| (a) General statement. (1) The Insurance Code, Article 1.33B, added by Chapter 685, §2.01, 73rd Legislature, 1993, mandates the commissioner of TDI and the chief administrative law judge of SOAH to adopt by rule a joint MOU governing hearings held by SOAH under the Insurance Code and other insurance laws of this state. The statute provides that the MOU shall require the chief administrative law judge and the commissioner of insurance to cooperate in conducting hearings subject to its provisions. Article 1.33B requires that an SOAH administrative law judge (ALJ) conduct any contested case hearing required or permitted to be held before a decision may be rendered or action taken by the commissioner or TDI, including, but not limited to, hearings relating to the approval or review of rates or rating manuals filed by individual companies, rate proceedings which include the benchmark rate hearings, and other annual rate hearings. However, no later
than September 1, 1994, or as long as the board retains jurisdiction of proceedings involving promulgation and approval of rates; promulgation and approval of policy forms and policy form endorsements; and hearings, proceedings, and rules related to the referenced activities, the proceedings that are held before or pending on January 1, 1994, shall be heard by the board or the board's designee. (2) The MOU is necessary to accomplish the efficient and expeditious hearing of matters under the jurisdiction of TDI by establishing the procedures to be used by each agency and clearly delineating each agency's responsibilities. Additionally, the MOU is necessary to inform the public of each agency's responsibilities and the procedures for the institution, conduct, and determination of proceedings before SOAH on behalf of TDI. (3) The MOU provides procedures for referring the case to SOAH, the notice of hearing, filing requirements,
hearings, final orders, motions for rehearing, and custody of the hearing record. (b) Definitions. The following meanings apply to this section unless expressly stated otherwise. (1) Contested case means a proceeding, including but not restricted to ratemaking and licensing, in which the legal rights, duties, or privileges of a party are to be determined by an agency after an opportunity for adjudicative hearing as defined in the Government Code, §2001.003. (2) Motion for reconsideration means a motion filed with the commissioner by any insurance company or other party at interest, if dissatisfied with any ruling, action, decision, regulation, order, rate, rule, form, act, or administrative ruling by TDI staff adopted by the commissioner. (3) Summary procedures means a set of procedures created by TDI for handling specifically designated routine matters, although such matters would otherwise be subject to
the Administrative Procedure Act, the Government Code, Chapter 2001. The procedures are published in §§1.701-1.705 of this title (relating to Summary Procedures for Routine Matters). (4) Interim order means an order by an ALJ which decides discovery and prehearing matters, including, but not limited to, matters concerning motions, evidence, or testimony, but which is not a final decision disposing of the whole case. (c) Referral of contested case to SOAH. (1) Referral of a contested case to SOAH may be made only by TDI. The referral is initiated by filing with SOAH either a request for setting of hearing form or a request for assignment of ALJ form as provided in subparagraphs (A) and (B) of this paragraph. In addition to filing the appropriate form, a referral also consists of items listed in subparagraphs (C)-(E) of this paragraph: (A) the request for setting of hearing form shall be filed when TDI
seeks to have the case set for hearing and no prehearing matters requiring resolution by an ALJ are anticipated. If prehearing matters arise after the request for setting of hearing form is filed, SOAH shall assign an ALJ to resolve the matter; (B) the request for assignment of ALJ form shall be filed when TDI anticipates the need for one or more prehearing conferences and/or the need for an ALJ's ruling on various matters prior to commencement of the hearing. If no request for setting of a hearing is included in the request for assignment of an ALJ, the date for the hearing shall be determined by the assigned ALJ; (C) all pleadings in the case, including, but not limited to, complaints, petitions, applications, motions, or such other documents describing agency action relating to the contested case; (D) an accurate service list; and (E) notification of any statutory deadlines involving the contested
case. (2) Following receipt of the request for assignment of ALJ form, SOAH shall assign the case a docket number, assign an ALJ, and notify all parties in writing of the ALJ assigned to the case. If TDI also requests a hearing date, then SOAH shall provide a date and a confirmation of the setting to TDI. Following receipt of the confirmation of the setting of the hearing, TDI shall send its notice of hearing. (3) TDI should file a request for setting of hearing within 24 hours of receipt of a request by any party for an expedited hearing in TDI referrals requiring expedited action such as supervision and conservation of insurers; emergency cease and desist proceedings; hearings required to be held before the statute of limitations runs; hearings required to be held in order to retain jurisdiction; and hearings involving a request for stay pending the determination of the case. In cases requiring an expedited hearing, SOAH should confirm with TDI
a hearing date and docket number within 24 hours of such request. (4) Any insurance company or other party at interest, if dissatisfied with any ruling, action, decision, regulation, order, rate, rule, form, act, or administrative ruling by TDI staff adopted by the commissioner, may file a motion for reconsideration with the TDI docket clerk. The TDI docket clerk shall forward the motion for reconsideration to the commissioner for a determination. If the motion is granted, the motion becomes the initial pleading and TDI shall initiate the contested case by filing either a request for setting of hearing form or a request for assignment of ALJ form. However, if the ruling concerns rulemaking proposals or other matters not subject to a contested case, including rulings relating to a regulation, rule, or form, the motion for reconsideration will not be forwarded to SOAH, but shall be handled by the commissioner in an appropriate manner consistent with the type of
case. (d) Notice of hearing. (1) Upon receipt of the docket number, location, and setting date from SOAH, TDI shall issue the notice of hearing as required by the Insurance Code and the Government Code, and will serve the notice of hearing by certified mail, return receipt requested, to all parties to the docketed matter. An administrative law judge may issue notice of date, time, and place for hearings. (2) Notice is governed by the Government Code, §2001.051 and §2001.052, unless alternative procedures are permitted by law. The notice shall include the time, place, and nature of the hearing; a statement of the legal authority and jurisdiction under which the hearing is to be held; a reference to the particular sections of the statutes and any corresponding regulations to which the hearing relates; a short, plain statement of the matters asserted; the docket number; and a certificate of service.
(e) Filing requirements. Filing of documents shall be made in accordance with the following. (1) Any party filing notices of hearing, staff memoranda, and pleadings (including discovery), motions and such other filings except motions for reconsideration, motions for review of summary procedures, motions for rehearing and appeals of interim orders, shall file the original with SOAH. (2) All motions, except motions for rehearing, motions for reconsideration, motions for review of summary procedures and appeals of interim orders, shall be addressed to SOAH. (3) All motions for rehearing, motions for review of summary procedures, motions for reconsideration, and appeal of interim orders seeking action to be taken by the commissioner of insurance shall be addressed to the commissioner and shall be filed with the TDI docket clerk. A true and correct copy of all motions for rehearing and appeals of interim orders shall
be filed with SOAH on the same date and by the same method as filed with TDI. (4) Any ruling or prehearing order concerning a delay, continuance, or future filing shall be forwarded to the TDI docket clerk on the same date and by the same method as forwarded to other parties. (f) Hearings. (1) Hearings, including prehearing proceedings on contested cases, shall be conducted in accordance with the Government Code, Chapter 2001, the Insurance Code, the TDI rules of procedure, and the SOAH rules of procedure; any other applicable law and accompanying regulations. Cont'd... |
