28 Tex. Admin. Code § 5.4201 - Coastal Outreach and Assistance Services Team (COAST) Program
(a) Establishment. The Texas Department of
Insurance (department) establishes the Coastal Outreach and Assistance Services
Team (COAST) Program to provide information and educational programs to assist
persons insured under Chapter 2210 of the Insurance Code with the claim
processes prescribed under Subchapter L-1, Chapter 2210 of the Insurance
Code.
(b) Administration. The COAST
Program is administratively attached to the department and will be administered
by the department.
(c) Staffing.
The COAST Program will include an ombudsman familiar with the claim processes
prescribed under Subchapter L-1, Chapter 2210, of the Insurance Code, as well
as sufficient staff to support its purpose. If a catastrophic event occurs, the
COAST Program may expand as necessary to support the increased number of
policyholders requiring assistance.
(d) Funding. The COAST Program will be funded
by the Texas Windstorm Insurance Association (the Association).
(1) Annual budget.
(A) The funding year shall be from May 1 of
each year to April 30 of the following year.
(B) Not later than March 1 of each year, the
department shall prepare and submit to the Commissioner of Insurance
(commissioner) a budget for the COAST Program, including approval of all
expenditures incurred to administer and operate the COAST Program. The
department may include ongoing ombudsman activities related to a prior
catastrophic event in the annual budget request. The commissioner will adopt or
modify and adopt the budget not later than April 1 of each year.
(C) Not later than May 1 of each year, the
Association shall transfer the budgeted amount adopted by the commissioner to
the department for the COAST Program.
(2) Amended budget.
(A) Not later than 60 days after a
catastrophic event, the department shall:
(i)
prepare and submit an amended budget to the commissioner for approval,
including staffing requirements and expenditures necessary to administer and
operate the COAST Program; and
(ii)
report to the commissioner the number of claimants eligible for COAST Program
services.
(B) The
commissioner may modify the amended budget before adopting it.
(C) Within 30 days after the commissioner
adopts the amended budget, the Association must transfer the additional money
required by the amended budget to the department for the COAST
Program.
(3) Return of
unexpended funds. Not later than April 30 of each year, the department must
return to the Association any unexpended funds that the COAST Program received
from the Association in the previous year.
(e) Services.
(1) The COAST Program may provide to persons
insured under Chapter 2210 of the Insurance Code information and educational
programs through means the COAST Program determines to be necessary and
appropriate. Possible means include:
(A)
informational materials;
(B)
toll-free telephone numbers;
(C)
public meetings;
(D) outreach
centers;
(E) the Internet;
and
(F) other reasonable
means.
(2) The COAST
Program shall prepare and make available to each person insured under Chapter
2210 of the Insurance Code information describing the functions of the COAST
Program.
(f) Notice
Requirement. The Association must provide each person insured by the
Association on or after November 27, 2011, notice of the operation of the COAST
Program. The Association shall fulfill this requirement by complying with
paragraphs (1), (2), and (3) of this subsection.
(1) The Association must include the notices
set forth in subsection (g)(1) and (2) of this section with each policy
delivered, issued for delivery, renewed, or otherwise processed by the
Association. Notwithstanding §
1.601(a)(3) of
this title (relating to Notice of Toll-Free Telephone Numbers and Information
and Complaint Procedures), the Association must fulfill this requirement by
printing the notice on a separate piece of paper to be included with the policy
or by incorporating the notice into the Important Notice required to be
attached to the policy under §
1.601 of this title.
(2) The Association must include the notice
set forth in subsection (g)(1) of this section with each written communication
acknowledging receipt of a claim. The Association must fulfill this requirement
by printing the notice on a separate piece of paper to be included with the
communication acknowledging receipt of a claim or by incorporating the notice
into the acknowledgement.
(3) The
Association must include the notice set forth in subsection (g)(1) of this
section with each written communication accepting or denying coverage of a
claim, in whole or in part, that is required to be provided to the claimant
under the Insurance Code §
2210.573(d).
The Association must fulfill this requirement by printing the notice on a
separate piece of paper to be included with the acceptance or denial
communication or by incorporating the notice into the acceptance or denial
document.
(g) Notice.
The notice required by subsection (f) of this section must include the
following text and be in at least 10 point type.
(1) "The Texas Department of Insurance has
established the Coastal Outreach and Assistance Services Team (COAST) Program
to assist consumers with understanding the TWIA claim process. To obtain
assistance from the COAST Program, please refer to the COAST Program website at
www.tdi.texas.gov/COAST; email ConsumerProtection@tdi.state.tx.us; call
toll-free 1-855-352-6278; or write to COAST Program - MC 111-1A, Texas
Department of Insurance, PO Box 149104, Austin, TX 78714-9104."
(2) "El Departamento de Seguros de Texas ha
establecido el Programa de Alcance Comunitario y Servicios de Asistencia para
el Area Costera (Coastal Outreach and Assistance Services Team (COAST) Program,
por su nombre y siglas en inglés) para ayudar a los consumidores a entender el
proceso de las reclamaciones de TWIA. Para obtener ayuda del Programa COAST,
visite el sitio Web del Programa COAST en www.tdi.texas.gov/COAST; por medio de
correo electrónico a ConsumerProtection@tdi.state.tx.us; o llame gratis al
1-855-352-6278; o escriba al Programa COAST - MC 111-1A, Texas Department of
Insurance, PO Box 149104, Austin, TX 78714-9104."
Notes
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