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Georgia Unfair Trade Practices, Claims and the Guaranty Association: Practice Questions
20 free practice questions with explanations. Pick an answer for each, then check your score.
Quick study guide
O.C.G.A. § 33-6-4(b) lists Georgia's core unfair and deceptive acts and § 33-6-5 adds more; § 33-6-3 bars any person in the business of insurance, including agents, brokers, counselors and adjusters (§ 33-6-2), from committing them, and false representations about the policy sold are also a misdemeanor (§ 33-6-4(c)).
Unfair and deceptive acts (§ 33-6-4(b))
False advertising (1): any untrue, deceptive or misleading statement about insurance, in print, on radio or "in any other way." Misrepresentation and twisting (2): misstating policy terms, benefits or dividends, or making any misrepresentation to a policyholder to induce a lapse, forfeiture or surrender. Defamation (3): statements false or maliciously critical of an insurer's financial condition, calculated to injure. Boycott, coercion and intimidation (4). Unfair discrimination (8)(A): in life insurance, among people of the same class, policy amount and expectation of life; in accident and sickness, among people of the same class and essentially the same hazard; and always on race, color or national or ethnic origin. Victims of family violence or sexual assault are protected by (15). Direct response ads may not imply coverage is "guaranteed issue" when conditions apply (13)(B). Section 33-6-5 also bars refusing life insurance solely because the applicant was a living organ donor (8.1). Controlled business (§ 33-23-1) means property or casualty insurance on an agent's own interests, family, employer or wards.
Rebating and gifts
Sections 33-6-4(b)(8)(B) and 33-9-36 ban rebates and any valuable consideration not specified in the policy, and knowingly accepting one is a violation too. Allowed: commissions, dividends, payroll-deduction discounts, client meals, food at seminars where no applications are taken, and promotional gifts worth up to $100 per customer in a calendar year that do not depend on a sale or renewal. Section 33-24-59.31 allows value-added services related to the coverage.
Claims
The claim acts in § 33-6-34 are unfair when committed flagrantly in conscious disregard of the law, or often enough to show a general business practice (§ 33-6-33).
| Duty | Time limit |
|---|---|
| Send claim forms after a request (§ 33-6-34(11)) | 15 calendar days |
| Health plan pays, or explains and lists what it needs (§ 33-24-59.5) | 15 working days electronic, 30 calendar days paper; 12% a year interest if late |
| Interest on individual life proceeds (§ 33-25-10) | From death (none if paid within 30 days of death); 12% a year from 30 days after the claim is filed |
Fraud and the guaranty association
Insurance fraud (§ 33-1-9), such as a knowingly false material statement in an application or claim or an agent converting premium money, is a felony: 2 to 10 years in prison, a fine, or both. Licensees must report suspected fraud to the Commissioner (§ 33-1-16(f)). Application statements are representations, not warranties (§ 33-24-7). Every licensed life or health insurer, HMO and health care corporation belongs to the Georgia Life and Health Insurance Guaranty Association, which protects residents when a member fails. Per life: $300,000 death benefit ($100,000 cash value), $300,000 annuity present value ($250,000 cash value), $300,000 disability income or long-term care, $500,000 health benefit plans. Fraternal benefit societies are not members, and no one may use the association's existence to sell (§ 33-38-21).