Insurance Claims in Georgia

What Are Insurance Claims?

Filing an insurance claim in Georgia can be a stressful process. Every policy is different, and insurance companies may not pay you what you deserve. In many cases, hiring an insurance claim lawyer is necessary. This page breaks down the nuances of different types of insurance claims.

What Is a Property Insurance Claim?

A homeowner’s insurance policy is an agreement to protect the home from damage under specific occurrences. When you as a policyholder suffer a loss, you should find a dedicated Georgia property insurance lawyer. Your legal advocate works on your claim to ensure that you receive the benefits necessary to repair or rebuild your Georgia property.

If the insurer denies coverage or delays, policyholders should consult a property insurance attorney about a bad faith claim. If your claim goes to court and you win, you can often recover your court costs, attorney fees, and coverage benefits. There is also the possibility of recovering more money depending on the state laws under which you file your claim.

What Types Of Damage Claims Apply to Property Insurance?

Specific geographic regions impact the design of insurance policies. For example, Florida property insurance policies have more provisions for hurricanes versus earthquakes. 

Policy Genius ranked Georgia 6th in the US for average homeowners’ insurance losses. Specifically, Georgia reported average losses of over $2 billion between 2015 and 2019. As well, Georgia was in the top five states for home insurance lightning claims, and in the top ten states for hurricane damage claims. In fact, a Category 5 hurricane is powerful enough to inflict damage on over 160,000 homes in Georgia.

How to File a Property Insurance Claim in Georgia

After you suffer a loss, you must contact your insurer as soon as possible. Taking this step begins the insurance claim process and gets things moving along. You need to notify your insurance company in writing or over the phone. From there, your insurer appoints a claim representative.

What to Expect Afterwards

Georgia’s Unfair Claims Settlement Practices Act helps protect homeowners by regulating claims processing by insurers. For example, Georgia has time limitations in which the insurer must respond to all insurance claims. Specifically, a company has 15 days to acknowledge receipt of a claim and to provide all required proof of loss forms. Additionally, the insurer must respond by accepting or denying a claim within 15 days after receiving all completed forms.

If the insurer needs more time to investigate the claim, the insurer must notify the claimant at least 5 days before the time limit is up. However, once coverage is confirmed, the insurer must pay the full amount of the claim within 10 days.

What Is an Auto Insurance Claim?

Auto insurance claims involve requesting compensation from an auto insurer after an accident. Car accidents are incredibly stressful, especially if there are uncooperative responsible parties. However, your insurer’s job is to work on your behalf to secure compensation for repairs, injuries and other expenses.

What Do You Do After a Car Accident?

Under Georgia Code, you must notify the local police department immediately if the accident resulted in injuries, death, or at least $500 in property damage. In fact, the Code specifies that you must use the quickest means of communication. If the accident occurs outside a municipality, you must notify the County Sheriff or the Georgia State Patrol.

Keep in mind, Georgia is an at-fault state for car insurance. This means if the other driver is at fault, you can seek damages from their insurance company. This includes medical expenses, property damage, pain and suffering, and lost wages. Consequently, it is important to get a copy of the written accident report from the police. However, proving fault can often be a difficult and complex process, even with the report. An experienced Georgia attorney can be helpful in optimizing the outcome of this process.

Auto Claims Adjuster

Your auto insurance company will assign a claims adjuster to your claim report. Your adjuster acts as your representation in any mediation between you and all other involved parties. This insurance representative bears responsibility for investigating the claim and seeing that you receive compensation for any repairs or injuries.

Whether there are repair claims, personal injury claims, or you are dealing with someone who does not have insurance, your auto insurance adjuster should see you through the process. Your claims adjuster may recommend a garage to handle your vehicle repairs. They may also make arrangements for a rental vehicle if required. The most important thing to note is that your auto claim adjuster is your primary point of contact regarding the status of your claim in Georgia.

Health Insurance Claims

Georgia policyholders file health insurance claims when they seek reimbursement for medical services or treatments. When you obtain a medical service from a provider, your health insurance carrier should be notified directly. If there are any discrepancies in your claim, consider hiring a health insurance claim specialist attorney.

How Do You File a Health Claim in Georgia?

There are two ways to file a health insurance claim on your behalf. The first is the medical facility notifies your insurer for you. You may be able to walk out of the facility without spending anything, but that depends on your policy. The other way is to file a health insurance claim yourself. Taking this route can occur when a health provider you use is not in your provider network. The facility may still file the claim on your behalf, but you may need to file it yourself.

According to 11 Alive, the Georgia Insurance Commissioner’s Office (GICO) fined Anthem Blue Cross Blue Shield $5 million over claims processing errors. Specifically, in-network claims were processed as out-of-network. This resulted in the company being out of compliance with claims timeliness requirements between 2018 and 2021. Additionally, a significant number of claims were rejected for unknown reasons. Anthem Blue Cross blamed the problem on the implementation of a new database system. In addition to the fine, Anthem will also be subject to periodic GICO examinations. Furthermore, provider complaints must now be responded to within 15 days.

Work with an Experienced Local Insurance Lawyer in Georgia

If your health insurance provider refuses to honor a claim, seek out a qualified Georgia insurance claim attorney’s help. An insurance claim attorney can help if you have been improperly denied coverage or sent a bill for a service you never received. We can even help you connect with an attorney across Georgia state lines.

Submit a request online or call us today at (866) 345-6784 to get in touch with an experienced lawyer in your area!

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