2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 6 - UNFAIR TRADE PRACTICES (§§ 33-6-1 — 33-6-37) › Article 2 - UNFAIR CLAIMS SETTLEMENT PRACTICES (§§ 33-6-30 — 33-6-37) › Section 33-6-34 - Unfair claims settlement practices

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;
(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 failure to pay a resolution organization as required under Code Section
33-20E-16
; and
(16)
Failure to comply with any insurer requirement relating to emergency services or care in Article 4 of Chapter 11 of Title 31, Article 1 of Chapter 20A of this title, Chapter 20E of this title, Chapter 21A of this title, Code Section
33-24-59.27
, and Chapter 30 of this title.
Amended by 2023 Ga. Laws 223,§ 1, eff. 7/1/2023.
Amended by 2022 Ga. Laws 833,§ 3, eff. 7/1/2022.
Amended by 2020 Ga. Laws 470,§ 2, eff. 1/1/2021.