1 Enforcement at TDI. 2 What We Do Regulate the business of insurance in Texas firmly and fairly by enforcing and implementing the law Ensure the Texas.

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Presentation transcript:

1 Enforcement at TDI

2 What We Do Regulate the business of insurance in Texas firmly and fairly by enforcing and implementing the law Ensure the Texas Insurance Code and other laws regarding insurance and insurance companies are executed

3 How does TDI learn of violations of the Insurance Code, Labor Code or other insurance laws? Complaints (Direct or Referred from Other TDI program) Consumer Agent Company Anonymous Internal Discovery Examination Failure to File Failure to Respond to TDI Inquiry Other Regulatory Agency Law Enforcement

4 Enforcement Division Teams Health, HMO, Life and Viatical Licensing P&C, Windstorm and Fire Marshal Rate, Title and Financial

5 Catherine Reyer Associate Commissioner Health/HMO Life/Viatical Leah Gillum 5 Attorneys 7 Investigators Agent Licensing Deea Western 11 Attorneys 7 Investigators P&C/Windstorm Fire Marshal Lorrie Ensley 5 Attorneys 4 Investigators Rate/Title/Financial Michael Rigby 5 Attorneys 2 Investigators Compliance Intake Unit Robert Gutierrez 6 Intake Staff Support Staff

6 Methods of Investigation Written Inquiry Subpoena Witness Statements Under Cover

7 Enforcement Actions In enforcement actions, TDI may seek: Revocation of License or Authorization Fine Restitution Corrective Action Cease and Desist Order

8 Explanation of Legal Actions No Automatic Penalties TIC Chapter 84 Factors: Materiality of the Violation Economic Harm Intent Deter Future Violations History of Previous Violations Corrective Actions

9 Possible Enforcement Outcomes Informal Resolution with or without Consent Order Contested Case Resolution with Notice Emergency Cease and Desist Order Referral to Attorney General

10 Current Investigations Prompt payment of claims Discrimination among types of providers Interference with provider/patient relationships/Dictation of treatment Improper preauthorization/notification policies

11 Things you can do to help Review your contracts Formally complain to TDI Provide copies of correspondence between yourself and insurer Provide other documentation supporting your complaint