Website SurveyReview Requirements Checklist
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| REVIEW REQUIREMENTS | REFERENCE | COMMENTS |
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FORMS | ||
| Filing Standards - Policy forms and endorsements may not be unjust, unfair, inequitable, misleading or deceptive. | ||
| POLICY FORMS & ENDORSEMENTS Prior Approval of Policy Forms and Endorsements |
Chapter 2301 (formerly Article 5.145, as governed by the provisions of §8, Article 5.13-2), 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. An insurer may continue to use the policy forms and endorsements promulgated, approved, or adopted under Article 5.35 on notification to the commissioner in writing that the insurer will continue to use those forms. |
| 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. | ||
| Explanatory Memorandum | Filings Made Easy Guide | A detailed explanatory memorandum must be attached to describe a new or revised product, its application and any changes in coverage, limits, exclusions, etc., from that provided by the previously promulgated/approved/adopted forms. |
| Comparative Evaluation | Filings Made Easy Guide | A side-by-side comparison must be attached showing any differences between the filed forms and the previously promulgated, approved, or adopted forms to which the filed form is being compared. Differences must be clearly indicated and explained. When a previously promulgated, approved, or adopted form is being amended, companies must use underlining to denote any new language added and bracketing to remove existing language from a form. |
| Flesch Scoring | §§2301.051 - 2301.055 (formerly Article 5.145), Texas Insurance Code and Commissioner Order No. 92-0573 |
Filings must include the Flesch Score indicating the filed forms meet the minimum readability standards established by the Commissioner of Insurance under Commissioner Order No. 92-0573. Forms that fail to meet a minimum Flesch Score of "40" cannot be approved. |
| Coverage Issues | ||
| Coverages for Spouses and Former Spouses | §2002.003 (formerly Article 5.35-1), Texas Insurance Code | Statutory requirement that a homeowner's policy or fire policy must contain a provision with the language quoted in §2002.003. |
| Lien on Insured Property | §2002.002 (formerly Article 5.37), Texas Insurance Code | Any provision in a residential property policy stating that property is encumbered by a lien of any character or shall after the issuance of such policy become encumbered by a lien of any character; then such encumbrance shall render such policy void, shall be of no force and effect. Any such provision within or placed upon such policy shall be null and void. |
| Fire Insurance: Total Loss of Real Property | §862.053, Texas Insurance Code | A fire insurance policy, in case of total loss by fire of property insured, shall be held and considered to be a liquidated demand against the company for the full amount of such policy. This subsection does not apply to personal property. |
| Interest of Mortgagee or Trustee | §862.055, Texas Insurance Code Commissioner's Bulletin B-0003-00 - Notification of Mortgagee When Insured Cancels Policy |
The interest of a mortgagee or trustee under a fire insurance contract covering property located in the state of Texas may not be invalidated by an act or neglect of the mortgagor or owner of the property; or the occurrence of a condition beyond the mortgagor's or owner's control. |
| Prohibited Practices Relating to Property Insurance | §549.003 (formerly Article 21.48A), Texas Insurance Code | Use language contained in the Texas policy. |
| Anti-Stacking Provisions | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | Other insurance clauses or other similar provisions should not contain an "anti-stacking" provision that excludes coverage in other separate, but applicable, policies issued by the same company or by other companies whether the company is a member of the same company group or a different company or company group. It is permissible to do this only if the other coverages are in the same package or policy issued by the same company. It is permissible to state whether the coverage is primary, secondary, or coordinate limits in proportion to total limits available. |
| Jewelry Coverage | §2002.004 (formerly Article 5.35-2), Texas Insurance Code | An insurer that provides personal jewelry coverage has the option to elect either to pay the stated value or actual replacement of the jewelry item with one of like kind and quality. |
| Defense | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | Cost of defense within limits is not permitted. |
| Special Conditions for Lloyds, Mutuals, Reciprocals, & Participating Stock Companies | General Casualty Bulletins Nos. 276, 443, and 446 | When a policy is issued by a Lloyds, a mutual company, a reciprocal association or a participating stock company having special provisions applicable to its membership, dividends and/or policyholders, such provisions, when approved, in accordance with the provisions of the Texas Insurance Code, of 1951, as amended must be inserted in the policy. |
| Communicable Disease Exclusion | General Casualty Bulletin No. 708 | A communicable disease exclusion will not be approved. EXCEPTION: Consideration for approval will be given to an exclusion with wording similar to that contained in "Exclusion of Sexually Transmitted Disease" as set forth in General Casualty Bulletin No. 708. |
| Intentional Acts | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | Policy language must protect interest of innocent spouse or insured. |
| Arbitration | ||
| Limited to Coverage Disputes | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | Voluntary, post dispute arbitration only. May be either binding or non-binding. |
| Toll Free Information | ||
| Notice of Policyholder Complaint Procedures | §521.005 (formerly Article 1.35), Texas Insurance Code | Texas Insurance Code requires 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. The notice must include the name and address of the department and the toll-free telephone number maintained under §§521.051 - 521.056 (formerly Article 1.35D) of the Texas Insurance Code. |
| Toll-Free Information & Complaint Number | §§521.051 - 521.056 (formerly Article 1.35D), Texas Insurance Code | The Texas Department of Insurance shall maintain a toll-free telephone number to facilitate distribution of information to be made available to aid in resolving complaints against insurers. Each insurer must include with the policy an information bulletin including the toll-free telephone number and describing the services offered through the number. |
| Insurer's Toll-Free Information & Complaint Number | §§521.101 - 521.103 (formerly Article 21.71), Texas Insurance Code | Insurer's requirement to maintain a toll-free number to provide information concerning policies issued by the insurer and to accept complaints from the policyholder. Article contains an exception for insurers whose gross initial premium receipts collected in this state are less than $2 million a year. |
| Notice of Toll-Free Telephone Numbers and Procedures for Obtaining Information and Filing Complaints | 28 TAC §1.601 - §1.602, Texas Administrative Code | To satisfy requirements for §521.005, §§521.051 - 521.056, and §§521.101 - 521.103 (formerly Article 1.35, 1.35D and 21.71) as noted above. |
| Cancellation, Nonrenewal and Other Termination Provisions | ||
| Authorized Cancellation and Nonrenewal of Policies | §§551.101 - 551.112 (formerly Article 21.49-2B), Texas Insurance Code | Cancellation and Nonrenewal of Certain Property and Casualty Policies: Note: Unless the insurer has mailed written notice of nonrenewal to the insured not later than the 30th day before the date on which the insurance policy expires, the insurer must renew an insurance policy, at the request of the insured, on the expiration of the policy. |
| Elected Officials | §§551.151 - 551.152 (formerly Article 21.49-2D), 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 (formerly Article 5.13-2, §8), Texas Insurance Code | Insurance company cannot limit or restrict the insured's right to cancel a policy. |
| Voiding Coverage | Chapter 705, Subchapter A (formerly Article 21.16), Texas Insurance Code | "Void Coverage" language must comply with Chapter 705, Subchapter A, and the misrepresentation must be material. |
| Claims Settlement | ||
| Prompt Payment of Claims | §§542.051 - 542.061 (formerly Article 21.55), Texas Insurance Code | Prompt payment of claim requirements. When the term "Business Day" is used, the definition must be in the policy. |
| Notice of Settlement of Liability Claims | §§542.151 - 542.154 (formerly Article 21.56), 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 | 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. |
| 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. |
| Damages | ||
| Punitive / Exemplary Damages | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | Exclusions may be considered with appropriate rate consideration and rate analysis. 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. Endorsements will not be approved until P&C Actuarial acknowledges that the rates are acceptable. NOTE: Approval of a punitive/exemplary damage exclusion does not relieve an insurer of any contractual obligation to defend which may otherwise exist in the policy. |
| Compensatory Damages | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | If insuring agreement specifies policy pays for compensatory damages, rate consideration may be necessary as policy may not cover non-compensatory damages such as punitive/exemplary damages. |
| Exclusions | ||
| Abuse, Physical Abuse or Molestation Exclusions | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | If policy or endorsement contains this type exclusion, definition of "abuse" in abuse, physical abuse, or molestation exclusion must be included. Must include wording, "For purposes of this endorsement, abuse means an act which is committed with the intent to cause harm." |
| Asbestos, Silica, Lead and Total Pollution Exclusions | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | These type exclusions will only be considered for approval if the request for approval of the coverage form/endorsement is accompanied by corresponding rate consideration and rate analysis. 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. Forms/endorsements will not be approved until P&C Actuarial acknowledges that rates are acceptable. Must attach a disclosure form to every policy to which the exclusion is attached. The disclosure form does not have to be signed by the insured. |
| "Expected or Intended Injury" or "Assault and Battery" | Chapter 2301 (formerly Article 5.13-2, §8), Texas Insurance Code | An exclusion for "expected or intended injury" or "assault and battery", must be limited to the "the" insured and not "any" insured. |
| Windstorm, Hurricane, or Hail Exclusion | §2210.205 (formerly Article 21.49 §7), Texas Insurance Code | Windstorm, hurricane, or hail may only be excluded in the catastrophe area as designated by the Texas Department of Insurance. The endorsement must limit the exclusion to the catastrophe area as designated by the Texas Department of Insurance and the windstorm, hurricane, or hail exclusion endorsement must be signed by the insured. In lieu of the signature being required on the endorsement, the Department will consider a signed disclosure form that clearly explains that coverage for windstorm, hurricane or hail is excluded from the policy. The Department will also consider optional windstorm, hurricane, or hail exclusions outside the designated catastrophe area only if there is proper rate consideration for the exclusion and the insured signs the endorsement or disclosure form as noted above. Must be optional from the insured's perspective and this should be reflected in the endorsement or in a rule. The Department will also consider windstorm, hurricane, or hail exclusions in the policy itself, if such coverage is made available to the consumer through a buy-back option and there is proper rate consideration for the exclusion and the buy-back option. Insurers are responsible for maintaining documentation in their underwriting files that supports that the coverage was made available to the insured. Forms and/or endorsements will not be approved until P&C Actuarial acknowledges that the rates are acceptable. |
| General Change Endorsements | ||
| May Not Manuscript Coverage Once Approved | Chapter 2301 (formerly Article 5.13-2, §8), 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 | ||
| Prohibited Practices and Rebates Relating to Policies | Chapter 1806, Subchapters A & D (formerly Article 5.41), Texas Insurance Code | Inducements prohibited. |
| Choice of Law | ||
| Texas Laws Govern Policies | Article 21.42, Texas Insurance Code | Texas must be choice if filing contains choice of law provision. |
|
RATES | ||
| Filing Standards | ||
| File & Use | Chapter 2251 (formerly Article 5.13-2), Texas Insurance Code | Each insurer shall file with the Commissioner all rates, applicable rating manuals, supplementary rating information, and additional information as required by the commissioner for risks written in this state. |
|
RULES | ||
| Filing Standards | ||
| File & Use | Chapter 2301 & Chapter 2251 (formerly Article 5.13-2), 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: 08/19/2009
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