Welcome to OPIC

    Welcome to the Office of Public Insurance Counsel (OPIC) website. OPIC's mission is to work hard each day to make the Texas insurance market more transparent, efficient, and responsive to its customers.  

    We represent the interests of Texas consumers in regulatory matters involving autoresidential property, and title insurance and we participate in rulemaking proceedings for life and health insurance.  We also work with the Texas Legislature and interested stakeholders to advance the interests of Texas insurance consumers. 

    This website provides detailed information on each major line of insurance as well as access to insurance-related articlespublications, and reports. We are always seeking to improve so please tell us how user-friendly you found this site by filling out our consumer survey.  

    Thanks for visiting and please come back often.  


    What the Fifth Circuit’s Decision in Ariana M. v. Humana Means for Texas Consumers

    • Texans who receive health insurance coverage through ERISA plans, which includes employees of most large and mid-sized companies, will likely have more of their claims covered as the result of a recent decision by the U.S. Court of Appeals for the Fifth Circuit (Fifth Circuit).

    • When an ERISA plan administrator denies a claim, the consumer has a right to appeal that decision for further review by the insurer and eventually a Texas district court.

    • The Fifth Circuit overturned a previous decision that required Texas district courts to defer to the ERISA plan’s factual determinations when there is an appeal of a claim denial. Factual determinations in these kinds of cases often involve disagreements over whether a person needs medical care and/or how long a person needs medical care, and whether the ERISA plan should pay for that medical care.

    • Texas district courts will no longer defer to ERISA plan administrators on these decisions about medical treatment and other factual issues. Instead, the Texas district courts will now perform their own independent review (a de novo review) of these cases. This change will improve the patient’s chance of success in getting claims paid when their doctor disagrees with an ERISA plan’s decision to deny a claim for medical treatment.

    • The Office of Public Insurance Counsel (OPIC) and Texas Department of Insurance (TDI) submitted amicus briefs in support of Texas consumers’ right to have the medical opinions of their doctors fully reviewed by an objective third party.

    Read the decision here.
    Read OPIC’s amicus brief here.
    Read an article about the decision here.

    OPIC is looking for Public Members to serve on the Governing Committee for TAIPA (Texas Automobile Insurance Plan Association)

    If you believe you may be interested, please read the following:

    About TAIPA: TAIPA is a nonprofit corporation composed of all licensed insurance companies who sell automobile insurance in Texas.  TAIPA is responsible for assigning eligible applicants to licensed insurance companies in order for the applicant to show proof of financial responsibility as required by the Texas Motor Vehicle Safety Responsibility Act. 

    TAIPA Governing Committee:  TAIPA is administered by a 15-member governing committee under its plan of operation. Five of these members are public members who are nominated by the Office of Public Insurance Counsel and selected by the Commissioner of Insurance. 

    TAIPA Public Members:  Public members serve two-year terms. You may not serve as a public member if you, an individual related to you within the second degree of consanguinity or affinity, or an individual residing in the same household as you are:
    • required to be registered or licensed under the Insurance Code;
    • employed by or acts as a consultant to a person required to be registered or licensed under the Insurance Code;
    • the owner of, or has a financial interest in, or participates in the management of an organization required to be registered or licensed under the Insurance Code;
    • an officer, employer or consultant of an association in the field of insurance or;
    • required to register as a lobbyist under Chapter 305 of the Government Code.
    The Office of Public Insurance Counsel may also nominate, and the Commissioner of Insurance may appoint, up to three additional persons who meet these qualifications to act as alternates for public members.

    Interested in Applying?:If you are interested in applying to serve on the TAIPA Governing Committee as a public member, please click here for an TAIPA Application.  Please send your completed application to David Nardecchia, Senior Specialist at the Office of Public Insurance Counsel, via email at dnardecchia@opic.texas.gov or by fax (512) 322-4148.
    You can also apply directly to the Texas Department of Insurance (TDI).  For information on applying directly with TDI click here, http://www.tdi.texas.gov/committee/gr/index.html.

    Did You Have Storm Damage to Your Home or Auto and Need Help Understanding Your Insurance Coverage?

    The information below is intended to provide some basic information for anyone with insurance questions related to the recent flooding and storm damage experienced in Texas.

    Homeowners Coverage

    ·       Wind, including a tornado:  A typical homeowners policy covers damage caused by wind, including tornadoes.
    ·       Hail:  A typical homeowners policy covers damage caused by hail.

    WIND and HAIL NOTE:  If your home is located in one of Texas' 14 coastal counties, or parts of southeastern Harris County, your homeowners policy MAY NOT cover damage caused by wind and hail. If your home is located in the above area, your wind and hail coverage may be written through the Texas Windstorm Insurance Association (TWIA.) If so, for additional information contact TWIA at 1-800-788-8247 or visit its website at www.twia.org.

    ·       Flood:  A typical homeowners policy DOES NOT cover damage caused by a flood.

    FLOOD NOTE:  To protect your home from damage caused by flood, you will need to purchase a separate flood policy from the National Flood Insurance Program (NFIP) administered by FEMA.  Flood policies typically have a 30-day waiting period before you will have coverage.  This link has a summary of coverage, https://www.floodsmart.gov/floodsmart/pdfs/Summary_of_Coverage_English.pdf 

    For additional information, contact NFIP at 1-888-FLOOD 29 (356-6329) or visit its website at www.floodsmart.gov.

    Auto Coverage

    If you purchased comprehensive (commonly referred to as “other than collision”), your personal auto policy may cover damage to your auto caused by flood, hail, or wind (including a tornado).  Comprehensive coverage typically pays for damage to your auto caused by events other than a collision, including theft, fire, flood, hail, and wind.  Comprehensive coverage also pays for a loss to your auto from contact with birds or animals or breakage of glass. 

    Auto Note:  If you only purchased auto liability insurance and did not purchase comprehensive coverage for damage to your auto, your personal auto policy will not pay for damage to your auto caused by events such as flood, hail, or wind.  Auto liability insurance pays for injuries to other people or property of others that you, or a covered person, cause in an auto accident. 

    Do You Need to File a Claim or Have Coverage Questions?

    If you have damage that may be covered under your insurance policy or questions about your coverage, contact your agent or company as soon as practical.  

    ·       Be sure to keep a record of all contacts you have with your agent or company.  
    ·       Be prepared to answer questions about the extent and severity of the damage. 

    Are You Temporarily Out of Your Home Due to Damage Covered by Your Homeowners Insurance Policy? 

    If so, ask your agent about coverage that may be available to you for your additional living expenses (ALE).  Homeowners insurance policies pay for your additional living expenses if you are unable to live in your home because of a covered loss.  You will need to provide documentation regarding your expenses.

    Flood Note:  Flood policies DO NOT cover your additional living expenses if you are unable to live in your home due to a covered flood loss.

    IMPORTANT: If you are making repairs prior to settling your insurance claim,  only make repairs necessary to protect your home and property from further damage, such as covering broken windows and holes to keep rain out. 

    •       Don't make permanent repairs until instructed by your insurance company. 
    •       Save all repair receipts. 

    Tips That May Assist You With Your Claim

    •       If you are temporarily out of your home, make sure your insurer knows where they can reach you.
    •       Inspect your property and cars for damage.
    •       Inventory your damage.
    •       Photograph or video the damage.
    •       Don’t throw away damaged property until your insurance adjuster has seen it.
    •       Get your insurance company’s approval before you make any permanent repairs.

    Try to be present when the insurance adjuster inspects the damage. Be sure your address is visible. If you moved out of your house temporarily, leave a note or a plywood sign with your temporary address, phone number, and name of your insurance company.

    For additional information, contact the Office of Public Insurance Counsel at 512-322-4143.

    Mediation Process for "Balance Billing" Expanded in Texas

    Senate Bill 507 by Senator Kelly Hancock expanded the availability of mediation for the settlement of certain out-of-network claims involving balance billing. For claims for health care or medical services or supplies provided after January 1, 2018, the bill:
    • Allows mediation for emergency care balance bills over $500 at any healthcare facility, regardless of network status.
    • Expands the scope of mediation to all types of out-of-network providers treating patients at in-network hospitals and other facilities, including freestanding emergency departments.
    • Extends the mediation option to individuals who receive coverage through the Teachers Retirement System of Texas. Previously, only enrollees in the Employees Retirement System of Texas or individuals enrolled in health plans regulated by the Texas Department of Insurance were eligible for mediation.
    • Requires health care providers and other facilities to include a statement on eligible balance bills informing consumers of the mediation process and that they may be able to reduce out-of-pocket costs for an out-of-network claim by contacting the Texas Department of Insurance (TDI).

    Health plans regulated by TDI will include either "DOI" or "TDI" on their health insurance cards.
    The complete text of Senate Bill 507 is available here.
    A copy of the form to request mediation is available here.

    OPIC Files Amicus Brief With Texas Supreme Court Seeking Review of Appraisal Process in Texas

    OPIC recently filed an Amicus Brief with the Texas Supreme Court in the case of Richardson East Baptist Church v. Philadelphia Insurance Company in support of review to address the appraisal process in Texas.  A copy of the Amicus brief is available by clicking here.  
    Case information is available at this website:  http://www.search.txcourts.gov/Case.aspx?cn=16-0347&coa=cossup

    OPIC Study Shows the Longer You Stay With the Same Insurance Company, the More Likely It Is You Are Being Overcharged

    A study conducted by The Office of Public Insurance Counsel (OPIC) supports the idea that shopping your insurance policy can yield savings.  The agency’s Executive Director, Deeia Beck said, “according to our data, the longer a policyholder stays with the same company, the more likely it is that they are overcharged.”  The study is available for review here.  A Spanish version is available here.

    What is a C.L.U.E. Report and What is in it?

    The information contained in a C.L.U.E. report for you, your car, your home, or a home you may purchase can have a negative impact on the cost of insurance for that auto or home.   C.L.U.E. (Comprehensive Loss Underwriting Exchange) is a claims history database generated by LexisNexis® that enables insurance companies to access certain consumer information, such as claims information, when they are underwriting or rating an insurance policy.  C.L.U.E. reports are used to underwrite and rate new policies or property.  The C.L.U.E. report contains up to 7 years of claim information, including the date of loss, type of loss, amounts paid, and a description of the property covered.

    You can obtain a copy of your C.L.U.E. report from LexisNexis at 1-866-312-8076 or at: https://personalreports.lexisnexis.com.  Under the federal Fair Credit Reporting Act, C.L.U.E. reports can be accessed only by the owner, insurer, or lender for the property.  You can ask the owner of the property you wish to purchase order the C.L.U.E. report for that property.  If you discover an error on your C.L.U.E. report, you should contact LexisNexis® directly and report the problem. LexisNexis® will then contact the insurance company on your behalf, ask for clarification on the matter, and notify you of the results within 30 days.    
    To view a news story revealing mistakes on C.L.U.E. reports, please visit:  http://www.click2houston.com/news/mistakes-on-insurance-reports-lead-to-massive-price-increases/34299658

    United Policyholders has a Great App That Helps Consumers Create Home Inventories and Recover After a Loss

    United Policyholders has released a great (and free!) app to help people create home inventories. Insurance companies and the IRS often require detailed inventories to document losses. But, after an event most consumers struggle to pull together all the information. United Policyholders’ new free tool can help policyholders create an inventory and prepare for future events. For more information and to download the app check out United Policyholders’ website at www.uphelp.org

    Office of Public Insurance Counsel Announces Historic $352.5 Million in Refunds for State Farm Lloyds’ Policyholders

    The Office of Public Insurance Counsel (OPIC) announced on February 27, 2015 that it has reached a settlement requiring State Farm Lloyds to refund $352.5 million in premium overcharges and interest to policyholders. 

    Public Counsel Deeia Beck stated, “OPIC is very pleased to settle this long-standing rate dispute with significant refunds to policyholders.  We are particularly glad that OPIC’s legal arguments resulted in the inclusion of policyholders from September 2006 through July 2008 in the settlement.  These policyholders will receive $119.1 million in refunds that they would not have otherwise obtained.” Beck also said, “While we argued for an even larger amount, at the end of the day it comes down to what is best for policyholders. We could have continued the litigation for years resulting in larger refunds, no refunds, or something in between.  Given all of the considerations and risks involved, we concluded that a settlement at this time on our agreed terms was in the best interests of policyholders.”   

    A copy of the Settlement Agreement is available for review by clicking here

    • autonewsAre You Paying Too Much For Car Insurance?

      You may be able to save a significant amount of money on your car insurance by simply shopping. The State of Texas has developed some easy to use resources to help you save money.  You can find out more by visiting OPIC's "Shopping For Auto Insurance" page by clicking here.

    • choices-slideshowComparing Policy Coverages

      Are you shoppping for new insurance or thinking about changing your current coverage?
      Deciding which coverage is best for you can be a difficult choice.  Our easy-to-use Policy Comparison Tool can provide the information you need to make an informed decision.  For Auto, click here.  For Residential Property, click here.

    • stormTexas Insurance Rates Again Among the Highest in the Country.

      The National Association of Insurance Commissioners (NAIC) again announced that Texans pay some of the highest insurance premiums in the country.  Why do Texans pay so much? What drives the premium increases? And, how can you keep from overpaying for insurance? A recent OPIC report titled, "Why Is Texas Homeowners Insurance So Expensive?" examines these issues. The report is available by clicking here.