Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-52 - FAIR AND EQUITABLE SETTLEMENT OF FIRST PARTY PROPERTY DAMAGE CLAIMS › Rule 120-2-52-.03 - Standards for Prompt and Fair Settlements of First Party Property Damage Claims

Current through Rules and Regulations filed through June 27, 2024
(1) Every insurer, upon receiving
				notification of a claim shall, within fifteen (15) days, acknowledge the
				receipt of such notice by the insured, unless payment is made within that time
				period. If an acknowledgment is made by means other than writing, a notation of
				the acknowledgment shall be made in the claim file of the insurer and dated.
				Notification of a claim given to an agent of an insurer shall be notification
				to the insurer.
(2) Every insurer,
				upon receiving notification of a claim shall, within fifteen (15) days, provide
				the insured with the proof of loss forms, if applicable, with reasonable
				explanations regarding their use. The providing of these forms will constitute
				an acknowledgement of receipt of the claim referred to in paragraph (1)
				above.
(3) The insurer shall affirm
				or deny liability on claims within fifteen (15) days of receiving the completed
				proof of loss from the insured for losses arising from motor vehicle policies,
				and sixty (60) days of receiving the completed proof of loss from the insured
				for losses arising from fire or extended coverage type policies. If the insurer
				does not require the proof of loss to be completed, a coverage investigation as
				is reasonably necessary to affirm or deny shall take place within thirty (30)
				days from the day communication of the claim was received by the
				insurer.
(4) Payment shall be
				tendered within ten (10) days after coverage is confirmed and the full amount
				of the claim is determined and not in dispute. In claims where multiple
				coverages are involved, payments for individual coverages, which are not in
				dispute and where the payee is known, shall be tendered within ten (10) days,
				if such payment would terminate the insurer's known liability under that
				individual coverage.
(5) If the
				insurer needs more time than that specified in paragraph (3) above, to
				determine whether a first party claim should be accepted or denied, it shall
				notify the claimant within five (5) business days after the time limitation has
				elapsed in paragraph (3) above giving the reason that more time is needed and
				an estimate of additional time needed to establish liability. This can be
				accomplished in writing or if by other means, a proper notation shall be made
				in the claim file and dated. The total time the insurer has to accept or deny
				liability shall not exceed 60 days from the company being notified of the
				claim, unless the company has documented the claim file where information that
				has been requested necessary to determine liability has not been
				submitted.
(6) If the insurer has
				affirmed liability on a claim, or affirmed liability for individual coverages
				where the claim involves multiple coverages and the amount payable is in
				dispute, the insured, or the insurer, may submit to the Commissioner a request
				for their case to be arbitrated. The request must be in writing and must
				include the facts of the case to include where each party currently stands in
				the negotiations. The Commissioner may establish a panel of arbitrators
				consisting of attorneys authorized to practice law in this State and insurance
				adjusters licensed to act as such in this State. The arbitrators will be
				charged with the duty of establishing a fair and equitable monetary settlement
				of the case. If an arbitration panel has been established, three (3)
				individuals from the panel of arbitrators, at least one of whom shall be an
				attorney authorized to practice law in this State and at least one of whom
				shall be an insurance adjuster licensed to act as such in this State, will be
				designated to hear each request for arbitration. Any claim settled pursuant to
				this Chapter shall be binding on both parties and fulfill any arbitration
				provision currently contained in the motor vehicle insurance policy, but shall
				not preclude or waive any other rights either party has under common law. The
				decision of the arbitration panel shall in no way be construed as a decision of
				the Commissioner. If an arbitration panel has been established, the
				Commissioner shall forward the written request for arbitration to the three (3)
				individuals selected to hear such request. The cost of the arbitration shall be
				borne equally by the parties to the arbitration.
(7) No insurer shall deny a claim on the
				grounds of a specific policy provision, condition or exclusion unless reference
				to such provision, condition, or exclusion is included in the denial. The
				denial shall be given to the insured in writing and the claim file of the
				insurer shall contain documentation of the denial.
(8) The insurer shall pay according to the
				terms of its policy for the covered loss up to the actual cash value to repair
				or to replace the damaged or stolen property subject to any deductibles.
				However, the insured has the right to choose the place of repair and pay the
				difference in cost, if the cost of the repair shop selected by the insured is
				greater than that obtained by the insurer.
(a)
				Unless permitted pursuant to the provisions of the policy of insurance, no
				insurer shall require an insured to utilize a particular person, firm, or
				corporation to repair a motor vehicle in order to settle a first party claim if
				the insured can obtain the repair work on the motor vehicle at the same cost
				from another source.