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Monday, December 13, 2010

TMA WINS INSURANCE CONSUMER PROTECTIONS

The Texas commissioner of insurance adopted three rules proposed by the Office of Public Insurance Counsel prohibiting discretionary clauses in insurance policies. Such clauses, already outlawed in 22 states, give insurers free rein to interpret policy terms and evaluate a patient's claim for benefits any way they choose. Public Insurance Counsel Deeia Beck praised TMA for being “instrumental in getting the new rules adopted.” In a letter supporting the rules, then-TMA President Bill Fleming, MD, wrote that discretionary clauses create a "fox guarding the henhouse situation that serves to provide the insurer with the authority to consistently deny benefits that a reasonable insured person would believe falls within the terms of the policy."

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