79C27(3) KLA

 

CHAPTER 1901.  PROFESSIONAL LIABILITY INSURANCE FOR
PHYSICIANS AND HEALTH CARE PROVIDERS

SUBCHAPTER A.  GENERAL PROVISIONS

Revised Law

Sec. 1901.001.  DEFINITIONS.  In this chapter:

(1)  "Health care provider" means:

(A)  a person, partnership, professional association, corporation, facility, or institution, or an officer, employee, or agent of the person or entity acting in the course and scope of authority, employment, or agency, as applicable, if the person or entity is licensed or chartered by this state to provide health care as:

(i)  a registered nurse;

(ii)  a hospital;

(iii)  a dentist;

(iv)  a podiatrist;

(v)  a chiropractor;

(vi)  an optometrist or therapeutic optometrist;

(vii)  a pharmacist;

(viii)  a veterinarian;

(ix)  a not-for-profit kidney dialysis center;

(x)  a blood bank that is a nonprofit corporation chartered to operate a blood bank and is accredited by the American Association of Blood Banks;

(xi)  a for-profit or not-for-profit nursing home; or

(xii)  a for-profit or not-for-profit assisted living facility; or

(B)  a health care practitioner or facility that the commissioner, in accordance with Section 2203.103(b), determines is eligible for coverage under this chapter.

(2)  "Hospital" means a public or private institution licensed under Chapter 241 or 577, Health and Safety Code.

(3)  "Physician" means a person licensed to practice medicine in this state.  (V.T.I.C. Art. 5.15-1, Sec. 2.)

Source Law

Sec. 2.  In this article:

(1)  "Physician" means a person licensed to practice medicine in this state.

(2)  "Health care provider" means any person, partnership, professional association, corporation, facility, or institution licensed or chartered by the State of Texas to provide health care as a registered nurse, hospital, dentist, podiatrist, chiropractor, optometrist, pharmacist, veterinarian, not-for-profit kidney dialysis center, blood bank that is a nonprofit corporation chartered to operate a blood bank and which is accredited by the American Association of Blood Banks, for-profit nursing home or not-for-profit nursing home, for-profit assisted living facility or not-for-profit assisted living facility, or an officer, employee, or agent of any of them acting in the course and scope of his employment, or a health care practitioner or facility that the commissioner, in accordance with Section 3B(b), Article 21.49-3, of this code, determines is eligible for coverage under this article.

(3)  "Hospital" means a licensed public or private institution as defined in Chapter 241, Health and Safety Code, or in Section 88, Chapter 243, Acts of the 55th Legislature, Regular Session, 1957 (Article 5547-88, Vernon's Texas Civil Statutes).

Revisor's Note

(1)  Section 2, V.T.I.C. Article 5.15-1, provides definitions applicable to "this article," meaning V.T.I.C. Article 5.15-1, which is revised in this chapter.  Although other provisions of this chapter are derived from V.T.I.C. Article 5.15-4, the revised law substitutes "this chapter" for "this article" in this context because the terms defined in Section 2 are not used in Article 5.15-4.

In addition, subsequent provisions of Article 5.15-1, including Section 2(2), revised in this section, refer to "this article."  Article 5.15-1 applies to professional liability insurance for physicians and health care providers, including the setting of rates for that kind of insurance.  Section 2(2) defines "health care provider" to include a nursing home.  Article 5.15-4, revised in this chapter as Subchapter D, in part governs the consideration of best practices for nursing homes in setting rates for professional liability insurance for nursing homes.  Because both Articles 5.15-1 and 5.15-4 apply to the setting of rates for professional liability insurance for nursing homes and the articles must, therefore, be read in conjunction with respect to that kind of insurance, it is appropriate throughout this chapter to substitute references to "this chapter" for references to "this article" in Article 5.15-1.  The revised law is drafted accordingly.

(2)  Section 2(2), V.T.I.C. Article 5.15-1, defines "health care provider" to include an "optometrist."  The revised law adds "therapeutic optometrist" for consistency with the terminology used in Chapter 351, Occupations Code, which governs the practice of optometry, and because Section 351.003, Occupations Code, provides that a reference in a law of this state to an optometrist means an optometrist or therapeutic optometrist, unless the context clearly indicates otherwise.

(3)  Section 2(3), V.T.I.C. Article 5.15-1, refers to Section 88, Chapter 243, Acts of the 55th Legislature, Regular Session, 1957 (Article 5547-88, Vernon's Texas Civil Statutes).  Article 5547-88 was codified in 1991 in Chapter 577, Health and Safety Code, which governs the licensing of certain mental health facilities.  The revised law is drafted accordingly.

Revised Law

Sec. 1901.002.  APPLICABILITY OF CHAPTER.  This chapter applies to:

(1)  an insurer authorized to write or engaged in writing professional liability insurance for a physician or health care provider; and

(2)  a rating organization acting on behalf of an insurer described by Subdivision (1).  (V.T.I.C. Art. 5.15-1, Sec. 1.)

Source Law

Art. 5.15-1

Sec. 1.  This article shall apply to the making and use of insurance rates by every insurer licensed to write or engaged in writing professional liability insurance for any physician or any health care provider including rating organizations, acting on behalf of insurers.

Revisor's Note

(1)  Section 1, V.T.I.C. Article 5.15-1, states that V.T.I.C. Article 5.15-1, which is revised in this chapter, applies to "the making and use of insurance rates" by an insurer authorized to write professional liability insurance for physicians or health care providers.  The revised law omits the quoted language because the article applies by its own terms to the making and use of insurance rates by an insurer to whom this chapter applies, and an additional statement to that effect is unnecessary.  In addition, the revised law omits the quoted language as misleading because the article applies to the making and use of insurance forms as well as insurance rates.  See, for example, Section 4(c), V.T.I.C. Article 5.15-1, revised in this chapter as Section 1901.201.

(2)  Section 1, V.T.I.C. Article 5.15-1, refers to an insurer "licensed to write" professional liability insurance for physicians or health care providers.  The revised law substitutes "authorized" for "licensed" because "certificate of authority" is the term used throughout this code in relation to an entity's authority to engage in business.

Revised Law

Sec. 1901.003.  APPLICABILITY OF OTHER LAW.  Chapters 2251 and 2301 and Article 5.13-2 apply to rates and forms for professional liability insurance for physicians and health care providers under this chapter.  (V.T.I.C. Art. 5.15-1, Sec. 4(a).)

Source Law

Sec. 4.  (a)  The provisions of Article 5.13-2 of this code shall apply to the filing of rates and rating information required under this article.

Revisor's Note

Section 4(a), V.T.I.C. Article 5.15-1, states that V.T.I.C. Article 5.13-2, revised in part in Chapters 2251 and 2301 of this code, applies to the filing of rates and rating information required under V.T.I.C. Article 5.15-1, which is revised in this chapter.  Article 5.13-2 applies by its own terms to both insurance rates and insurance forms for certain specified kinds of insurance, including the kinds of insurance regulated under this chapter.  The revised law is drafted to accurately reflect that applicability.

In addition, although Chapter 2251 is also derived in part from V.T.I.C. Article 5.13-2C and Chapter 2301 is also derived in part from V.T.I.C. Article 5.145, the revised law appropriately refers to both chapters in their entirety because Article 5.13-2C relates only to certain insurers writing residential property insurance and Article 5.145 relates only to personal automobile and residential property insurance;  therefore, the provisions of Chapters 2251 and 2301 derived from Articles 5.13-2C and 5.145 are inapplicable by their own terms to rates and forms for the kinds of insurance regulated under this chapter.

Revised Law

Sec. 1901.004.  ANNUAL REPORTS.  (a)  An insurer that issues professional liability insurance policies covering physicians and health care providers shall file annually with the commissioner a report of:

(1)  all claims and the amounts of those claims;

(2)  amounts of claims reserves;

(3)  investment income of the insurer derived from medical professional liability premiums;

(4)  information relating to amounts of judgments and settlements paid on claims; and

(5)  other information required by the commissioner.

(b)  The commissioner may promulgate a form on which the information under Subsection (a) must be reported.  The form must require that the information be reported in an accurate manner and be reasonably calculated to:

(1)  facilitate interpretation; and

(2)  protect the confidentiality of the physician or health care provider.  (V.T.I.C. Art. 5.15-1, Sec. 5.)

Source Law

Sec. 5.  Each insurer who issues policies of professional liability insurance covering physicians and health care providers shall file annually with the State Board of Insurance a report of all claims and amount of claims, amounts of claims reserves, investment income of the company derived from medical professional liability premiums, information relating to amounts of judgments and settlements paid on claims, and other information required by the board.  The board may formulate and promulgate a form on which this information shall be reported. The form shall be so devised as to require the information to be reported in an accurate manner, reasonably calculated to facilitate interpretation and to protect the confidentiality of the health care provider or physician.

Revisor's Note

(1)  Section 5, V.T.I.C. Article 5.15-1, refers to the State Board of Insurance.  Chapter 685, Acts of the 73rd Legislature, Regular Session, 1993, abolished the board and transferred its functions to the commissioner of insurance and the Texas Department of Insurance.  Throughout this chapter, references to the board have been changed appropriately.

(2)  Section 5, V.T.I.C. Article 5.15-1, authorizes the State Board of Insurance, meaning the commissioner of insurance for the reason stated in Revisor's Note (1) to this section, to "formulate and promulgate" a form.  The revised law omits "formulate" because "formulate" is included within the meaning of "promulgate."

Revised Law

Sec. 1901.005.  RULES.  The commissioner shall establish by rule:

(1)  criteria that insurers must follow in establishing reconsideration procedures under Section 1901.101; and

(2)  standards and procedures to be followed in the review of rates and premiums by the commissioner.  (V.T.I.C. Art. 5.15-1, Sec. 4B(c).)

Source Law

(c)  The State Board of Insurance by rule shall establish criteria to be followed by insurers in establishing reconsideration procedures under Subsection (a)  of this section and standards and procedures to be followed in review of rates and premiums by the board.

[Sections 1901.006-1901.050 reserved for expansion]

SUBCHAPTER B.  RATE STANDARDS

Revised Law

Sec. 1901.051.  CONSIDERATIONS IN SETTING RATES.  (a)  In setting rates, an insurer shall consider:

(1)  past and prospective loss and expense experience for all professional liability insurance for physicians and health care providers written in this state, subject to Subsection (b);

(2)  a reasonable margin for underwriting profit and contingencies;

(3)  investment income; and

(4)  dividends or savings allowed or returned by the insurer to the insurer's policyholders or members.

(b)  If the department finds that the group or risk to be insured is not of sufficient size to be credible, an insurer must also consider in setting rates past and prospective loss and expense experience for all professional liability insurance for physicians and health care providers written outside this state. (V.T.I.C. Art. 5.15-1, Sec. 3 (part).)

Source Law

Sec. 3.  Rates shall be made in accordance with the following provisions:

(a)  Consideration shall be given to past and prospective loss and expense experience for all professional liability insurance for physicians and health care providers written in this state, unless the State Board of Insurance shall find that the group or risk to be insured is not of sufficient size to be deemed credible, in which event, past and prospective loss and expense experience for all professional liability insurance for physicians and health care providers written outside this state shall also be considered, to a reasonable margin for underwriting profit and contingencies, to investment income, to dividends or savings allowed or returned by insurers to their policyholders or members.

…

Revised Law

Sec. 1901.052.  GROUPING OF RISKS.  In setting rates, an insurer may group risks by classification, rating schedule, or any other reasonable method.  (V.T.I.C. Art. 5.15-1, Sec. 3 (part).)

Source Law

Sec. 3.  Rates shall be made in accordance with the following provisions:

…

(c)  For the establishment of rates, risks may be grouped by classifications, by rating schedules, or by any other reasonable methods… .

Revised Law

Sec. 1901.053.  MODIFICATION OF CLASSIFICATION RATES.  (a)  An insurer may modify classification rates to produce rates for individual risks in accordance with rating plans that establish standards for measuring variations in hazards or expense provisions.

(b)  The standards may measure any difference among risks that can be demonstrated to have a probable effect on losses or expenses.  (V.T.I.C. Art. 5.15-1, Sec. 3 (part).)

Source Law

Sec. 3.  Rates shall be made in accordance with the following provisions:

…

(c)  … Classification rates may be modified to produce rates for individual risks in accordance with rating plans which establish standards for measuring variations in hazards or expense provisions, or both.  Those standards may measure any difference among risks that can be demonstrated to have a probable effect upon losses or expenses.

…

Revised Law

Sec. 1901.054.  LIMITATIONS ON RATES.  (a)  Rates set under this chapter may not be excessive or inadequate, as described by this section, or unreasonable or unfairly discriminatory.

(b)  A rate is not excessive unless:

(1)  the rate is unreasonably high for the insurance coverage provided; and

(2)  a reasonable degree of competition does not exist in the area with respect to the classification to which the rate applies.

(c)  A rate is not inadequate unless the rate is unreasonably low for the insurance coverage provided and:

(1)  is insufficient to sustain projected losses and expenses; or

(2)  the use of the rate has or, if continued, will have the effect of destroying competition or creating a monopoly.  (V.T.I.C. Art. 5.15-1, Sec. 3 (part).)

Source Law

Sec. 3.  Rates shall be made in accordance with the following provisions:

…

(d)  Rates shall be reasonable and shall not be excessive or inadequate, as defined in this subsection, nor shall they be unfairly discriminatory.  No rate shall be held to be excessive unless the rate is unreasonably high for the insurance coverage provided and a reasonable degree of competition does not exist in the area with respect to the classification to which the rate is applicable.  No rate shall be held to be inadequate unless the rate is unreasonably low for the insurance coverage provided and is insufficient to sustain projected losses and expenses; or unless the rate is unreasonably low for the insurance coverage provided and the use of the rate has or, if continued, will have the effect of destroying competition or creating a monopoly.

Revised Law

Sec. 1901.055.  CLAIM SURCHARGE.  A claim surcharge assessed by an insurer against a physician or health care provider under a professional liability insurance policy may be based only on claims actually paid by an insurer as a result of:

(1)  a settlement; or

(2)  an adverse judgment or decision of a court.  (V.T.I.C. Art. 5.15-1, Sec. 9.)

Source Law

Sec. 9.  A claim surcharge assessed by an insurer against a health care provider or physician under a professional liability insurance policy may be based only on claims actually paid by an insurer as a result of a settlement or an adverse judgment or an adverse decision of a court.

Revised Law

Sec. 1901.056.  ABSOLUTE RATES PROHIBITED.  (a)  In this section, "absolute rates" means rates, rating plans, or rating classifications that are filed under Chapter 2251 or Article 5.13-2 by an insurer or authorized rating organization and that are required to be used, to the exclusion of all others, by each insurer authorized to write policies.

(b)  A provision of this chapter, Chapter 2251, or Article 5.13-2 relating to the regulation of rates, rating plans, and rating classifications for professional liability insurance for physicians and health care providers does not:

(1)  give the commissioner the power to promulgate uniform or absolute rates; or

(2)  prevent different insurers or organizations authorized to file rates from filing different rates for risks in a given classification or modified rates for individual risks made in accordance with rating plans.  (V.T.I.C. Art. 5.15-1, Sec. 4(b).)

Source Law

(b)  Nothing contained in this article or other provisions of this subchapter concerning the regulation of rates, rating plans, and rating classifications shall, as applies to the writing of professional liability insurance for health care providers and physicians, give the board the power to prescribe uniform or absolute rates; nor shall anything therein be construed as preventing the filing of different rates for risks in a given classification or modified rates for individual risks made in accordance with rating plans, as filed by different insurers or organizations authorized to file such rates.  As used in this subsection, "absolute rates" means rates, rating classifications, or rating plans filed by an insurer or authorized rating organization in accordance with this subchapter and the rates, rating classifications, or rating plans so filed are required to be used, to the exclusion of all others, by each insurer lawfully engaged in writing policies.

Revisor's Note

Section 4(b), V.T.I.C. Article 5.15-1, refers to the filing and regulation of rates, rating plans, and rating classifications under "this subchapter," meaning Subchapter B, V.T.I.C. Chapter 5.  The pertinent provisions of Subchapter B, Chapter 5, are contained in V.T.I.C. Article 5.13-2, revised in part in Chapter 2251 of this code, and the revised law is drafted accordingly.  Although Chapter 2251 is also derived in part from V.T.I.C. Article 5.13-2C, the revised law refers to that chapter in its entirety for the reason stated in the revisor's note to Section 1901.003.

Revised Law

Sec. 1901.057.  CONSIDERATIONS IN APPROVING RATES.  In approving rates under this chapter, the commissioner shall consider the impact of risk management courses taken by physicians and health care providers in this state.  (V.T.I.C. Art. 5.15-1, Sec. 3 (part).)

Source Law

Sec. 3.  Rates shall be made in accordance with the following provisions:

…

(b)  The State Board of Insurance shall consider the impact of risk management courses taken by physicians and health care providers in this state in approving rates under this article.

…

[Sections 1901.058-1901.100 reserved for expansion]

SUBCHAPTER C.  REVIEW OF RATES

Revised Law

Sec. 1901.101.  RECONSIDERATION OF RATES AND PREMIUMS.  (a)  Each insurer to which this chapter applies shall adopt a procedure for reconsideration of a rate or premium charged a physician or health care provider for professional liability insurance coverage.

(b)  The procedure must include:

(1)  an opportunity for a hearing before officers or employees who have responsibility for determining rates and premiums to be charged for professional liability insurance; and

(2)  a requirement that the insurer reconsider the rate or premium and provide the physician or health care provider a written explanation of the rate or premium being charged.  (V.T.I.C. Art. 5.15-1, Sec. 4B(a).)

Source Law

Sec. 4B.  (a)  Each insurer covered by this article shall adopt a procedure for reconsideration of a rate or premium charged a physician or health care provider for professional liability insurance coverage.  The procedure shall include an opportunity for a hearing before officers or employees who have responsibility for determining rates and premiums to be charged for professional liability insurance and a requirement that the insurer reconsider the rate or premium and provide the physician or health care provider a written explanation of the rate or premium being charged.

Revised Law

Sec. 1901.102.  APPEAL.  A physician or health care provider that is not satisfied with a decision under procedures established under Section 1901.101 may appeal to the commissioner for:

(1)  a review of the rate or premium; and

(2)  a determination of whether the rate or premium being charged complies with criteria under Sections 1901.051-1901.054 and 1901.057.  (V.T.I.C. Art. 5.15-1, Sec. 4B(b).)

Source Law

(b)  If a physician or health care provider is not satisfied with a decision under procedures established under Subsection (a) of this section, the physician or health care provider may appeal to the State Board of Insurance for a review of the rate or premium and a determination if the rate or premium being charged complies with criteria under Section 3 of this article.

[Sections 1901.103-1901.150 reserved for expansion]

SUBCHAPTER D.  BEST PRACTICES FOR NURSING HOMES

Revised Law

Sec. 1901.151.  BEST PRACTICES.  (a)  The commissioner shall adopt best practices for risk management and loss control that may be used by for-profit and not-for-profit nursing homes.

(b)  In developing or amending the best practices, the commissioner shall consult with the Health and Human Services Commission and a task force appointed by the commissioner.

(c)  The task force must be composed of representatives of:

(1)  insurers that write professional liability insurance for nursing homes;

(2)  the Texas Medical Liability Insurance Underwriting Association;

(3)  nursing homes; and

(4)  consumers.  (V.T.I.C. Art. 5.15-4, Secs. (a), (c).)

Source Law

Art. 5.15-4. (a)  The commissioner shall adopt best practices for risk management and loss control that may be used by for-profit and not-for-profit nursing homes.

(c)  In developing or amending best practices for for-profit and not-for-profit nursing homes, the commissioner shall consult with the Health and Human Services Commission and a task force appointed by the commissioner. The task force must be composed of representatives of:

(1)  insurance companies that write professional liability insurance for nursing homes;

(2)  the Texas Medical Liability Insurance Underwriting Association;

(3)  nursing homes; and

(4)  consumers.

Revised Law

Sec. 1901.152.  CONSIDERATION OF BEST PRACTICES IN SETTING RATES.  In setting rates for professional liability insurance applicable to a for-profit or not-for-profit nursing home, an insurer or the Texas Medical Liability Insurance Underwriting Association may consider whether the nursing home adopts and implements the best practices adopted under this subchapter. (V.T.I.C. Art. 5.15-4, Sec. (b).)

Source Law

(b)  In determining rates for professional liability insurance applicable to a for-profit or not-for-profit nursing home, an insurance company or the Texas Medical Liability Insurance Underwriting Association may consider whether the nursing home adopts and implements the best practices adopted by the commissioner under Subsection (a) of this article.

Revised Law

Sec. 1901.153.  STANDARD OF CARE FOR CIVIL ACTIONS NOT ESTABLISHED.  The best practices for risk management and loss control adopted under this subchapter do not establish standards of care for nursing homes applicable in a civil action against a nursing home. (V.T.I.C. Art. 5.15-4, Sec. (d).)

Source Law

(d)  The best practices for risk management and loss control adopted under this article do not establish standards of care for nursing homes applicable in a civil action against a nursing home.

[Sections 1901.154-1901.200 reserved for expansion]

SUBCHAPTER E.  POLICY FORMS

Revised Law

Sec. 1901.201.  STANDARDIZED POLICY FORMS; APPROVAL OF OTHER FORMS.  (a)  The commissioner shall prescribe standardized policy forms for occurrence, claims-made, and claims-paid professional liability insurance policies for physicians and health care providers.

(b)  An insurer may not use a form other than a standardized policy form in writing professional liability insurance for physicians and health care providers unless the form has been approved by the commissioner.

(c)  An insurer writing professional liability insurance for physicians and health care providers may use an endorsement if the endorsement has been filed with and approved by the commissioner.  (V.T.I.C. Art. 5.15-1, Sec. 4(c).)

Source Law

(c)  The State Board of Insurance shall prescribe standardized policy forms for occurrence, claims-made and claims-paid policies of professional liability insurance covering health care providers and physicians, and no insurer may use any other forms in writing professional liability insurance for health care providers and physicians without the prior approval of the State Board of Insurance.  However, an insurer writing professional liability insurance for health care providers and physicians may use any form of endorsement if the endorsement is first submitted to and approved by the board.

[Sections 1901.202-1901.250 reserved for expansion]

SUBCHAPTER F.  COVERAGE

Revised Law

Sec. 1901.251.  PREMIUM BASIS.  An insurer may not write a professional liability insurance policy under this chapter on less than an annual premium basis.  (V.T.I.C. Art. 5.15-1, Sec. 6.)

Source Law

Sec. 6.  Policies of professional liability insurance under this article shall be written on not less than an annual premium basis.

Revised Law

Sec. 1901.252.  COVERAGE FOR EXEMPLARY DAMAGES.  (a)  Except as provided by Subsection (b), a medical professional liability insurance policy issued to or renewed for a physician or health care provider in this state may not include coverage for exemplary damages that may be assessed against the physician or health care provider.

(b)  The commissioner may approve an endorsement form that provides for coverage for exemplary damages for use on a medical professional liability insurance policy issued to:

(1)  a hospital; or

(2)  a for-profit or not-for-profit nursing home or assisted living facility.  (V.T.I.C. Art. 5.15-1, Sec. 8.)

Source Law

Sec. 8.  No policy of medical professional liability insurance issued to or renewed for a health care provider or physician in this state may include coverage for exemplary damages that may be assessed against the health care provider or physician;  provided, however, that the commissioner may approve an endorsement form that provides for coverage for exemplary damages to be used on a policy of medical professional liability insurance issued to a hospital, as the term "hospital" is defined in this article, or to a for-profit or not-for-profit nursing home or assisted living facility.

Revised Law

Sec. 1901.253.  NOTICE OF PREMIUM INCREASE, CANCELLATION, OR NONRENEWAL.  (a)  An insurer that issues a professional liability insurance policy for a physician or health care provider must provide to the insured written notice of at least 90 days if the insurer intends to:

(1)  increase the premiums on the policy; or

(2)  cancel or not renew the policy for a reason other than for nonpayment of premiums or because the insured is no longer licensed.

(b)  If the insurer intends to increase the premiums, the insurer shall state in the notice the amount of the increase.

(c)  If the insurer intends to cancel or not renew the policy, the insurer shall state in the notice the reason for cancellation or nonrenewal.

(d)  An insurer may provide notice of cancellation under this section only within the first 90 days from the effective date of the policy.  (V.T.I.C. Art. 5.15-1, Sec. 7.)

Source Law

Sec. 7.  An insurer who issues a policy of professional liability insurance covered by this article shall give at least 90 days' written notice to an insured if premiums on the insurance are to be increased or the policy is to be cancelled or is not to be renewed other than for nonpayment of premiums or because the insured is no longer licensed.  If the premiums are to be increased, the notice shall state the amount of the increase, and if the policy is to be cancelled or is not to be renewed, the insurer shall state in the notice the reason for cancellation or nonrenewal.  Notice of cancellation under this section may only be given within the first 90 days from the effective date of the policy.