Texas Attorney General Opinion: JM-1154 Page: 2 of 3
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Honorable Juan J. Hinojosa - Page 2 (JM-1154)
remitted to an insured by the person as a
rebate.
(b) A person who is insured under a
property or casualty insurance policy commits
an offense if the person:
(1) submits a claim under the policy
based on charges that are in violation of
Subsection (a) of this section; or
(2) knowingly allows a claim in
violation of Subsection (a) of this
section to be submitted, unless the person
promptly notifies the insurer of the
excessive charges.
(c) An offense under this section is a
Class A misdemeanor.
You ask whether a person who advertises or promises to
.provide a good or service and "waives the deductible"
violates section 27.02(a). We understand you to be asking
about an advertisement or promise to engage in the following
transaction: A person providing a good or service would
submit a bill directly to an insurer and then accept the
portion of the bill paid by the insurer as satisfaction for
the entire claim. In other words, the person providing the
good or service would not seek payment of the unpaid portion
-- the insured's deductible -- from the insured.
Certainly that type of transaction comes within the
spirit of the prohibitions set out in section 27.02(a).
Declining to seek payment of the portion of the bill for
which the insured is responsible has the same effect as
rebating the amount of the deductible. Nonetheless,
"waiving the deductible" is not encompassed by the actual
language of either subsection (a) (1) (A) or subsection
(a) (1)(B). Declining to seek all or part of the deductible
is technically not the same as "pay[ing] all or part of any
applicable insurance deductible." Nor is it the same as
giving a rebate of all or part of the deductible. Due
process requires that criminal statutes give fait notice of
the activity that is outlawed. Papachristou v. City of
Jacksonville, 405 U.S. 156 (1972). A forbidden act must
come within the prohibition of the statute and any doubt as
to whether an offense has been committed should be resolved
in favor of the accused. Engelking v. State, 750 S.W.2d 213
(Tex. Crim. App. 1988). Because of the constitutionalp. 6093
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Texas. Attorney-General's Office. Texas Attorney General Opinion: JM-1154, text, April 12, 1990; (https://texashistory.unt.edu/ark:/67531/metapth273592/m1/2/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.