The Texas Department of Insurance works for you. The Department of Insurance regulates approximately 29,000 businesses and over 7,000,000 public employees in the State of Texas. The Department of Insurance works to promote business and individual health and safety in all 50 states and the District of Columbia. The Texas Department of Insurance also has an Office of Financial Services that provides financial education and insurance information for Texans.
The Texas Department of Insurance (TDI) protects insurance consumers by:
- regulate the industry fairly and diligently.
- promote a stable and competitive market.
- provide information that makes a difference.
For more information or answers to general insurance questions, call our Help Line toll-free at 800-252-3439 or visit our website.
Regulation of the insurance industry
Licenses
Texas law requires most insurance companies and insurance-related businesses to be licensed to sell their products or services. TDI issues licenses to:
- insurance companies and agents.
- third party administrators.
- Health Maintenance Organizations (HMOs).
- long-term care retirement communities.
- insurance adjusters.
- public insurance adjusters.
Compliance and enforcement
TDI also enforces Texas insurance laws and regulations, investigates misconduct, and enforces against companies and agents.
TDI can fine agents and companies that delay claim payments, misrepresent policies, charge incorrect prices, or commit other wrongful acts.
Financial regulation
To ensure that insurance companies have money to pay claims and expenses, TDI reviews the financial condition of companies and enforces regulations to ensure they remain financially stable.
Texas Department of Insurance (TDI) publishes company profiles showing the company’s complaint history and other useful information, including the company’s history and any enforcement actions TDI has taken against the company. To get information about a company, call our Help Line or search for company information on our website.
Insurance fraud
TDI investigates insurance fraud and helps prosecute offenders. The most common types of fraud are selling insurance without a license, insurance companies overbilling, increasing claims, or submitting claims for losses that didn’t happen.
To report suspected insurance fraud, call the Helpline.
Advertising
TDI reviews insurance advertising materials to ensure they comply with laws and regulations, to detect possible fraud, and to detect misleading representations.
TDI can fine insurance companies and agents that use unfair business practices or misleading advertising. Fines include warnings, fines, and license revocation. In some cases, TDI may require companies to reimburse consumers for insurance premiums.
Technical analysis
TDI reviews the prices that companies submit to TDI and provides information to help consumers and policymakers. We also examine the data to spot insurance companies that are problematic.
Division of Workers’ Compensation (DWC)
TDI regulates the state’s system for paying medical benefits and income benefits to workers who are injured on the job or have a work-related illness.
The division:
- licenses insurance companies and workers’ compensation networks.
- approves companies that want to self-insure.
- enforces workers’ compensation laws and regulations.
- promotes worker health and safety.
- provides access to medical care for injured workers.
- administers the dispute resolution system for disputes related to workers’ compensation benefits.
- provides services to help injured workers return to work.
Help for consumers
Help line
TDI Helpline staff can answer insurance-related questions and help with complaints. The Helpline is available Monday through Friday, 8 a.m. to 5 p.m. to 5 p.m. Central time.
Insurance Complaints
We help consumers recover millions of dollars each year in refunds and additional payments on claims. If you have a complaint against an insurance company or agent, you should first notify your company and try to resolve it. If you are still not satisfied, you can file a complaint with TDI. You can file the complaint online or by mail.
Note about health plans: Most people with health insurance in Texas have a self-funded plan. This means that it is the employer who pays for the costs of the employees’ health services, not an insurance company. The United States Department of Labor regulates self-funded plans. Because we have no authority over these types of plans, we cannot help you with complaints against them.
If you work in the private sector, file a complaint against your self-funded plan with the US Department of Labor. If you work for a school district, city or county government, union, or church, file your complaint directly with the plan.
To find out if your health plan is self-funded, check your insurance card. If your insurance card has “TDI” or “DOI” written on it, then your plan is fully funded and regulated by TDI. If you don’t see this on your insurance card, your plan is self-funded.
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