Texas Insurance Codes 5.55C

deductible plans to allow policyholders to self-insure for the deductible amount.

(b) Not later than January 1, 1992, the Board shall promulgate at least three plans with varying deductible options. In addition, the Board by rule shall permit an employer to enter into an agreement with an insurer for a negotiated deductible in excess of the largest promulgated deductible.

(c) The Board shall perform an actuarial analysis to determine the amount of rate reduction applicable to policies under this article as opposed to standard policies without a deductible. In subsequent years, the Board shall determine the amount of rate reduction according to rating procedures adopted by the Board. When establishing procedures for the calculation of experience modifiers, the Board may allow the exclusion of the claim amount paid under the deductible by the employer.

(d) A deductible policy must provide that the company or association will make all payments for benefits that are payable from the deductible amount and that reimbursement by the policyholder shall be made periodically, rather than at the time claim costs are incurred. The State Board of Insurance shall promulgate rules that provide for adequate security for reimbursement of the amount paid by the company or association which is payable from the deductible.

(e) The company or association shall service all claims that arise during the policy period, including those claims payable, in whole or in part, from the deductible amount.

(f) A person who is employed by a policyholder who self-insures the deductible amount as provided under this article may not be required to pay any of the deductible amount.

(g)(1) A person who is employed by a policyholder who self-insures the deductible amount as provided under this article may not be harassed, discharged, or otherwise discriminated against because the employee, in good faith:

(A) is considering initiating a workers' compensation claim;

(B) has initiated a workers' compensation claim;

(C) has retained a representative to represent the employee regarding a claim;

(D) has testified or is about to testify at an administrative or judicial proceeding under the Texas Workers' Compensation Act (S.B. No. 1, Acts of the 71st Legislature, 2nd Called Session, 1989);

(E) has reported a hazardous working condition or hazardous practice to the commission; or

(F) has taken any other action or is considering taking any other action that may result in the policyholder being required to pay a deductible amount through the self-insurance plan.

(2) Liability for damages for violations of this article shall be determined exclusively pursuant to the Texas Workers' Compensation Act (S.B. No. 1, Acts of the 71st Legislature, 2nd Called Session, 1989).

(h) Any person who engages in conduct prohibited under this article commits a Class A administrative violation under the Texas Workers' Compensation Act (S.B. No. 1, Acts of the 71st Legislature, 2nd Called Session, 1989).

Added by Acts 1989, 71st Leg., 2nd C.S., ch. 1, Sec. 13.08, eff. Jan. 1, 1991.