Ga. Comp. R. & Regs. R. 120-2-52-.03 - Standards for Prompt and Fair Settlements of First Party Property Damage Claims
(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.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.