Tex. Codes » Insurance Code · TITLE 9. PROVISIONS APPLICABLE TO LIFE INSURANCE, ANNUITY CONTRACTS, AND ACCIDENT AND HEALTH COVERAGES · CHAPTER 1701. POLICY FORMS
Texas Codes

Tex. Ins. Code § 1701.062 (2026)

Discretionary Clauses Prohibited

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Sec. 1701.062. DISCRETIONARY CLAUSES PROHIBITED. (a) An insurer may not use a document described by Section 1701.002 in this state if the document contains a discretionary clause.

(b) A discretionary clause includes a provision that:

(1) purports or acts to bind the claimant to, or grant deference in subsequent proceedings to, adverse eligibility or claim decisions or policy interpretations by the insurer; or

(2) specifies:

(A) that a policyholder or other claimant may not contest or appeal a denial of a claim;

(B) that the insurer's interpretation of the terms of a document or decision to deny coverage or the amount of benefits is binding upon a policyholder or other claimant;

(C) that in an appeal, the insurer's decision about or interpretation of the terms of a document or coverage is binding; or

(D) 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 the laws of this state, including the common law.

Added by Acts 2011, 82nd Leg., R.S., Ch. 560 (H.B. 3017), Sec. 2, eff. June 17, 2011.

SUBCHAPTER C. SANCTIONS; APPLICABILITY OF OTHER LAWS


Notes of Decisions
Cited in 22 cases (11 in the last 5 years), 2017–2026 · leading case: Ariana M. v. Humana Health Plan of Tex., Inc., 884 F.3d 246 (5th Cir. 2018).
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Ariana M. v. Humana Health Plan of Tex., Inc., 884 F.3d 246 (5th Cir. 2018). · cites it 5× “TEX. INS. CODE § 1701.062(a). Assuming that the antidelegation statute is not preempted by federal law-something we do not decide today as that defense has not been asserted-a lot more ERISA cases will be subject to Firestone 's default standard of review.”
Ariana M. v. Humana Health Plan of Texas, Inc., 854 F.3d 753 (5th Cir. 2017). · cites it 8× “002 [among other things, policies for health and medical insurance] in this state if the document contains a discretionary clause.”
Woods v. Riverbend Country Club, Inc., 320 F. Supp. 3d 901 (S.D. Tex. 2018). · cites it 4× “In this case, the Plan "provides payment for medical care, salary continuance, and certain death and dismemberment benefits arising from accidental injuries within the course and scope of employment.”
Pike v. Hartford Life & Accident Ins. Co., 368 F. Supp. 3d 1018 (E.D. Tex. 2019). “See Tex. Ins. Code § 1701.062(a). The Court will incorporate the pertinent facts in its discussion of Defendant's objections.”
Byerly v. Prudential Ins. Co. of Am., No. 4:18-cv-00592 (E.D. Tex. Mar. 25, 2020). · cites it 3× “Missouri law applied, the Fifth Circuit continued, because Rittinger involved “a plan sold in Missouri by a Missouri insurer to a Missouri employer.”
Cottingim v. Reliastar Life Ins. Co., 723 F. Supp. 3d 1174 (M.D. Fla. 2024). · cites it 2× “Tex. Ins. Code Ann. § 1701.062 (b). The Fifth Circuit recently noted that the Texas insurance code provision only renders discretionary clauses unenforceable; “it does not attempt to prescribe the standard of review for federal courts deciding ERISA cases.”
Burrell v. Metro. Life Ins. Co., No. 1:18-cv-00174, 2020 WL 532934 (W.D. Tex. Feb. 3, 2020). · cites it 2× “3d at 955 (“[E]ven though Texas Insurance Code § 1701.062 bans insurers’ use of delegation clauses in Texas, Missouri law governs this case.”
Hernandez v. Life Ins. Co. of North Am., No. 5:19-cv-00022 (W.D. Tex. Apr. 1, 2020). · cites it 2× “Tex. Ins. Code § 1701.062(a). The chapter in which Section 1701.”
Gilmour v. Aetna Health, Inc., No. 5:17-cv-00510 (W.D. Tex. June 12, 2020). · cites it 2× “Tex. Ins. Code § 1701.062(a). The chapter in which Section 1701.”
Messer v. Lincoln Nat'l Life Ins. Co., No. 1:20-cv-00125 (W.D. Tex. July 16, 2021). · cites it 2× “3d at 955 (“[E]ven though Texas Insurance Code § 1701.062 bans insurers’ use of delegation clauses in Texas, Missouri law governs this case.”
Byerly v. Stnrd Ins, No. 20-40302 (5th Cir. Feb. 2, 2021). “See TEX. INS. CODE § 1701.062(a); Nat’l Ass’n of Ins.”
Brandt v. Unum Life Ins. Co. of Am., 377 F. Supp. 3d 683 (S.D. Tex. 2019). “See Tex. Ins. Code § 1701.062(a). Some have argued that state statutes that prohibit discretionary clauses are ineffective because they are preempted.”
Show all 22 citing cases →
Tex. Ins. Code § 1701.062(a): 16 cases
Ariana M. v. Humana Health Plan of Tex., Inc., 884 F.3d 246 (5th Cir. 2018). “TEX. INS. CODE § 1701.062(a). Assuming that the antidelegation statute is not preempted by federal law-something we do not decide today as that defense has not been asserted-a lot more ERISA cases will be subject to Firestone 's default standard of review.”
Ariana M. v. Humana Health Plan of Texas, Inc., 854 F.3d 753 (5th Cir. 2017). “002 [among other things, policies for health and medical insurance] in this state if the document contains a discretionary clause.”
Pike v. Hartford Life & Accident Ins. Co., 368 F. Supp. 3d 1018 (E.D. Tex. 2019). “See Tex. Ins. Code § 1701.062(a). The Court will incorporate the pertinent facts in its discussion of Defendant's objections.”
Byerly v. Stnrd Ins, No. 20-40302 (5th Cir. Feb. 2, 2021). “See TEX. INS. CODE § 1701.062(a); Nat’l Ass’n of Ins.”
Brandt v. Unum Life Ins. Co. of Am., 377 F. Supp. 3d 683 (S.D. Tex. 2019). “See Tex. Ins. Code § 1701.062(a). Some have argued that state statutes that prohibit discretionary clauses are ineffective because they are preempted.”
Tex. Ins. Code § 1701.062(b): 1 case
Woods v. Riverbend Country Club, Inc., 320 F. Supp. 3d 901 (S.D. Tex. 2018). “In this case, the Plan "provides payment for medical care, salary continuance, and certain death and dismemberment benefits arising from accidental injuries within the course and scope of employment.”
Tex. Ins. Code § 1701.062(b)(1): 5 cases
Ariana M. v. Humana Health Plan of Tex., Inc., 884 F.3d 246 (5th Cir. 2018). “TEX. INS. CODE § 1701.062(a). Assuming that the antidelegation statute is not preempted by federal law-something we do not decide today as that defense has not been asserted-a lot more ERISA cases will be subject to Firestone 's default standard of review.”
Ariana M. v. Humana Health Plan of Texas, Inc., 854 F.3d 753 (5th Cir. 2017). “002 [among other things, policies for health and medical insurance] in this state if the document contains a discretionary clause.”
Woods v. Riverbend Country Club, Inc., 320 F. Supp. 3d 901 (S.D. Tex. 2018). “In this case, the Plan "provides payment for medical care, salary continuance, and certain death and dismemberment benefits arising from accidental injuries within the course and scope of employment.”
Hernandez v. Life Ins. Co. of North Am., No. 5:19-cv-00022 (W.D. Tex. Apr. 1, 2020). “Tex. Ins. Code § 1701.062(a). The chapter in which Section 1701.”
Gilmour v. Aetna Health, Inc., No. 5:17-cv-00510 (W.D. Tex. June 12, 2020). “Tex. Ins. Code § 1701.062(a). The chapter in which Section 1701.”
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