HB1419: HB1419 Insurance; timely claims processing in supplemental estimates for repairs under motor vehicle liability insurance policies; provide

26 LC 52 1050 House Bill 1419 By: Representatives Franklin of the 160th, Stephens of the 164th, Ridley of the 6th, Gullett of the 19th, 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 timely claims processing in supplemental estimates for repa irs under motor vehicle3 liability insurance policies; to provide for unfair claims settlement practices; to provide for4 written explanations; to provide for definitions; to provide fo r rules and regulations; to5 provide for related matters; to repeal conflicting laws; and for other purposes.6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 SECTION 1.8 Chapter 6 of Title 33 of the Official Code of Georgia Annotated , relating to unfair trade9 practices, is amended by revising paragraphs (15) and (16) in Code Section 33-6-34, relating10 to unfair claims settlement practices, as follows:11 "(15) Failure to comply with any insurer requirement in Chapter 20E of this title, the12 'Surprise Billing Consumer Protection Act,' including:13 (A) The failure to designate whether the healthcare plan is su bject to the exclusive14 jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec.15 1001, et seq.;16 H. B. 1419 - 1 - 26 LC 52 1050 (B) The failure to directly pay the provider or facility withi n 15 working days for17 electronic claims or 30 calendar days for paper claims any mone ys due under Code18 Section 33-20E-4 or 33-20E-5; or19 (C) The failure to pay a resolution organization as required u nder Code20 Section 33-20E-16; and21 (16) Failure to comply with any insurer requirement relating to emergency services or22 care in Article 4 of Chapter 11 of Title 31, Article 1 of Chapter 20A of this title, Chapter23 20E of this title, Chapter 21A of this title, Code Section 33-24-59.27, and Chapter 30 of24 this title; and25 (17) Failure to comply with any insurer requirement relating to timely claims processing26 and supplemental estimates under a motor vehicle liability insurance policy as provided27 under Code Section 33-34-10."28 SECTION 2.29 Chapter 34 of said title, relating to motor vehicle accident reparations, is amended by adding30 a new Code section to read as follows:31 "33-34-10.32 (a) As used in this Code section, the term:33 (1) 'Appraiser' means any person evaluating motor vehicle damage and determining the34 cost of parts and labor required to repair such damage.35 (2) 'Claimant' means either a first-party claimant or insured or a third-party claimant who36 asserts a claim for payment, benefits, reimbursement, or damages under a motor vehicle37 liability insurance policy arising out of, based on, or in any way related to a motor vehicle38 collision, loss, ownership, maintenance, or use. Such term incl udes any assignee,39 subrogee, or legal representative of a first-party claimant or third-party claimant to the40 extent such assignee, subrogee, or legal representative asserts the claim.41 H. B. 1419 - 2 - 26 LC 52 1050 (3) 'Motor vehicle liability insurance' means motor vehicle insurance that covers the use42 of a motor vehicle and its operating equipment; covers liability, collision, comprehensive,43 personal injury protection or medical payments, or uninsured or underinsured motorist44 protection; or provides the mandatory minimum limits required under this chapter for the45 personal use of a private passenger automobile. Such term includes coverage provided46 through an approved plan or certificate of self-insurance to the extent recognized under47 state law as satisfying such minimum limits.48 (4) 'Repair facility' means a motor vehicle dealer, garage, bo dy shop, or other49 commercial entity which undertakes the repair or replacement of parts of a motor vehicle,50 including, but not limited to, frames, doors, bumpers, and paint.51 (5) 'Supplemental damage' means additional physical damage to a motor vehicle that was52 not visible or reasonably ascertainable at the time of the original inspection or appraisal53 and is discovered after the initial insurance claim or estimated repair cost is filed.54 (6) 'Supplemental estimate' means a written estimate for supplemental damage prepared55 by an appraiser.56 (b) An insurer providing coverage under a motor vehicle liability insurance policy shall57 promptly acknowledge and investigate claims of supplemental dam age submitted by a58 repair facility or claimant by meeting at least the following requirements:59 (1) Within one business day of a notification of supplemental damage and supplemental60 estimate, the insurer shall assign an appraiser to inspect the damaged motor vehicle in61 person or review the supplemental estimate; and62 (2) Within three business days of a notification of supplement al damage and63 supplemental estimate, the insurer shall complete an inspection of the damaged motor64 vehicle in person or review the supplemental estimate and provi de a written response;65 provided, however, that the time for inspection or review may b e extended for an66 additional three business days if unforeseen circumstances make inspection or review67 within three business days impracticable, provided that the ins urer notifies the repair68 H. B. 1419 - 3 - 26 LC 52 1050 facility and claimant of the specific unforeseen circumstance t hat necessitates such69 extension.70 (c) Within ten business days of receipt of a notification of s upplemental damage and71 supplemental estimate, an insurer shall provide a repair facility and claimant with a written72 decision indicating the line items, parts, or operations that are approved and authorized for73 payment; those that are denied, reduced, or altered from the supplemental estimate; and a74 written explanation for such denial, reduction, or alteration, including, but not limited to,75 policy coverage limitations, prior payment, duplication, or unr elated to loss. No insurer76 shall issue payment or settlement for a supplemental estimate without such written decision77 and explanation.78 (d) A violation of this Code section that occurs with such fre quency as to constitute a79 general business practice shall be a violation of Article 2 of Chapter 6 of this title, the80 'Unfair Claims Settlement Practices Act.'81 (e) The Commissioner shall promulgate rules and regulations necessary to implement this82 Code section, which may include, but shall not be limited to, p rescribing uniform83 supplemental estimate and written explanation forms."84 SECTION 3.85 All laws and parts of laws in conflict with this Act are repealed.86 H. B. 1419 - 4 -