Sec. 4151.111. ADJUDICATION OF CLAIMS. (a) An administrator shall adjudicate a claim not later than the 60th day after the date on which the administrator receives valid proof of loss in connection with the claim.
(b) The administrator shall pay each claim on a draft authorized by the insurer, plan, or plan sponsor in the written agreement.
(c) In the event of a conflict between this section and a provision of the Labor Code relating to time periods for adjudication and payment of workers' compensation claims, the Labor Code provision prevails.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.13, eff. September 1, 2007.
Structure Texas Statutes
Title 13 - Regulation of Professionals
Subtitle D - Other Professionals
Chapter 4151 - Third-Party Administrators
Subchapter C. Powers and Duties of Administrators and Insurers
Section 4151.101. Written Agreement With Insurer or Plan Sponsor Required
Section 4151.102. Contents of Written Agreement
Section 4151.103. Retention of Written Agreement; Inspection by Commissioner
Section 4151.104. Notice of Use of Administrator's Services
Section 4151.1041. Referral by Insurer
Section 4151.1042. Responsibilities of Insurer; Semiannual Audit
Section 4151.105. Payments to Administrator
Section 4151.106. Certain Funds Collected or Received by Administrator
Section 4151.107. Delivery or Deposit of Certain Funds Received by Administrator
Section 4151.108. Withdrawals From Fiduciary Account
Section 4151.109. Payment of Claims From Fiduciary Account Prohibited
Section 4151.110. Underwriting Standards
Section 4151.111. Adjudication of Claims
Section 4151.112. Maintenance of Books and Records
Section 4151.113. Access to Books and Records
Section 4151.114. Disposition of Books and Records on Termination of Written Agreement