Who Regulates Insurance and Provides Protection to Insurance Consumers in Georgia?

The Insurance Division in the Office of Insurance and Safety Fire Commissioner (OCI) regulates insurance activities in Georgia. The insurance division is responsible for:

1. Responding to queries and questions from members of the public

2. Licensing insurance companies

3. Conducting product reviews while approving or disapproving insurance products for sale in Georgia

4. Licensing agents, counselors, brokers, and adjusters in the state

5. Enforcing legal or administrative actions against insurance companies at hearings called by the OCI

6. Investigating fraudulent activities by insurance companies

Georgia has a population of over 10.7 million with more than 1 million active businesses, creating a large pool of policyholders and the resulting need for the insurance regulation. These numbers create a vibrant market for insurers, brokers, and agents. The OCI enforces flood coverage in Georgia; however, the Federal Emergency Management Authority (FEMA) is primarily responsible for issuing and administering the National flood Insurance Program (NFIP).

The Insurance and Safety Fire Commissioner heads the OCI and has the jurisdiction to act across the entire state. The OCI is available to respond to inquiries or provide information via email or phone at (800) 656-2298. Alternatively, you can visit the office of the OCI located at:

2 Martin Luther King Jr. Dr.

West Tower, Suite 702

Atlanta, GA 30334

What is the Georgia Department of Insurance?

The Insurance Division of the Office of Insurance and Safety Fire Commissioner (OCI) is the Georgia Department of Insurance. It provides insurance regulation for the entire insurance industry in the state: residential insurance, health insurance, life insurance, coverage for annuities and senior citizens, business insurance, auto insurance, and more. The primary duty of the OCI is to protect Georgians by providing access to vital insurance products and ensuring the safety of buildings through fair procedures and regulation, ensuring equitable access to economic opportunities.

The insurance division operates an enforcement unit that represents the OCI at public hearings called by the commissioner. The enforcement unit also renders administrative and legal research review services to the commissioner and staff members.

The Georgia Insurance Division's regulatory activities primarily include:

1. Consumer Services: The Insurance Division investigates complaints made by policyholders and responds to general inquiries from members of the public. The division ensures fair resolution of disputes involving Georgia's policyholders, insurers, agents, and brokers

2. Insurance Financial Oversight: The division licenses insurance companies in Georgia, ensuring that only insurance companies meeting a minimum commitment standard can operate in the state

3. Insurance Product Reviews: The insurance department is responsible for reviewing property and casualty insurance to approve or disapprove for sale in Georgia. Additionally, the insurance division reviews life and health insurance sold by insurers in in the state

4. Agent Licensing: The insurance division issues licenses to insurance agents, solicitors, brokers, and insurance adjusters in Georgia before operating

5. Fraud Investigation: The insurance division maintains a fraud investigation unit that investigates illegal insurance activities by insurance companies, agents, brokers, adjusters, and other individuals or entities operating in the state’s insurance industry

Who Regulates the Georgia Department of Insurance?

The insurance division in Georgia is under the purview of the Office of Insurance and Safety Fire Commissioner (OCI), also known as the Director.

What are the Unfair Trade Practices in Georgia?

Unfair practices refer to deceptive practices carried out in a marketplace. In Georgia, unfair trade practices are regulated in accordance with Georgia's Fair Business Practices Act. The Act is enforceable on consumer transactions involving selling, leasing, and renting goods, services, or property. Some unlawful trade practices as described in the Fair business practices Act are:

1. Representing goods and services as offered by another. For example, if a product is produced by company A but is represented as being made by company B

2. Claims that a product originates from a certain place when it is not. For example, claiming that a good made in the United States of America when it is made in China or elsewhere is illegal

3. Misrepresentation of the quality or grade of a product. It is illegal to represent a good as new when it is used, deteriorated, reconditioned, reclaimed, used, or secondhand. Also, products must conform to the style and model as advertised

4. Intentional misleading statement about another business or its products and offerings

5. The use of bait-and-switch tactics. As such, advertisements of goods and services that do not sell what was advertised are illegal

6. Advertising goods or services without the necessary inventory to meet the expected demand unless the advertisement specifically states “quantities limited”

7. Confusing the source, sponsorship, approval, or certification of goods or services

8. Making false statements about prices. For example, stating that an item is on sale currently at a certain price when that has been the price for the last month is illegal

9. Intentionally causing confusion about the affiliation, connection, or association with or certification by another

The Fair Business Practices Act contains specific statutes relating to the following:

• Health clubs and fitness organizations

• Promotions, contests, and other forms of giveaways

• Telemarketing fraud

• Internet fraud

• Price gouging in time of emergency

• Hoarding of goods and services

• Credit reports

• Going-out-of-business sales

• Vacation prize offerings

• Tampering with Odometers

The Governor's Office of Consumer Protection investigates complaints and enforces the Fair Business Practices Act. Chapter 120-2-20 of Georgia Code lists the prohibited Unfair Trade and Claims Settlement Practices in insurance by insurance companies, brokers, solicitors, and agents. These include providing misleading information, or advertisements to the public.

How to Report Suspected Unfair Trade Practices in Georgia?

You can report suspected insurance unfair trade practices in Georgia by submitting a complaint to the Consumer Protection Division of the Georgia Department of Law through the Consumer Complaint Portal. Alternatively, you can download a Complaint Form available in Spanish or English and submit it via mail to:

2 Martin Luther King Jr. Drive

Suite 356

Atlanta, GA 30334-9077

The Consumer Protection Division does not receive complaints by email; so if you see email complaint requests, they may be scams. You should also avoid submitting multiple reports to address the same issue, since this may delay the process. Once your report is received, the OCI will send you an acknowledgment answer in a letter containing the following:

1. Your case number

2. The contact details of your assigned complaints support analyst

What is the Georgia Life and Health Insurance Guaranty Association?

The Georgia Life and Health Insurance Guaranty Association (GAIGA) was created in 1981 when the State Legislature enacted the Georgia Guaranty Association Act. The association comprises all insurers in Georgia licensed to sell life, accident, health insurance, and annuities in the state. All members are subject to the same community standards.

When a member of the association is declared insolvent by a competent court, the Guaranty Association Act enables the guarantee association to offer protection as specified in the Act. Georgians who are holders of life and health insurance policies with the insolvent insurer will automatically be covered by the association when the insurer is declared insolvent. A special deputy receiver specifically assumes control of the insurer under the supervision of the courts. It administers the assets and obligations via liquidation when a member insurer is judged insolvent and is ordered to be liquidated. The guaranty association takes charge of servicing the insurance company's policies and providing coverage to clients who reside in Georgia. Georgia legislation and the wording of the insolvent company's policies at the time of insolvency serve as the foundation for the protection offered by the guaranty association.

How Does the Georgia Life and Health Insurance Guaranty Association Work?

When an insurer member of the Guaranty Association goes out of business, the association will continue to offer coverage to the insurer’s clients who continue to pay premiums. The Guaranty Association also has a right to transfer and shuffle policyholders from a defunct insurance company to a functional one to ensure continuity. Policyholders only need to keep making premiums payments to keep the coverage intact and in force. When the association takes over your insurer, it has the same rights as stated in your original policy contract as your defunct insurer.

Coverage provided by the association is broadly determined by Georgia law and the policy contract between the policyholder and the defunct insurer at the point where the association is activated.

When an insurer becomes insolvent and defunct, individual policyholders and persons holding certificates of insurance from the insurer under the group health and life insurance are automatically covered by the association. If you move to another state after purchasing a policy, you will still have coverage from the association if your insurer is a member of the Guaranty Association where you now reside.

If your insurance company in Georgia becomes insolvent and defunct, below is an overview of the maximum payouts allowed per policyholder:

The liabilities held by the Guaranty Association cannot be greater than the obligations for which the insolvent insurer would have been. Policies not protected by the association include:

1. Health Maintenance Organization (HMO) Contracts

2. Self-insured employer plans

3. Fraternal benefit society insurance certificate

You should always consult with a licensed insurance agent to verify if the Guaranty Association protects your policy. If your insurer becomes insolvent or defunct, you will receive a notification from the Georgia Guaranty Association. Georgia law prohibits agents from advertising using the Guaranty Association since it is not a substitute for insurance companies.

What is the Georgia Property and Casualty Insurance Guaranty Association?

In Georgia, the association responsible for guaranteeing property and casualty insurance is the Georgia Insurers Insolvency Pool, which operates under the umbrella of Georgia Life and Health Insurance Guaranty Association. The pool was created in 1970 under the Georgia Insurers Insolvency Pool Act. The pool is a non-profit legal entity tasked with intervening when a member of the association becomes insolvent or defunct.

The Georgia Insurance Insolvency Pool consists of three major accounts, namely:

1. The automobile account

2. The worker’s compensation insurance

3. All other covered insurance accounts

The pool is responsible for:

1. Investigating, adjusting, and settling covered claims

2. Investigating, handling, and denial of noncovered claims

3. Managing and investing funds administered by the pool

If you have questions regarding how the Georgia Insurers Insolvency Pool operates, contact them at (770) 621-9835, or by fax at (770) 938-3296. Alternatively, you can visit or write to their office at:

Georgia Insurers Insolvency Pool

Gwinnett Commerce Center

3700 Crestwood Parkway, NW

Suite 400

Duluth, GA 30096

How Does the Georgia Property and Casualty Insurance Guaranty Association Work?

The members of the Georgia Insurers Insolvency Pool are property and casualty insurers operating in the state. According to the Georgia Insurers Insolvency Pool Act, every authorized property and casualty insurance company in the state must be registered as a member of the insolvency pool. However, such insurers must meet the requirements and payments of assessment levies as prescribed by the Pool.

The Pool is governed by a board of trustees, which consists of seven members. The commissioner of the pool selects the members of the board. When an insurer member of the pool becomes insolvent or defunct, the coverage provided by P&C insurance policies issued by the insurer becomes the obligation of the pool until the following happens:

1. If the policy expiration is less than 30 days from the date of the court proclamation

2. Until the policy is replaced by the insurer within the allotted 30-day period

The pool will only be considered as the insurer according to the rights, duties, and obligations of the insolvent insurer as outlined in the original policy contract.

In Georgia, the Insurers Insolvency Pool is authorized to investigate, adjust, compromise, settle, and deny covered or non-covered claims. Once a property and casualty insurer becomes defunct, the insureds have a maximum of 18 months after the date the court orders the insurer to be liquidated or a final date set by the court to file claims.

Check with a licensed insurance agent to find out if your policy would be covered by the Georgia Insurance Insolvency Pool if your insurer becomes insolvent or defunct.