On October 9, 2018, in anticipation of Hurricane Michael pushing through the panhandle of Florida and impacting the lower half of Georgia, Governor Nathan Deal issued a State of Emergency for most of the counties in the southern half of the state. Based on the size and intensity of Hurricane Michael as it makes landfall in Florida, it is likely that many of those counties will encounter intense winds and significant rainfall.
Georgia insurers are subject to various statutory and regulatory requirements, some of which mandate that they act within certain timelines in the adjustment of claims. In the aftermath of Hurricane Michael, this non-exhaustive reference checklist may prove helpful as insurers begin to tackle the property claims that will follow in the wake of the storm.
- Response to Notice – 15 days to acknowledge claim or make payment. Ga. Comp. R. & Regs. 120-2-52-.03(1). If the acknowledgement is made by means other than writing, the notification must be noted in the claim file and dated.
- Proof of Loss – 15 days. If applicable, the insurer must provide the insured with proof of loss forms and a reasonable explanation regarding their use within 15 days from the receipt of notice. Ga. Comp. R. & Regs. 120-2-52-.03(2). The provision of these forms will constitute acknowledgement of service under 120-2-52-.03(1).
- Confirmation of Liability – 15 or 30 days. The insurer must affirm or deny liability on claims within 15 days of receiving the completed proof of loss. Ga. Comp. R. & Regs. 120-2-52-.03(3). If the insurer does not require a proof of loss, then the affirmation or denial of the claim must be made within 30 days from the date the claim was reported.
- Payment – 10 days. Payment must be tendered within 10 days after coverage is confirmed and there is no dispute in the value of the claim. Ga. Comp. R. & Regs. 120-2-52-.03(4).
- Additional Time for Investigation- If the insurer needs more than the 15 or 30 days provided for to confirm liability, it must notify the insured within five (5) business days after the time limitation has elapsed. Ga. Comp. R. & Regs. 120-2-52-.03(5). The notice must give the reason that more time is needed and an estimate of the additional time needed to establish liability. If done by means other than writing, a 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 date of notice, unless the company has documented the claim file where necessary information that has been requested and not been submitted.
- Arbitration of Disputed Claim Amount- If the Insurer has accepted coverage or accepted coverage on at least a portion of the claim and the amount payable is in dispute, the insurer, or the insured may submit to the Commissioner of Insurance a request for the case to arbitrated. Ga. Comp. R. & Regs. 120-2-52-.03(6). 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.
- Denial- Any denial of a claim must state the specific policy provision, condition or exclusions relied upon for the denial. The denial shall be provided to the insured in writing and the claim file must contain documentation of the denial. Ga. Comp. R. & Regs. 120-2-52-.03(7).