Authorization at TDI - PowerPoint PPT Presentation

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Authorization at TDI

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  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. Methods of Investigation • Written Inquiry • Subpoena • Witness Statements • Under Cover

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

  7. 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

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

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

  10. 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