| 1 | 1 | | By: Davis of Dallas H.B. No. 4277 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | A BILL TO BE ENTITLED |
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| 5 | 5 | | AN ACT |
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| 6 | 6 | | relating to the establishment of the consumer complaint review |
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| 7 | 7 | | panel by the State Office of Administrative Hearings to conduct |
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| 8 | 8 | | certain insurance appeals. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Chapter 2003, Government Code, is amended by |
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| 11 | 11 | | adding Subchapter E to read as follows: |
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| 12 | 12 | | SUBCHAPTER E. INSURANCE APPEALS |
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| 13 | 13 | | Sec. 2003.151. DEFINITIONS. In this subchapter: |
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| 14 | 14 | | (1) "Department" means the Texas Department of |
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| 15 | 15 | | Insurance. |
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| 16 | 16 | | (2) "Panel" means the consumer complaint review panel |
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| 17 | 17 | | established under this subchapter. |
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| 18 | 18 | | Sec. 2003.152. CONSUMER COMPLAINT REVIEW PANEL. (a) The |
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| 19 | 19 | | office shall establish a consumer complaint review panel to conduct |
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| 20 | 20 | | an appeal from the complaint resolution program established under |
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| 21 | 21 | | Chapter 521, Insurance Code, of a policyholder complaint: |
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| 22 | 22 | | (1) that is denied by the department; |
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| 23 | 23 | | (2) that is determined to be without merit by the |
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| 24 | 24 | | department; or |
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| 25 | 25 | | (3) for which the department did not confirm receipt |
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| 26 | 26 | | of the complaint. |
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| 27 | 27 | | (b) Except as provided by this subchapter, an appeal under |
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| 28 | 28 | | this section is a contested case under Chapter 2001. |
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| 29 | 29 | | Sec. 2003.152. TIMELINESS OF APPEAL. (a) The panel shall |
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| 30 | 30 | | conduct all appeals under this subchapter in a timely manner. |
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| 31 | 31 | | (b) The panel shall use every reasonable means to expedite |
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| 32 | 32 | | an appeal under this subchapter when the policyholder or department |
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| 33 | 33 | | provides good cause that the panel expedite the appeal. |
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| 34 | 34 | | Sec. 2003.153. CONFIDENTIALITY OF INFORMATION. (a) The |
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| 35 | 35 | | panel shall keep information that identifies a policyholder who |
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| 36 | 36 | | participates in an appeal under this subchapter confidential, |
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| 37 | 37 | | including the policyholder's name and medical condition, if |
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| 38 | 38 | | applicable. |
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| 39 | 39 | | (b) The provision of information to the panel that is |
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| 40 | 40 | | confidential under any law does not affect the confidentiality of |
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| 41 | 41 | | the information, and the panel shall maintain that confidentiality. |
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| 42 | 42 | | (c) An appeal conducted under this subchapter is |
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| 43 | 43 | | confidential and not open to the public. |
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| 44 | 44 | | Sec. 2003.154. DECISION. The panel shall determine whether |
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| 45 | 45 | | an appeal conducted under this subchapter has merit and if so, |
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| 46 | 46 | | remand the case to the department for resolution. |
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| 47 | 47 | | Sec. 2003.155. RULES. The commissioner of insurance may |
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| 48 | 48 | | adopt rules necessary to implement this subchapter. |
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| 49 | 49 | | SECTION 2. Not later than January 1, 2020, the State |
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| 50 | 50 | | Office |
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| 51 | 51 | | of Administrative Hearings shall establish the consumer complaint |
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| 52 | 52 | | review panel under Section 2003.152, Government Code, as added by |
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| 53 | 53 | | this Act. |
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| 54 | 54 | | SECTION 3. This Act takes effect September 1, 2019. |
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