Texas Disability Insurance laws & HR compliance analysis

Texas Disability Insurance: What you need to know

Disability insurance pays benefits to employees who are not working due to non-job-related accidents or illnesses. (Workers' compensation covers job-related injuries.) It also provides coverage for employees who may not be eligible for workers' compensation, or it may supplement workers' compensation.
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A few states have laws that require employers to provide disability insurance, but Texas is not among them. Texas employers may provide such insurance, but they are not required to do so. State law, however, may require specific provisions in a group disability policy sold by insurers in Texas.
Texas Department of Insurance regulations provide that, generally, disability insurance policies offered, issued, renewed, or delivered on or after February 1, 2011, may not include a discretionary clause (TX Admin. Code Ch. 28 Sec. 3.1201 et seq.). A "discretionary clause" is defined as a provision that:
• Purports or acts to bind a claimant to, or grants deference in subsequent proceedings to, adverse claim decisions or policy interpretations by the insurer;
• Specifies that a policyholder or other claimant may not contest or appeal a denial of a claim;
• Specifies that the insurer's interpretation of the terms of a policy or its decision to deny coverage or the amount of benefits is binding on a policyholder or other claimant;
• Specifies that in any appeal of the insurer's decision-making power as to the interpretation of the terms of a policy is binding; or
• Specifies a standard of review in any appeal process that gives deference to the original claim decision or provides standards of interpretation or review that are inconsistent with Texas law.
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