State RegulationsTX specificDifficulty 1/5
A Texas policyholder files a written complaint with the department about her health insurer's claim denial. What is the department required to do with respect to that complaint?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under TIC 521.003, when a written complaint is filed with the department, the department must notify each party to the complaint of the complaint's status until final disposition, unless doing so would jeopardize an undercover investigation. TIC 521.004 separately requires the department to keep an information file about each complaint concerning an activity regulated by the department or the commissioner. In practice this means the agent or insurer named in the complaint will hear from the department and must respond substantively.
Why the other options are wrong
- A) The department does not require a pending lawsuit before it will act on a written complaint.
- B) The department is a regulator, not a court, and does not award damages to complainants.
- C) The department tracks the matter to final disposition and maintains a complaint file; it does not simply close on referral.
Memory hook
Written complaint: track the status, keep the file.