Current through Reg. 50, No. 13; March 28, 2025
At least every two years, the State Board of Insurance
will conduct an evaluation of the loss control information/services of each
insurer writing commercial automobile liability insurance in Texas.
(1) Location of evaluations. Evaluations will
be conducted in Texas at a company home office, division office, regional
office, or office closest to Austin, unless otherwise arranged through mutual
consent between a representative of the director of loss control regulation for
the State Board of Insurance and a representative of the insurer. Companies out
of state with no office in Texas will be required to bring necessary files to
Austin. The insurer shall bring all account files selected by the director of
loss control regulation from all Texas company offices or operating locations
to the selected evaluation location. All affiliated companies of an insurer
shall be evaluated at the same time and place.
(2) Notification and preparation.
Notification and preparation for evaluations shall proceed as contained in
subparagraphs (A)-(F) of this paragraph.
(A)
Notice of date of evaluation. The director of loss control regulation will
notify each company of the proposed date of the company's evaluation a minimum
of 60 days in advance of the evaluation.
(B) List of policyholder accounts. At least
45 days prior to the date set for the evaluation, the company must provide the
director of loss control regulation with a list of policyholder accounts, by
premium grouping and servicing location. The list shall be separated by
affiliated insurance companies, including the name and policy number of each
policyholder, and arranged in order of descending premium.
(C) Notice of accounts to be evaluated. Upon
receipt of this list, the director of loss control regulation will select those
accounts to be evaluated, notify the company, and specify each account for
which an evaluation worksheet must be prepared by the company. Worksheet forms
will be provided to the company at the time the accounts to be evaluated are
identified.
(D) Information
required. The company will have at least 30 days from the time the accounts are
selected to complete the worksheets. Information on the worksheet will include
the following:
(i) account identification and
location;
(ii) estimated annual
premium;
(iii) description of
operations;
(iv) date of last
safety visit, or direct communication (if any);
(vi) loss potential of risk;
(vii) information submitted to policyholders
for loss control purposes;
(viii)
number and type of vehicles;
(xi) effective date of
policy.
(E) Delivery of
information to the board. Five working days prior to the inspection, the
insurer must deliver the completed worksheets to the Loss Control Regulation
Division, State Board of Insurance. Information from account files and other
appropriate information and documents shall be made available to the inspectors
during the evaluation.
(F) Possible
policyholder visit. If considered necessary, the inspector may visit a
policyholder to make further evaluation of the loss control information and
services provided. If requested by the inspector, a representative of the
insurer shall make the necessary notifications and arrangements and shall be
afforded the opportunity to accompany the inspector. If the director of loss
control regulation for the State Board of Insurance considers it appropriate,
the inspector will make the visit without notifying the insurer.
(3) Conduct of the evaluation. The
inspector will work with a responsible member of insurance company management,
or a designated representative, in the evaluation of the adequacy of the loss
control information and services provided to policyholders. The evaluation will
be conducted in two parts. Part one will consist of the review and analysis of
company records and a determination of how loss control information and
services are made available to policyholders. Part two will consist of an exit
briefing on the preliminary results of the evaluation. A written report will be
provided in accordance with paragraph (5) of this section.
(4) Review of records and procedures. Records
and procedures which the company must make available for review and evaluation
are listed in subparagraphs (A)-(E) of this paragraph.
(A) Loss control personnel qualifications.
The insurer shall make available, prior to the beginning of the evaluation, a
list of personnel performing the duties of providing loss information and
services. The list will include the name, office location, designation as
employee or contractor, and statement of qualifications pursuant to §
5.311 of this title (relating to
Qualifications of Personnel Providing Loss Control Information and Services).
The inspector will review qualifications of all personnel performing the duties
of providing loss control information and services.
(B) Availability of information and services.
The company shall make available examples of procedures by which policyholders
are informed of the availability of loss control information and services. Also
to be reviewed are the procedures followed by the company regarding requests by
the insured for loss control information and services.
(C) Loss control information and services.
The inspector will review the mechanisms and procedures by which the
appropriate loss control information or service is determined under the
guidelines outlined in §
5.301 of this title (relating to
Loss Control Information). The company shall maintain a record by policyholder
of all loss control information and services rendered.
(D) Worksheets and policyholder files. A
detailed review of completed worksheets and information from selected
policyholder files will be made to ascertain the adequacy and quality of loss
control information and services.
(E) Other data. The inspector may review
other data or information in the course of the evaluation of the adequacy of
loss control information and services. Such information may include, but is not
limited to, accident/claims notification procedures, accident investigation and
analysis, examples of cost savings for policyholders as a result of safety
practices, and follow-up efforts on recommendations made to
policyholders.
(5) Loss
control reports. Upon completion of the inspection, the inspector will prepare
a written report to be provided to upper level management of the insurance
company. The report will reflect the inspector's observations, conclusions, and
analyses of the adequacy of the company's loss control information and services
as required by the Insurance Code, Article 5.06-4. When appropriate,
recommendations for improvement will be a part of the report.
