2022 Georgia Code
Title 33 - Insurance
Chapter 6 - Unfair Trade Practices
Article 2 - Unfair Claims Settlement Practices
§ 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 Title 33, the “Surprise Billing Consumer Protection Act,” including 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.

History. Code 1981, § 33-6-34 , enacted by Ga. L. 1992, p. 3048, § 9; Ga. L. 2020, p. 210, § 2/HB 888; Ga. L. 2022, p. 598, § 3/HB 1324.

The 2020 amendment, effective January 1, 2021, deleted “and” at the end of paragraph (13), substituted “; and” for the period at the end of paragraph (14), and added paragraph (15).

The 2022 amendment, effective July 1, 2022, deleted “and” from the end of paragraph (14); substituted “; and” for a period at the end of paragraph (15); and added paragraph (16).

Code Commission notes.

Pursuant to Code Section 28-9-5, in 1992, “first-party” was substituted for “first party” in two places in paragraph (13).

Editor’s notes.

Ga. L. 2022, p. 598, § 1/HB 1324, not codified by the General Assembly, provides: “The General Assembly finds that: (1) This state recognizes a ‘prudent layperson’ standard with regard to the need for emergency care;

“(2) Insurance companies operating in this state are required to adhere to that standard;

“(3) Patients in this state have had emergency medical claims denied due to insurers’ failure to adhere to the prudent layperson standard as intended;

“(4) The federal court system has recognized that this standard is not intended to look to the diagnosis that a patient receives. Rather, the only relevant considerations are the patient’s symptoms and whether a prudent layperson would think that emergency medical attention is necessary based on those symptoms;

“(5) This legislative body has intended and continues to intend that the prudent layperson standard be applied in the same manner;

“(6) In order to better protect Georgians seeking emergency care, legislation is needed not to change the meaning but to clarify the intended application of the prudent layperson standard in this state; and

“(7) Nothing in this Act is intended to be applicable to healthcare plans which are subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq.”