Georgia Rules and Codes Pertinent To
Accident and Sickness Insurance Only
The policy, application, and potential riders and amendments make up the entire contract,
which is agreed on and signed by both parties. - ANSWER>>Entire Contract
An insurer may not deny a claim due to statements on the application after the policy has been
in force for 2 years - ANSWER>>Time limit on certain defenses
An insured is entitled to a grace period of 30 days, in which the policy premium may be paid,
and the policy must remain in force; - ANSWER>>Grace period
A lapsed policy may be reinstated once an insured has paid an outstanding premium and an
application for reinstatement has been approved or 45 days have passed following a
conditional receipt. A health insurance policy may only cover losses occurring no sooner than
10 days after reinstatement. - ANSWER>>Reinstatement
Written notice of a claim must be submitted to an insurer within 20 days of a loss; -
ANSWER>>Notice of claims
An insurer must furnish an insured with proof of loss forms within 10 working days of a notice
of claim; - ANSWER>>Claim forms
An insured must submit written proof of loss to an insurer, no later than 90 days from the date
of such loss; - ANSWER>>Proof of loss
An insurer must pay claim benefits, no later than 30 days from receiving proof of loss; -
ANSWER>>Time of payment of claims
Indemnity for loss of life must be payable to a beneficiary or trust; - ANSWER>>Payment of
claims
an insurer may require the physical examination or autopsy of an insured whenever necessary
during the pendency of a claim; - ANSWER>>Physical examinations and autopsy
An insured has the right to designate beneficiaries at any time, unless a beneficiary is deemed
irrevocable; and - ANSWER>>Change of beneficiary
, No legal action may be brought against an insurer any sooner than 60 days before or 3 years
after proof of loss. - ANSWER>>Legal action
if the insured makes a change in occupation, upon claim, the insurer will either reduce the
benefits to what premiums paid would have purchased assuming the more hazardous
occupation, or reduce the premium and return the excess pro rate unearned premium if the
change is to a less hazardous occupation. - ANSWER>>Change of occupation
the insurer will adjust the amount payable under the policy according to what the premium
paid would have bought at the correct age of the insured. - ANSWER>>Misstatement of age
if a policyholder holds multiple policies with the same company and the aggregate coverage is
in excess of the maximum limit of indemnity, The excess insurance will be void, and the insurer
will return all premiums paid for the excess; or The insured may choose which policy will remain
in effect, and the insurer will return all premiums paid for all other policies. - ANSWER>>Other
insurance in this insurer
insurer may limit the insured's benefits based on their average monthly earnings for the
previous 2 years. - ANSWER>>Relations of earnings to insurance
upon the payment of a claim, any unpaid premium that is due to the insurer will be deducted
from the benefit. - ANSWER>>Unpaid premium
if the insured cancels a policy, the earned premium will be computed on a short-rate basis. -
ANSWER>>Return of premium on cancellation
any provision that is in conflict with the statutes of the state in which the insured resides will be
amended to conform to the minimum requirements of the statutes. - ANSWER>>Conformity
with state statutes
the insurer is not liable for any loss sustained as a result of the insured's commission or
attempted commission of a felony, or for any loss contributed to by the insured's engagement
in an illegal occupation. - ANSWER>>Illegal occupation
the insurer is not liable for any loss sustained as a result of the insured's being intoxicated or
under the influence of any non-prescribed narcotic. - ANSWER>>Intoxicants and narcotics
Accident and Sickness Insurance Only
The policy, application, and potential riders and amendments make up the entire contract,
which is agreed on and signed by both parties. - ANSWER>>Entire Contract
An insurer may not deny a claim due to statements on the application after the policy has been
in force for 2 years - ANSWER>>Time limit on certain defenses
An insured is entitled to a grace period of 30 days, in which the policy premium may be paid,
and the policy must remain in force; - ANSWER>>Grace period
A lapsed policy may be reinstated once an insured has paid an outstanding premium and an
application for reinstatement has been approved or 45 days have passed following a
conditional receipt. A health insurance policy may only cover losses occurring no sooner than
10 days after reinstatement. - ANSWER>>Reinstatement
Written notice of a claim must be submitted to an insurer within 20 days of a loss; -
ANSWER>>Notice of claims
An insurer must furnish an insured with proof of loss forms within 10 working days of a notice
of claim; - ANSWER>>Claim forms
An insured must submit written proof of loss to an insurer, no later than 90 days from the date
of such loss; - ANSWER>>Proof of loss
An insurer must pay claim benefits, no later than 30 days from receiving proof of loss; -
ANSWER>>Time of payment of claims
Indemnity for loss of life must be payable to a beneficiary or trust; - ANSWER>>Payment of
claims
an insurer may require the physical examination or autopsy of an insured whenever necessary
during the pendency of a claim; - ANSWER>>Physical examinations and autopsy
An insured has the right to designate beneficiaries at any time, unless a beneficiary is deemed
irrevocable; and - ANSWER>>Change of beneficiary
, No legal action may be brought against an insurer any sooner than 60 days before or 3 years
after proof of loss. - ANSWER>>Legal action
if the insured makes a change in occupation, upon claim, the insurer will either reduce the
benefits to what premiums paid would have purchased assuming the more hazardous
occupation, or reduce the premium and return the excess pro rate unearned premium if the
change is to a less hazardous occupation. - ANSWER>>Change of occupation
the insurer will adjust the amount payable under the policy according to what the premium
paid would have bought at the correct age of the insured. - ANSWER>>Misstatement of age
if a policyholder holds multiple policies with the same company and the aggregate coverage is
in excess of the maximum limit of indemnity, The excess insurance will be void, and the insurer
will return all premiums paid for the excess; or The insured may choose which policy will remain
in effect, and the insurer will return all premiums paid for all other policies. - ANSWER>>Other
insurance in this insurer
insurer may limit the insured's benefits based on their average monthly earnings for the
previous 2 years. - ANSWER>>Relations of earnings to insurance
upon the payment of a claim, any unpaid premium that is due to the insurer will be deducted
from the benefit. - ANSWER>>Unpaid premium
if the insured cancels a policy, the earned premium will be computed on a short-rate basis. -
ANSWER>>Return of premium on cancellation
any provision that is in conflict with the statutes of the state in which the insured resides will be
amended to conform to the minimum requirements of the statutes. - ANSWER>>Conformity
with state statutes
the insurer is not liable for any loss sustained as a result of the insured's commission or
attempted commission of a felony, or for any loss contributed to by the insured's engagement
in an illegal occupation. - ANSWER>>Illegal occupation
the insurer is not liable for any loss sustained as a result of the insured's being intoxicated or
under the influence of any non-prescribed narcotic. - ANSWER>>Intoxicants and narcotics
