HB1117: HB1117 Insurance; claims processing for repairs under motor vehicle liability insurance policies; provide

26 LC 52 0982 House Bill 1117 By: Representatives Franklin of the 160th, Smith of the 18th, Stephens of the 164th, Cheokas of the 151st, Gambill of the 15th, and others A BILL TO BE ENTITLED AN ACT To amend Chapters 6 and 34 of Title 33 of the Official Code of Georgia Annotated, relating1 to unfair trade practices and motor vehicle accident reparations, respectively, so as to provide2 for claims processing for repairs under motor vehicle liability insurance policies; to provide3 for unfair claims settlement practices; to provide for the sele ction of a repair facility; to4 provide for payment for repairs; to provide for certain disclos ures and notifications; to5 provide for original equipment manufacturer repair procedures; to provide for supplemental6 estimates; to provide for timely claims processing; to provide for written explanations; to7 provide for definitions; to provide for private causes of actio n; to provide for rules and8 regulations; to provide for related matters; to repeal conflicting laws; and for other purposes.9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10 SECTION 1.11 Chapter 6 of Title 33 of the Official Code of Georgia Annotated , relating to unfair trade12 practices, is amended by revising paragraphs (15) and (16) in Code Section 33-6-34, relating13 to unfair claims settlement practices, as follows:14 "(15) Failure to comply with any insurer requirement in Chapter 20E of this title, the15 'Surprise Billing Consumer Protection Act,' including:16 H. B. 1117 - 1 - 26 LC 52 0982 (A) The failure to designate whether the healthcare plan is su bject to the exclusive17 jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec.18 1001, et seq.;19 (B) The failure to directly pay the provider or facility withi n 15 working days for20 electronic claims or 30 calendar days for paper claims any mone ys due under Code21 Section 33-20E-4 or 33-20E-5; or22 (C) The failure to pay a resolution organization as required u nder Code Section23 33-20E-16; and24 (16) Failure to comply with any insurer requirement relating to emergency services or25 care in Article 4 of Chapter 11 of Title 31, Article 1 of Chapter 20A of this title, Chapter26 20E of this title, Chapter 21A of this title, Code Section 33-24-59.27, and Chapter 30 of27 this title; and28 (17) Failure to comply with any insurer requirement relating t o claims processing as29 provided under Code Sections 33-34-6, 33-34-10, and 33-34-11."30 SECTION 2.31 Chapter 34 of said title, relating to motor vehicle accident re parations, is amended by32 revising Code Section 33-34-6, relating to selection of motor v ehicle repair facility, as33 follows:34 "33-34-6.35 (a) Subject to the provisions of subsection (b) of this Code s ection, no insurer shall36 represent to a person making a claim under a motor vehicle insurance policy that the use37 of or the failure to use a particular repair facility or particular repair facilities may result38 in the nonpayment of a claim.39 (b) No insurer shall require a person making a claim under a m otor vehicle insurance40 policy to use a particular repair facility or particular repair facilities in order to settle a41 H. B. 1117 - 2 - 26 LC 52 0982 claim if the person making the claim can obtain the repair work on the motor vehicle at the42 same cost from another source.43 (a) As used in this Code section, the term:44 (1) 'Claimant' means either a first-party claimant or insured or a third-party claimant who45 asserts a claim for payment, benefits, reimbursement, or damages under a motor vehicle46 liability insurance policy arising out of, based on, or in any way related to a motor vehicle47 collision, loss, ownership, maintenance, or use. Such term inc ludes any assignee,48 subrogee, or legal representative of a first-party claimant or third-party claimant to the49 extent such assignee, subrogee, or legal representative asserts the claim.50 (2) 'Financial interest' means any stake of monetary value, direct or indirect, in an entity. 51 Such term includes any ownership interest, direct repair program, affiliation agreement,52 favored facility agreement, labor rate agreement, parts agreeme nt, or service level53 agreement.54 (3) 'Motor vehicle liability insurance' means motor vehicle insurance that covers the use55 of a motor vehicle and its operating equipment; covers liability, collision, comprehensive,56 personal injury protection or medical payments, or uninsured or underinsured motorist57 protection; or provides the mandatory minimum limits required under this chapter for the58 personal use of a private passenger automobile. Such term includes coverage provided59 through an approved plan or certificate of self-insurance to the extent recognized under60 state law as satisfying such minimum limits.61 (b) All policies of motor vehicle liability insurance shall al low a claimant under such62 policy to select the repair facility to provide repairs covered under such policy. No insurer63 shall require a claimant under such policy to use a repair facility in which such insurer has64 a financial interest. No insurer shall represent to a claimant under such policy that the use65 of or the failure to use a particular repair facility or particular repair facilities may result66 in nonpayment or delayed or reduced payment of a claim or less quality or timeliness of67 H. B. 1117 - 3 - 26 LC 52 0982 repair under a claim. The amount determined to be payable under a motor vehicle liability68 insurance policy shall be paid regardless of the repair facility selected by a claimant.69 (c) No insurer shall recommend the use of a particular repair facility without clearly70 informing a claimant under a motor vehicle liability insurance policy that:71 (1) The claimant is under no obligation to use the recommended repair facility;72 (2) The claimant may use a repair facility of the claimant's choice;73 (3) The amount determined by the insurer to be payable under such policy will be paid74 regardless of whether or not the claimant uses the recommended repair facility; and75 (4) Whether or not the insurer has a financial interest in the recommended repair facility.76 (d)(1) A violation of this Code section that occurs with such frequency as to constitute77 a general business practice shall be a violation of Article 2 of Chapter 6 of this title, the78 'Unfair Claims Settlement Practices Act.'79 (2) Any claimant aggrieved by a violation of the provisions of this Code section shall80 have a private cause of action for injunctive relief, treble damages, and any other relief81 available under law.82 (e) The Commissioner shall promulgate rules and regulations necessary to implement this83 Code section."84 SECTION 3.85 Said chapter is further amended by adding new Code sections to read as follows:86 "33-34-10.87 (a) As used in this Code section, the term:88 (1) 'Claimant' shall have the same meaning as set forth in Code Section 34-34-6.89 (2) 'Motor vehicle liability insurance' shall have the same meaning as set forth in Code90 Section 34-34-6.91 (3) 'Original equipment manufacturer repair procedure' means a ny written, electronic,92 or published repair standard, procedure, specification, or dire ctive issued by a motor93 H. B. 1117 - 4 - 26 LC 52 0982 vehicle's original equipment manufacturer, including, but not l imited to, body, frame,94 structural, mechanical, electronic, scanning, calibration, and refinishing operations.95 (4) 'Repair facility' means a motor vehicle dealer, garage, bo dy shop, or other96 commercial entity which undertakes the repair or replacement of parts of a motor vehicle.97 (b) All policies of motor vehicle liability insurance shall provide for all repairs to be made98 in accordance with the applicable original equipment manufacturer repair procedures.99 (c) No insurer that issues, delivers, issues for delivery, or renews a motor vehicle liability100 insurance policy shall require a claimant to deviate from or de ny, omit, or disregard101 original equipment manufacturer repair procedures or to use non original equipment102 manufacturer parts, procedures, or specifications.103 (d) An insurer that issues, delivers, issues for delivery, or renews a motor vehicle liability104 insurance policy shall:105 (1) Approve any original equipment manufacturer repair procedure, including, but not106 limited to, any labor, materials, parts, calibrations, scanning , or sublet operations107 necessary to perform such procedure, that is documented in a wr itten estimate or108 supplemental estimate from a repair facility or in a written request from a repair facility109 or claimant when the applicable original equipment manufacturer service publication,110 position statement, or procedure is identified; and111 (2) Only deny reimbursement for a documented original equipment manufacturer repair112 procedure if, within three business days of receipt of the written estimate, supplemental113 estimate, or written request provided for in paragraph (1) of this subsection, such insurer114 provides to the claimant:115 (A) A written itemized explanation for such denial, including, but not limited to, policy116 coverage limitations, prior payment, duplication, or unrelated to loss, specific to the117 original equipment manufacturer repair procedure; and118 (B) Notice that such denial might constitute an unfair claims settlement practice under119 state law.120 H. B. 1117 - 5 - 26 LC 52 0982 (e)(1) A violation of this Code section that occurs with such frequency as to constitute121 a general business practice shall be a violation of Article 2 of Chapter 6 of this title, the122 'Unfair Claims Settlement Practices Act.'123 (2) Any claimant aggrieved by a violation of the provisions of this Code section shall124 have a private cause of action for injunctive relief, treble damages, and any other relief125 available under law.126 (f) The Commissioner shall promulgate rules and regulations necessary to implement this127 Code section.128 33-34-11.129 (a) As used in this Code section, the term:130 (1) 'Appraiser' means any person evaluating motor vehicle damage and determining the131 cost of parts and labor required to repair such damage.132 (2) 'Claimant' shall have the same meaning as set forth in Code Section 34-34-6.133 (3) 'Motor vehicle liability insurance' shall have the same meaning as set forth in Code134 Section 34-34-6.135 (4) 'Repair facility' means a motor vehicle dealer, garage, bo dy shop, or other136 commercial entity which undertakes the repair or replacement of parts of a motor vehicle,137 including, but not limited to, frames, doors, bumpers, and paint.138 (5) 'Supplemental damage' means additional physical damage to a motor vehicle that was139 not visible or reasonably ascertainable at the time of the original inspection or appraisal140 and is discovered after the initial insurance claim or estimated repair cost is filed.141 (6) 'Supplemental estimate' means a written estimate for supplemental damage prepared142 by an appraiser.143 (b) An insurer providing coverage under a motor vehicle insurance liability policy shall144 promptly acknowledge and investigate claims of supplemental dam age submitted by a145 repair facility or claimant by meeting at least the following requirements:146 H. B. 1117 - 6 - 26 LC 52 0982 (1) Within one business day of a notification of supplemental damage and supplemental147 estimate, the insurer shall assign an appraiser to inspect the damaged motor vehicle in148 person or review the supplemental estimate; and149 (2) Within three business days of a notification of supplement al damage and150 supplemental estimate, the insurer shall complete an inspection of the damaged motor151 vehicle in person or review the supplemental estimate and provi de a written response;152 provided, however, that the time for inspection or review may b e extended for an153 additional three business days if unforeseen circumstances make inspection or review154 within three business days impracticable, provided that the ins urer notifies the repair155 facility and claimant of the specific unforeseen circumstance t hat necessitates such156 extension.157 (c) Within ten business days of receipt of a notification of s upplemental damage and158 supplemental estimate, an insurer shall provide a repair facility and claimant with a written159 decision indicating the line items, parts, or operations that are approved and authorized for160 payment; those that are denied, reduced, or altered from the supplemental estimate; and a161 written explanation for such denial, reduction, or alteration, including, but not limited to,162 policy coverage limitations, prior payment, duplication, or unr elated to loss. No insurer163 shall issue payment or settlement for a supplemental estimate without such written decision164 and explanation.165 (d)(1) A violation of this Code section that occurs with such frequency as to constitute166 a general business practice shall be a violation of Article 2 of Chapter 6 of this title, the167 'Unfair Claims Settlement Practices Act.'168 (2) Any claimant aggrieved by a violation of the provisions of this Code section shall169 have a private cause of action for injunctive relief, treble damages, and any other relief170 available under law.171 H. B. 1117 - 7 - 26 LC 52 0982 (e) The Commissioner shall promulgate rules and regulations necessary to implement this172 Code section, which may include, but shall not be limited to, p rescribing uniform173 supplemental estimate and written explanation forms."174 SECTION 4.175 All laws and parts of laws in conflict with this Act are repealed.176 H. B. 1117 - 8 -