State Law

Georgia Code-Title 33-Chapter 6- Article 2-Unfair Claims Settlement Practices

07/14/2023 Georgia Section 33-6-34

Unfair Claims Settlement Practices

Prompt Payment Deadlines

See the bold text below:

Any of the following acts of an insurer when committed as provided in Code Section 33-6-33 shall constitute an unfair claims settlement practice:

1. Knowingly misrepresenting to claimants and insureds relevant facts or policy provisions relating to coverages at issue;

2. Failing to acknowledge with reasonable promptness pertinent communications with respect to claims arising under its policies;

3. Failing to adopt and implement procedures for the prompt investigation and settlement of claims arising under its policies;

4. Not attempting in good faith to effectuate prompt, fair, and equitable settlement of claims submitted in which liability has become reasonably clear;

5. Compelling insureds or beneficiaries to institute suits to recover amounts due under its policies by offering substantially less than the amounts ultimately recovered in suits brought by them;

6. Refusing to pay claims without conducting a reasonable investigation;

7. When requested by the insured in writing, failing to affirm or deny coverage of claims within a reasonable time after having completed its investigation related to such claim or claims;

8. When requested by the insured in writing, making claims payments to an insured or beneficiary without indicating the coverage under which each payment is being made;

9. Unreasonably delaying the investigation or payment of claims by requiring both a formal proof of loss and subsequent verification that would result in duplication of information and verification appearing in the formal proof of loss form; provided, however, this paragraph shall not preclude an insurer from obtaining sworn statements if permitted under the policy;

10. When requested by the insured in writing, failing in the case of claims denial or offers of compromise settlement to provide promptly a reasonable and accurate explanation of the basis for such actions. In the case of claims denials, such denials shall be in writing;

11. Failing to provide forms necessary to file claims within 15 calendar days of a request with reasonable explanations regarding their use;

12. Failing to adopt and implement reasonable standards to assure that the repairs of a repairer owned by the insurer are performed in a workmanlike manner;

13. Indicating to a first-party claimant on a payment, draft check, or accompanying letter that said payment is final or a release of any claim unless the policy limit has been paid or there has been a compromise settlement agreed to by the first-party claimant and the insurer as to coverage and amount payable under the contract;

14. Issuing checks or drafts in partial settlement of a loss or claim under a specific coverage which contain language which releases the insurer or its insured from its total liability; and

15. Failure to comply with any insurer requirement in Chapter 20E of this title, the “Surprise Billing Consumer Protection Act,” including:

(A) The failure to designate whether the healthcare plan is subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec. 1001, et seq.;

(B) The failure to directly pay the provider or facility within 15 working days for electronic claims or 30 calendar days for paper claims any moneys due under Code Section 33-20E-4 or 33-20E-5; or

(C) The the failure to pay a resolution organization as required under Code 21 Section 33-20E-16….

See generally  Sections (A), (B), and (C) under 15. above were added in 2023 by HB 295 (2023).  See