The Texas Department of Insurance (TDI) governs agent and adjuster licensing, and company licensing and registration. Its Agent and Adjuster Licensing Office is responsible for the licensing, registration, certification, and regulation of persons who wish to sell insurance or adjust property and casualty claims in Texas, including insurance agents, insurance adjusters, risk managers, life insurance counselors, discount healthcare operators, title agents, escrow officers, and small employer health benefit plans.
Each year thousands of complaints are filed against insurance agents and adjusters in Texas. When a complaint is filed against you with the TDI, your livelihood and career are put in jeopardy. Even if you feel the complaint is unfounded, it is critical that you take it seriously from the start. We urge you to contact an experienced insurance license defense attorney as soon as you are notified of a complaint filed against you.
The Texas Department of Insurance Helps Consumers Resolve Complaints
The TDI helps consumers resolve complaints against insurance companies, health maintenance organizations (HMOs), insurance agents, and adjusters.
Recent Disciplinary Orders issued by the TDI include:
- License revoked for engaging in “fraudulent or dishonest acts or practices,” among other violations.
- License revoked for failure to comply with an agreed settlement issued by the Commissioner of Insurance (SOAH Docket No. 454-17-5884.C).
- License revoked because the agent “engaged in fraudulent or dishonest acts or practices; misrepresented, converted to own use, or illegally withheld money belonging to an insurer; willfully violated the Insurance Code.” (SOAH Docket No. 454-17-5914.C)
- $45,000 Fine for using unapproved adverse determination templates.
- $40,000 Fine for failing to properly monitor a delegated entity that was using unapproved adverse determination templates.
The TDI states that it can help consumers with the following types of complaints:
- Late or slow payment of claims;
- Policy cancellations and nonrenewals;
- Improper claim denials;
- Health care treatment or service denials;
- Poor customer service;
- Misrepresentation about what a policy covers;
- Discriminatory rate increases;
- False or misleading advertising; and
- Suspected insurance fraud.
The TDI will not help consumers find out who is at fault in an accident, settle a dispute between a consumer and insurance company when the only evidence is the consumer’s word, or give legal advice or make medical judgments.
The TDI’s Compact with Texans is “to fulfill our legislative mandate to regulate the insurance industry while protecting the people and businesses that are served by insurance.” The TDI states that every year “we help thousands of Texans get millions of dollars in additional claim payments and refunds.”
The Texas Department of Insurance Complaint Resolution Process
When the TDI receives a complaint, it will contact the company or agent the complaint is against in an effort to help resolve the dispute. It will request a detailed response from you and will provide a copy of your response to the complainant (the person who filed the complaint).
Your initial responses to the complaint are critical in resolving a complaint at the start. Hiring an insurance license defense attorney to help you craft your initial response to the allegations helps ensure the most favorable outcome in your case.
After the TDI receives your response to the complaint, it will then decide if you or the company handled the issue appropriately and within the terms of the policy or certificate of coverage, and if Texas state insurance laws were violated. If the TDI determines any laws were broken, it will take enforcement action against the licensee.
Complicated insurance license defense cases can be difficult. We can help. At BERTOLINO LLP we can work with you to combat any formal complaints filed against you. We can investigate your complaint and help you build a strong case designed to succeed.
Learn more about how we help our clients in our article 5 FAQ’s We Answer for Our Clients.
BERTOLINO LLP represents licensed professionals across the entire State of Texas. To best serve our clients we have offices in Austin, Houston, and San Antonio. Our honest, experienced attorneys will fight aggressively on behalf of your license and reputation. Contact us today or call (512) 476-5757 and schedule a case evaluation.
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