2010 Georgia Code

 

TITLE 33 – INSURANCE

 

CHAPTER 6 – UNFAIR TRADE PRACTICES

 

ARTICLE 2 – UNFAIR CLAIMS SETTLEMENT PRACTICES

 

§ 33-6-34 – Unfair claims settlement practices

O.C.G.A. 33-6-34 (2010)

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; and

 

(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.

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Unfair Claims Settlement Practice Act

1. 2nd Guess Medical Opinion
2. Skewing The Prognosis
3. Manipulate The Trauma Line
4. Dragging The Injury Severity Line

Reduced Severity Non-Rate Action Plan