Rule 120-2-2-.65 - Procedures-Claims and Investigation Division(1) Action by this Division is instigated by either a written complaint or a personal visit to the office by a complainant.(2) A record is made of the complaint. Such record contains the name of the complainant, the person or party against whom the complaint is made and a statement of the nature of the complaint.(3) The complaint is then assigned to the investigator best qualified to make the particular investigation.(4) The investigator obtains through investigation all available data necessary to properly evaluate the claim. The investigator will obtain copies of the statement of the claim made by the claimant; all available medical data; and the policy will be thoroughly evaluated to determine if a legitimate claim has been denied.(5) The Division reviews the estimates of loss in all claims involving fire and casualty to determine if an offer is based on a legitimate estimate.(6) If an investigation discloses misrepresentation or any other unfair trade practice, the facts are submitted to the Commissioner for his determination as to the course the Department will follow to halt the practice.(7) Investigation is made regardless of amount and the policyholder is informed as to the Division's view and if the claim is uncollectible, the file is closed.(8) The Division will not actively participate in third party claims unless it is obvious on the face of the complaint that either party is acting in bad faith.Ga. Comp. R. & Regs. R. 120-2-2-.65
O.C.G.A. § 33-2-9et seq.
Original Rule entitled "Procedures-Claims and Investigation Division" adopted. F. Dec. 13, 2019; eff. Jan. 1, 2020, as specified by the Agency.