Applicability and Purpose

This subchapter applies to all insurers as defined in §21.2502 of this title (relating to Definitions). The purpose of this subchapter is to prescribe the minimum information required to be maintained in the complaint record of an insurer, to provide a recommended format for the maintenance of such a record by insurers, and to require presentation of such information at the time of examination of insurers or upon other request for complaint record information by the department. Complaint record maintenance provisions of this subchapter apply to all complaints of an insurer not specifically excepted by this subchapter, including complaints relating to the claims settlement practices of an insurer.

(1) This subchapter does not apply to complaints received and maintained by Health Maintenance Organizations. Insurance Code Chapter 843, Subchapter G, as amended, as well as §11.205 of this title (relating to Additional Documents to be Available for Review), expressly and specifically provide for complaint record maintenance by HMOs.

(2) This subchapter does not apply to the complaints received by an insurer in its capacity as a utilization review agent. Complaint record maintenance and reporting for such complaints are addressed in §19.1705 of this title (relating to General Standards of Utilization Review).

Source Note: The provisions of this §21.2501 adopted to be effective December 7, 1998, 23 TexReg 12398; amended to be effective November 7, 2021, 46 TexReg 7408.