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Texas Department of Insurance Mini-Conference for Chiropractors Audrey Selden, Senior Associate Commissioner, Consumer Protection Valerie Brown, Director, Complaints Resolution, Consumer Protection Teresa Carney, Director of System Monitoring and Oversight, Division of Workers Compensation Catherine Reyer, Associate Commissioner, Enforcement Dennis Pompa, Associate Commissioner, Fraud Jennifer Ahrens, Senior Associate Commissioner/Provider Ombudsman, Life, Health, and Licensing Slide 2 2 Agenda Welcome and Introductions Antitrust Statement Texas Department of Insurance Key Regulatory Functions The Complaint Process Written complaints How complaints are resolved Topics and trends How TDI uses complaint data Division of Workers Compensation Complaints Performance based oversight Dispute resolution The Enforcement Process Regulatory philosophy Referrals Sanctions TDI Fraud Unit TDI Resources for Chiropractors Slide 3 3 Key Regulatory Functions Licensing, Certification, and Registration Life/health companies Property/casualty Health maintenance organizations (HMOs) Multiple employer welfare arrangements (MEWAs) Continuing care retirement communities (CCRCs) Workers compensation self- insured groups (WC SIGs) Surplus lines carriers (SLs) Accredited/trusteed reinsurers Risk retention groups (RRGs) Purchasing groups (PGs) Workers compensation networks Slide 4 4 Key Regulatory Functions Slide 5 5 mergers redomestications license amendments charter amendments withdrawal plans cancellation of licenses dissolutions, etc. Assists the industry with processing and guidance on various corporate transactions, including: Slide 6 6 Regulatory Functions 24 license types (effective September 1, 2007) 700,000 filings processed each year $14.7 million expected in FY 2007 fee revenue collections 2.2 days average processing time 370,218 active licenses (as of August 31, 2007) Slide 7 7 Regulatory Functions Fire Alarm, Extinguisher, and Sprinkler 2,500 businesses registered 7,000 employees licensed $1.75 million in revenue generated Fireworks 50 firms licensed 600 public fireworks displays licensed 800 individuals display operators licensed 5,000 retail fireworks stands licensed $250,000 in revenue generated Slide 8 8 Regulatory Functions Review individual insurer form and rate filings and certain advertising Promulgated form File and use Prior approval Exempt Slide 9 9 Regulatory Functions Complaint and Dispute Resolution Examination, Monitoring, and Solvency Intervention Enforcement, Fraud, and Investigations Slide 10 10 Regulatory Functions Education, Outreach and Customer Assistance Live, face-to-face outreach TDI website Print publications, DVDs, and video loans Telephone assistance Stakeholder meetings/public hearings Partnerships Slide 11 11 When a fire breaks out in a crowded place, everyone runs to the entrance. The crush of bodies forms a bottleneck. People panic and start pushing. Some fall down. Some even die. When you walk into a public place, do your homework. Plan an exit strategy. And keep in mind, the best way out may not be the way in. Slide 12 12 Regulatory Functions Inspections and Consultations Commercial property oversight Loss control inspections Amusement ride compliance Windstorm inspection program and engineering Inspect for fire and life safety hazards New responsibility fire-safe cigarettes Accident prevention programs Voluntary Occupational Safety and Health Administration (OSHA) Compliance Assistance Slide 13 13 Regulatory Functions Research and Analysis Evaluates and sets insurance rates Monitors insurance marketplace Monitors loss experience and tracks system trends Checks for compliance with statutes and rules Conducts studies on special issues Responds to information requests Slide 14 14 Average Medical Cost Per Claim Network and Non-Network Claims, 6 Months Post Injury Source: Texas Department of Insurance, Workers Compensation Research and Evaluation Group, 2007 Slide 15 15 Texans Insurance Status - 2005 GroupPopulation Texas Percentage National Average Percentage Insured Population17,304,00075.8%84.1% Employment-Based11,965,00052.4%59.5% Individual1,624,0007.1%9.1% Government-Based5,866,00025.7%27.3% Uninsured Population5,516,00024.2%15.9% Total Population22,819,000100% Source: U.S. Census Bureau, Current Population Survey, 2006 Slide 16 16 Financial Program Catastrophe Planning Financial Program tests insurance company catastrophe sensitivity to determine if any solvency concerns exist as the result of a natural catastrophe, specifically hurricanes Conducts company inquiries to gather additional information Holds management conferences Intervenes, as necessary Slide 17 17 Financial Program Catastrophe Planning