Sec. 4152.208. SETTLEMENT OF CLAIMS. (a) This section applies only to a contract entered into under Section 4152.201 that permits a manager to settle claims on behalf of an insurer.
(b) All claims must be reported to the insurer at least quarterly.
(c) The manager shall send a copy of the claim file to the insurer at the insurer's request or as soon as it is known that the claim:
(1) has the potential to exceed the lesser of:
(A) an amount determined by the commissioner; or
(B) the limit set by the insurer;
(2) involves a coverage dispute;
(3) may exceed the manager's claims settlement authority;
(4) has been open for more than six months; or
(5) has been closed by payment of the lesser of:
(A) an amount determined by the commissioner; or
(B) the limit set by the insurer.
(d) A claim file is the joint property of the insurer and manager, except that on an order of liquidation of the insurer the file becomes the sole property of the insurer or the insurer's estate. The manager is entitled to reasonable access to the claim file and may copy the file on a timely basis.
(e) Any settlement authority granted to the manager may be terminated for cause on the insurer's written notice by certified mail, return receipt requested, to the manager or on the termination of the contract. The insurer may suspend the settlement authority during any dispute regarding the cause of termination.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.
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