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You are here: Home . rules . 2002 . 0505-059
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Subchapter F. Summary Procedures for Routine Matters

28 TAC §§1.702 - 1.705

The Commissioner of Insurance adopts amendments to §§1.702 - 1.705 concerning activities related to summary procedures for routine matters. The amendments to §§1.702 and 1.704 are adopted with changes to the proposed text as published in the December 6, 2002 issue of the Texas Register (27 TexReg 11451). The amendments to §§1.703 and 1.705 are adopted without changes to the proposed text and will not be republished.

The amendments are necessary to update Subchapter F to reflect the restructuring of the department´s divisions, statutory changes, and technological advancements regarding communication between the department and persons affected by these routine matters. Insurance Code §36.102 permits the commissioner by rule to create a summary procedure for certain routine matters. This subchapter sets forth those activities that have been designated by the commissioner as routine because they are voluminous, repetitive, believed to be noncontroversial, and of limited interest to persons other than those immediately involved or affected.

The amendments to §1.702 set forth the activities designated for summary procedure disposition. Among other things, these amendments add viatical and life settlement certificates of registration, utilization review and independent review organization certificates, and third-party administrator certificates of authority to the list of designated forms and filings and licenses, certificates, or registrations, as applicable. The amendments also eliminate outdated references to Insurance Code Chapter 5, Subchapter B, (a) rates; Chapter 5, Subchapter B, excess rate or umbrella; excess inland marine; and cessation of acceptance of workers´ compensation of small premium policies. Due to statutory changes, (a) rates are no longer accepted, personal umbrella rates are subject to prior approval, and commercial umbrella rates are submitted as file and use. In House Bill 2 (72nd Legislative Session, 1991) the Texas Legislature deregulated commercial property and general liability insurance rates, and in Board Order No. 59970 (1992), the former State Board of Insurance re-designated the status of the rates to "standard" from "approved standard and uniform." The department no longer approves standard and uniform rates and Insurance Code Article 5.26 provides for rates in excess of the promulgated rate, making the language in §1.702 regarding "excess of" no longer applicable. Insurance Code Article 5.65-2, which among other things contained provisions regarding the workers´ compensation small premium policy plan, was repealed effective December 31, 1993. Minor changes were also made to the section to correct punctuation.

The amendments to §1.703 delegate the various activities listed in §1.702 to the appropriate associate or deputy commissioner within the department responsible for summary procedure disposition of those activities. These amendments reflect a restructuring of various divisions within the department and assignment of responsibilities for certain functions, including the regulatory functions regarding health maintenance organizations, which is delegated in part to the Financial Program and in part to the HMO Division. Language was also added to recognize that, in the event of such a restructuring of the department in the future, the delegation of the administration over the activities will follow the appropriate associate or deputy commissioner assuming responsibility for the activities. The amendments to this section also delete language referencing the filings for which the deputy commissioner of property insurance was delegated responsibility because they were previously deleted pursuant to Board Order No. 59970 (1992). The amendments also change various references to the former state board of insurance to commissioner or department, as appropriate.

Amendments to §1.704 add electronic transmission as another means of notifying a person of an action regarding a matter requiring final disposition by the department. The amendments to this section also establish the procedure to be used by the department in notifying a person of a departmental action affecting the person. Minor changes were also made to the section to correct punctuation. The amendments to §1.705 correct statutory references to the Insurance Code and clarify how to file a petition for review.

No comments were received.

The sections are adopted pursuant to Insurance Code §§36.102 and 36.001. Insurance Code §36.102 provides that the commissioner of insurance may, by rule, create a summary procedure for routine matters and designate department activities that otherwise would be subject to Government Code Chapter 2001, as routine matters to be handled under summary procedure. Insurance Code §36.001 permits the commissioner to adopt rules for the conduct and execution of the powers and duties of the department as authorized by statute.

§1.702. Designated Activities. The following statutorily prescribed activities are designated for summary procedure disposition:

(1) Filings of forms, rates, and related filings pursuant to Insurance Code Articles 3.42, 3.50-6A, 3.70-12, 3.53, 3.74, 5.13-1; Chapters 23 and 26; and §3.3325(f) and (g) of this title (relating to Medicare Select Policies, Certificates, and Plans of Operation), but not withdrawals of approval pursuant to Insurance Code Articles 3.42, 3.53, 5.13-1, and Chapter 23.

(2) Filings of forms, rates, and related filings by health maintenance organizations pursuant to §11.301(4)(A), (B), and (L), and (5)(C), (G), (K), (M), and (N) of this title (relating to Filing Requirements), but not withdrawals of approval pursuant to Insurance Code Chapter 20A.

(3) Filings of forms, rates, and related filings by health maintenance organizations pursuant to §11.301 of this title, except those listed in paragraph (2) of this section, but not withdrawals of approval pursuant to Insurance Code Chapter 20A.

(4) Filings of application or renewal for the following:

(A) agents and adjusters licenses pursuant to Insurance Code Articles 1.14-2, 3.75, 21.07, 21.07-1, 21.07-2, 21.07-3, 21.07-4, 21.09, 21.11, 21.14, and 23.23, insurance premium finance licenses pursuant to Insurance Code Article 24.03, and third party administrator certificates of authority pursuant to Insurance Code Article 21.07-6;

(B) viatical and life settlement certificates of registration pursuant to Insurance Code Article 3.50-6A;

(C) utilization review agent certificates pursuant to Insurance Code Article 21.58A and §§19.1704(g) and 19.2004 of this title (relating to Certification of Utilization Review Agents), and independent review organization certificates pursuant to Insurance Code Article 21.58C and §12.109 of this title (relating to Appeal of Denial of Application or Renewal); and

(D) licenses pursuant to Insurance Code Articles 9.35 - 9.38, 9.41 - 9.45, 9.56, and 9.58.

(5) Applications to change rates, forms, or deductibles for motor vehicle insurance on an individual risk basis pursuant to Rule 4 in the Texas Automobile Rules and Rating Manual adopted under Insurance Code Article 5.101.

(6) Applications to charge a rate or premium greater than the standard rate or premium approved by the commissioner for the types of insurance specified in Insurance Code Article 5.13, pursuant to Insurance Code Article 5.15(c).

(7) Filings of endorsements for negotiated deductible plans for workers' compensation insurance policies made pursuant to Insurance Code Article 5.55C.

§1.703. Delegation. The Commissioner of Insurance hereby delegates to the following associate or deputy commissioners administration over the activities designated in paragraphs (1) - (7) of this section. In the event the names of certain divisions, titles, or positions within the department are changed due to consolidation or expansion of the department's activities or divisions, the delegation of the administration over the following activities will follow the appropriate associate or deputy commissioner assuming responsibility for the activity.

(1) Deputy commissioner for life/health insurance is responsible for activities listed in §1.702(1) and (4)(B) of this subchapter (relating to Designated Activities).

(2) Deputy commissioner for health maintenance organization is responsible for activities listed in §1.702(2) and (4)(C) of this subchapter.

(3) Senior associate commissioner for financial is responsible for activities listed in §1.702(3) of this subchapter.

(4) Deputy commissioner for licensing is responsible for activities listed in §1.702(4)(A) of this subchapter.

(5) Deputy commissioner for title insurance is responsible for activities listed in §1.702(4)(D) of this subchapter.

(6) Associate commissioner for property and casualty insurance is responsible for activities listed in §1.702(5) - (6) of this subchapter.

(7) Deputy commissioner of workers' compensation insurance is responsible for activities listed in §1.702(7) of this subchapter.

§1.704. Summary Procedure; Notice.

(a) Actual notice for proposed negative action. In the case of proposed negative action with regard to any delegated activity designated under §1.702 of this subchapter (relating to Designated Activities), parties directly involved shall be given actual notice at least five days in advance of the action proposed. Actual notice means written or electronic notice. If the actual notice is a written notice, it will be sent by mail addressed to the last known address of the person, or, if the person is represented by an attorney, to the person´s attorney of record, as submitted with the filing, application, form, or submission that is the subject of the proposed negative action. If the actual notice is electronic, it will be sent electronically to the email address or to the electronic destination, as applicable, from which the person submitted the filing, application, form, or submission which is the subject of the proposed negative action.

(b) Notice of decision. For §1.702(1) - (7) of this subchapter, the appropriate associate or deputy commissioner shall notify the person by mail or electronic transmission of a positive or negative decision and the date of the decision, shall record the decision in the department's electronic files, and shall retain a record of the notification with the filing, application, form, or submission or cause the appropriate license, certificate, or registration to be mailed to the person.

§1.705. Review. Any person affected by any action taken by an associate or deputy commissioner under this subchapter may petition the commissioner for a hearing to review the matter. The petition shall contain an identification of the matter complained of and a petitioner´s statement, including a rebuttal of the associate or deputy commissioner´s action with specific particularity to inform the commissioner and any interested persons of the petitioner´s reasons and arguments serving as the basis of the petition. The petition shall be filed with the Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. The review shall be conducted pursuant to the Texas Administrative Procedure Act. Any further relief sought is governed by Insurance Code §§36.201 - 36.205.



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