Providing Claims Information to Insureds
Information on Liability Claims
Section 542.101 of the Texas Insurance Code requires insurers to provide claims information on certain policies upon request by the insured. This provision applies to the following lines of insurance:
- General Liability;
- Medical and Other Professional Liability;
- Commercial Auto Liability; and
- the liability portion of Commercial Multi Peril coverage.
On written request by the named insured under one of the above policies, the insurer must provide the information relating to the disposition of a claim within 30 days from the date the request is received by the insurer. The insured's request must be transmitted to the insurer within six months from the date of disposition of the claim. The information supplied to the insured must include:
- the name of each claimant;
- details relating to the amount paid on the claim, settlement of the claim, or judgment on the claim; and
- details as to how the claim, settlement or judgment is to be paid.
Notice of Settlement of Liability Claims
Section 542.151 of the Texas Insurance Code, applicable to any casualty policy written by any insurer including surplus lines, requires the insurer to notify the named insured in writing of an initial offer to compromise or settle a liability claim against the insured within 10 days after the offer. In addition, the statute requires the insurer to notify the insured of any settlement of a claim within 30 days after the settlement.
Information on Workers Compensation Claims
Section 2051.151 of the Texas Insurance Code requires an insurer providing workers' compensation insurance to provide the following notices to their policyholders:
- notification of any claim filed against the policy;
- any proposal to settle a claim;
- if requested in writing by the insured, notification of any administrative or judicial proceeding relating to the resolution of a claim, including a benefit review conference; and
- if requested in writing by the insured, a list of claims charged against the policy, including payments made and reserves established on each claim. A statement explaining the effect of claims on premium rates should accompany this information. This information must be provided within 30 days of the policyholder's written request.
The Texas Amendatory Endorsement (WC 42 03 01 C) incorporates these notification requirements into the policy and must be attached to all policies.
Information on All Other Lines
Section 542.102 of the Texas Insurance Code requires an insurer that writes property and casualty insurance, on written request of the policyholder, to provide the policyholder with a list of claims charged against the policy and payments made on each claim. The insurer must provide the information not later than the 30th day after the date on which the written request is received by the insurer. The information is considered to be provided on the date that the information is received by the United States Postal Service or personally delivered.
Information on Group Health Claims
Section 1251.001 of the Texas Insurance Code requires an insurer to respond within 30 days to a request for claims information from a plan, plan sponsor or plan administrator.