, contract, or agreement to a period shorter than two years. A stipulation, contract, or agreement that establishes a limitations period that is shorter than two years is void in this state. The Texas Third Court of Appeals issued an opinion that acknowledges that the language providing 2 years and 1 day from the date the cause of action first accrues satisfies the statutory requirement of §16.070, Civil Practices and Remedy Code. ( http://www.search.txcourts.gov/Case.aspx?cn=03-08-00408-CV) Case #03-08-00408-CV
Notice Requirements §16.071, Civil Practice & Remedies A contract stipulation that requires a claimant to give notice of a claim for damages as a condition precedent to the right to sue on the contract is not valid unless the stipulation is reasonable. A stipulation that requires notification within less than 90 days is void.
Providing Certain Claims Information On Request §§542.101-542.104, Texas Insurance Code; and Commissioner's Bulletin No. B-0043-05 If a policy form or endorsement contains language addressing the request or furnishing of claims information, it would need to comply with the applicable statute(s).
Coverage Issues
Defense Coverage Chapter 2301, Texas Insurance Code Policy must provide for defense or reimbursement of defense costs for policies that reimburse or pay on behalf of the insured employer who has opted out of the workers compensation system for sums that the employer must legally pay as damages because of bodily injury to the employer's employees.
Examination Under Oath Chapter 2301, Texas Insurance Code If policy language requires examination under oath for anyone other than the named insured and spouse, the provision must also state that a parent or guardian may be present during any examination of a minor.
No Payment On Behalf Of Insured For Benefits Chapter 2301, Texas Insurance Code Policy may not pay on behalf of insured or directly to the employers employees for benefits in policies that reimburse the insured employer who has opted our of the workers compensation system for sums paid by the employer as benefits to the employers employees because of bodily injury that arises out of and in the course of employment by the insured employer.
Policies May Provide Coverage For Occupational Disease and Accident Coverage and Employers Liability Chapter 2301, Texas Insurance Code Employers Indemnity Policies must: (A) reimburse the insured employer who has opted out of the workers compensation system for sums paid by the employer as benefits to the employers employees because of bodily injury that arises out of and in the course of employment by the insured employer; AND/OR (B) reimburse or pay on behalf of the insured employer who has opted out of the workers compensation system for sums that the employer must legally pay as damages because of bodily injury to the employer's employees.
Reimbursement Only Chapter 2301, Texas Insurance Code Policy that provides for reimbursement to the employer for payment of benefits to employees must limit the reimbursement to benefits and/or damages paid to the employees for occupational disease, accident, disability, or loss of life under a self funded plan.
Disclosure of Non Workers Compensation 28 TAC §5.6302 The first page of the policy must contain the following notice in 10-point boldface type: THIS IS NOT A POLICY OF WORKERS' COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS' COMPENSATION SYSTEM BY PURCHASING THIS POLICY, AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS' COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS' COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.
Tie-In Sales Chapter 1806, Texas Insurance Code & 6/1/78 Board Letter Tie-in sales may violate state law.
Exclusions
Asbestos, Lead and Silica Exclusions Chapter 2301, Texas Insurance Code These types of exclusions require a rate analysis and may also require rate consideration. A "rate analysis" is the company's actuarial justification for the rate consideration given, or not given, for use of the exclusion. This would include the reasons for the amount of any rate credit or the justification for the position that no rate credit is given. Must attach a disclosure form to every policy to which the exclusion is attached and manual rules should reflect this requirement.
General Change Endorsements
May Not Manuscript Coverage Once Approved Chapter 2301, Texas Insurance Code Coverage forms are prior approval. Change endorsements may be used to change insured address, etc. but may not be used to change, alter or "clarify" coverage in any way. Company must provide verification that the endorsement will not be used to change, alter, or clarify coverage.
Rebating or Discrimination
Rebating or Discrimination Chapter 1806, Texas Insurance Code Inducements prohibited.
Toll Free Information
Notice of Policyholder Complaint Procedures §521.005, Texas Insurance Code A brief written notice of suggested procedure to be followed by the policyholder in the event of a dispute concerning a policyholder's claim or premium.
Toll-Free Information & Complaint Number §§521.051 - 521.056, Texas Insurance Code Toll-Free number for the Texas Department of Insurance.
Insurer's Toll-Free Information & Complaint Number §§521.101 - 521.103, Texas Insurance Code Insurer's requirement to maintain toll-free number to provide information concerning policies issued by the insurer and to accept complaints from policyholder. Article contains an exception for insurers whose gross initial premium receipts collected in this state are less than $2 million a year or to an insurer with regard to fidelity, surety, or guaranty bonds.
Notice of Toll-Free Telephone Numbers and Information & Complaint Procedures Indicates new addition since last update.28 TAC §1.601 & §1.602, Texas Administrative Code and Commissioner’s Order 3952 To satisfy requirements for §521.005, §§521.051 - 521.056, and §§521.101 - 521.103 noted above.
Texas Lloyds, Mutual, Reciprocals and Participating Stock Cos.
Special Policy Conditions General Casualty Bulletins Nos. 276, 443, and 446 Requiring specific language be contained in policies issued by Lloyds, Mutuals, Reciprocals, and Participating Stock Companies.
RATES
Filing Standards
File & Use Chapter 2251, Texas Insurance Code Each insurer shall file with the Commissioner all rates, supplementary rating information, and reasonable and pertinent supporting information for risks written in this state.
RULES
Filing Standards
File & Use Chapter 2301 & Chapter 2251, Texas Insurance Code Manual rules should reflect specific requirements for usage of policy forms, endorsements, and disclosures.
Required Documentation
Refer to Property & Casualty Filings Made Easy Go to Property & Casualty Filings Made Easy now


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Last updated: 10/14/2016

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