Insurance DOI Complaint and Bad-Faith Demand — Georgia

comments before sending. -->

Insurance DOI Complaint and Bad-Faith Demand (GEORGIA)

Quick-Reference Summary

PART A — DOI COMPLAINT COVER LETTER

Sender Letterhead

[ATTORNEY OR FIRM / INSURED NAME]
[STREET ADDRESS]
[CITY], GA [ZIP]
Phone: [____________]
Email: [____________]
Georgia Bar No. (if attorney): [____________]

Date and Recipient

Date: [__/__/____]

Sent Via:
☐ OCI online complaint portal (https://ociapp.oci.ga.gov/ConsumerService/Complaint.aspx)
☐ Email to [email protected]
☐ U.S. Certified Mail, Return Receipt Requested (Tracking No. [____________])
☐ Fax to 404-657-8542

To:
Georgia Office of Insurance and Safety Fire Commissioner
Consumer Services Division
2 Martin Luther King Jr. Drive
Suite 716 West Tower
Atlanta, GA 30334

Subject: Consumer Complaint Against [INSURER LEGAL NAME], NAIC No. [_____] — Unfair Claims Settlement Practices Under O.C.G.A. § 33-6-34; Claim No. [____________]

I. Insured / Complainant Information

II. Carrier and Policy Information

III. Claim Background

[Dated chronology. Note: a DOI complaint by itself does NOT satisfy § 33-4-6's 60-day demand requirement (Thompson v. Homesite). Use Part B for the statutory demand.]

[____________________________________________________________]
[____________________________________________________________]
[____________________________________________________________]
[____________________________________________________________]

IV. Specific Unfair Claims Practices Alleged

The conduct described above violates one or more provisions of O.C.G.A. § 33-6-34, including:

☐ § 33-6-34(1) — Knowingly misrepresenting facts or policy provisions
☐ § 33-6-34(2) — Failure to acknowledge with reasonable promptness pertinent communications
☐ § 33-6-34(3) — Failure to adopt and implement standards for prompt investigation
☐ § 33-6-34(4) — Failure to act with reasonable promptness in settlement
☐ § 33-6-34(7) — Failure to affirm or deny coverage within a reasonable time
☐ § 33-6-34(9) — Unreasonable delay by requiring both preliminary claim report and formal proof of loss
☐ § 33-6-34(10) — Failure to provide reasonable, accurate explanation of denial or compromise basis
☐ § 33-6-34(11) — Failure to provide forms necessary to file claims within 15 calendar days
☐ Other: [____________________________________________________________]

V. Documents Enclosed

☐ Declarations page and complete policy
☐ Sworn proof of loss
☐ Notice of loss / first report of claim
☐ Estimates, invoices, repair / valuation documentation
☐ Medical records and bills (if PI/UM/health)
☐ Photos / video of damage
☐ All correspondence with insurer and adjuster
☐ Denial / reservation-of-rights letter(s)
☐ Authorization for OCI to obtain claim file (signed)
☐ Other: [____________________________________________________________]

VI. Requested OCI Action

The Insured respectfully requests that the Commissioner:

1. Open a formal investigation under O.C.G.A. § 33-6-30 et seq.;
2. Require [INSURER] to provide a written explanation of its handling of Claim No. [____________];
3. Determine whether the insurer's conduct constitutes an unfair claims settlement practice;
4. Take administrative action consistent with O.C.G.A. § 33-6-35, including referral for market-conduct examination if a pattern is identified.

The Insured understands that the Commissioner cannot act as legal counsel, recommend an insurer, identify policies, resolve word-against-word disputes, make medical judgments, or determine fault. This complaint does not satisfy the 60-day pre-suit demand requirement under O.C.G.A. § 33-4-6; that demand is being made separately under Part B.

VII. Authorization

I, [INSURED NAME], authorize the Georgia Office of Insurance and Safety Fire Commissioner to obtain from [INSURER] the complete claim file, underwriting file, and all related correspondence concerning Claim No. [____________] under Policy No. [____________], and to share information with [INSURER] necessary to investigate this complaint.

VIII. Signature

Respectfully submitted,

_______________________________
[INSURED OR COUNSEL NAME]
Date: [__/__/____]

---

PART B — STATUTORY BAD-FAITH DEMAND LETTER (O.C.G.A. § 33-4-6)

Sender Letterhead

[ATTORNEY OR FIRM NAME]
[STREET ADDRESS]
[CITY], GA [ZIP]
Phone: [____________]
Email: [____________]
Georgia Bar No.: [____________]

Date and Recipient

Date: [__/__/____]

Sent Via:
☐ U.S. Certified Mail, Return Receipt Requested (Tracking No. [____________])
☐ FedEx / UPS Overnight (Tracking No. [____________])
☐ Email to [____________] (read-receipt requested)
☐ Hand delivery with witness

To:
[INSURER LEGAL NAME]
Attn: General Counsel / Claims Director
[STREET ADDRESS]
[CITY], [STATE] [ZIP]

cc: [Claims Adjuster], [Adjuster Email]
cc: Registered Agent for Service in Georgia — [____________]

Re: FORMAL 60-DAY STATUTORY DEMAND PURSUANT TO O.C.G.A. § 33-4-6 — Bad-Faith Refusal to Pay
Insured: [____________]
Policy No.: [____________]
Claim No.: [____________]
Date of Loss: [__/__/____]

THIS IS A STATUTORY DEMAND. TIME IS OF THE ESSENCE.

I. Parties

The undersigned represents [INSURED LEGAL NAME] ("Insured" or "Policyholder") in connection with the above-captioned insurance claim against [INSURER LEGAL NAME] ("Insurer"), authorized to transact insurance in Georgia (NAIC No. [_____]).

II. Claim and Response History

The loss is due and payable as of [__/__/____] because [proof of loss received / contractual investigation period expired / claim was acknowledged]. Insurer has had reasonable opportunity to investigate and pay, and Insured is in a position to demand immediate payment.

III. Violations of the Unfair Claims Settlement Practices Act (O.C.G.A. § 33-6-34)

Insurer's conduct constitutes one or more unfair claims settlement practices under O.C.G.A. § 33-6-34:

• § 33-6-34(1) — knowingly misrepresenting facts or policy provisions;
• § 33-6-34(2) — failure to acknowledge with reasonable promptness pertinent communications;
• § 33-6-34(3) and (4) — failure to investigate and settle promptly;
• § 33-6-34(7) — failure to affirm or deny coverage within a reasonable time;
• § 33-6-34(10) — failure to provide a reasonable and accurate explanation of denial or compromise.

These practices are evidence of bad faith for purposes of O.C.G.A. § 33-4-6, although the UCPA itself does not create a private right of action (§ 33-6-37).

IV. Statutory Demand Under O.C.G.A. § 33-4-6

THIS LETTER IS A FORMAL STATUTORY DEMAND PURSUANT TO O.C.G.A. § 33-4-6. Insurer is hereby placed on notice that it is facing a bad-faith claim under § 33-4-6 for its specific refusal to pay the covered loss described above.

Under O.C.G.A. § 33-4-6(a), if Insurer fails to pay the loss within SIXTY (60) DAYS of receipt of this demand and that refusal is later found to have been in bad faith, Insurer will be liable for:

1. The full amount of the covered loss;
2. An additional penalty of up to 50% of Insurer's liability for the loss OR $5,000, whichever is greater; and
3. All reasonable attorney fees for the prosecution of the action, set by the trial jury.

Insured will NOT abate or dismiss the bad-faith action by Insurer's payment after the 60-day period; the statute expressly preserves the claim. O.C.G.A. § 33-4-6(a).

STATUTORY DEADLINE: Payment must be received within 60 DAYS of Insurer's receipt of this demand.
Deadline Date: [__/__/____]

V. Commissioner Notice Required Upon Filing Suit

Insured acknowledges that within twenty (20) days of bringing any action under O.C.G.A. § 33-4-6, the plaintiff must mail to the Commissioner of Insurance a copy of this demand and the complaint by first-class mail. O.C.G.A. § 33-4-6(b). Insured will comply.

VI. Demand for Payment

Insured demands payment of the following within SIXTY (60) DAYS of Insurer's receipt of this letter:

Payment must be by company check or wire to: [____________________________________________________________].

VII. Damages if Not Resolved

If Insurer does not tender full payment by the 60-day deadline, Insured will, without further notice:

1. File suit on the policy in [Superior / State Court of ____________ County, Georgia / U.S. District Court for the ____________ District of Georgia];
2. Plead O.C.G.A. § 33-4-6 for the 50%-or-$5,000 statutory penalty and all reasonable attorney fees;
3. Within 20 days of filing, mail to the Commissioner of Insurance a copy of this demand and the complaint as required by O.C.G.A. § 33-4-6(b);
4. Plead (where supported) common-law fraud, O.C.G.A. § 13-6-11 expenses of litigation (bad faith, stubborn litigiousness, or unnecessary trouble and expense), and punitive damages under O.C.G.A. § 51-12-5.1; and
5. Seek prejudgment interest under O.C.G.A. § 7-4-15 / § 51-12-14 as applicable.

VIII. Litigation Hold

Insurer is hereby placed on formal litigation hold. Preserve all documents and ESI relating to this claim, including:

• Complete claim file and activity / diary notes (electronic and paper);
• All recorded statements, IME / EUO transcripts, and SIU files;
• Underwriting file and policy administration records;
• Reserve worksheets, indemnity / expense reserves history, and committee minutes;
• All communications (email, chat, voicemail, telephony metadata) with the Insured, counsel, experts, and reinsurers;
• Claims handling manuals, bulletins, scripts, and training materials in effect on the date of loss;
• All third-party vendor files (independent adjusters, engineers, contractors, appraisers, medical reviewers).

Insurer is reminded that auto-deletion policies must be suspended for the duration of this dispute.

IX. Response Deadline

Please direct your written response to the undersigned no later than [__/__/____] (the 60-day statutory deadline).

Nothing in this letter waives, modifies, or releases any right, claim, defense, or remedy of the Insured, all of which are expressly reserved.

X. Signature

Respectfully,

_______________________________
[ATTORNEY NAME]
[FIRM NAME]
Georgia Bar No. [____________]
Counsel for [INSURED]

Enclosures: Declarations page; sworn proof of loss; correspondence file; itemization of damages; valuation evidence

---

PART C — Pre-Filing Checklist

A. Coverage and Policy

☐ Full certified copy of the policy in effect on the date of loss obtained
☐ All endorsements / exclusions reviewed
☐ Premium-paid status confirmed
☐ Named insureds, additional insureds, loss payees identified
☐ Other potentially applicable policies (umbrella, excess, UM/UIM) identified

B. § 33-4-6 Prerequisites — STRICTLY CONSTRUED

☐ Loss is COVERED by the policy (independent verification)
☐ Loss is DUE AND PAYABLE — all policy investigation periods have run
☐ No outstanding insurer information request that would render demand premature (BayRock Mortg.)
☐ 60-day demand SENT IN WRITING by the policyholder or counsel (not merely a DOI complaint)
☐ Demand SPECIFICALLY references O.C.G.A. § 33-4-6 and threat of bad-faith litigation (Thompson)
☐ Demand specifies the amount demanded and the specific refusal complained of
☐ Receipt of demand documented (certified mail, FedEx)
☐ 60-day clock calendared; suit not filed before day 61

C. Claim Process

☐ Notice of loss documented
☐ Sworn proof of loss timely submitted (or excuse documented)
☐ Cooperation clause complied with
☐ IME / EUO transcripts obtained
☐ Contractual SOL / suit-limitation clause calendared
☐ Appraisal clause analyzed

D. Damages Documentation

☐ Itemized scope of loss / estimate from qualified expert
☐ Comparable replacement-cost evidence
☐ Medical records and bills (if PI/UM/health)
☐ Lost-income documentation
☐ Photographs / video of loss

E. Suit Filing — Mandatory Commissioner Notice

☐ Complaint pleads § 33-4-6 with specificity
☐ Within 20 days of filing, copy of demand AND complaint mailed first-class to Commissioner of Insurance (§ 33-4-6(b))
☐ Mailing documented (certified mail recommended even though statute requires only first-class)
☐ § 13-6-11 expenses-of-litigation count considered
☐ Punitive damages count under § 51-12-5.1 considered

F. Regulatory and Procedural

☐ OCI complaint filed (Part A) or strategic decision documented not to file
☐ Authorization for OCI to access claim file signed
☐ Venue, jurisdiction, removal analysis complete
☐ Litigation hold sent to insurer (Part B § VIII)

Sources and References

• Georgia Office of Commissioner of Insurance and Safety Fire — Consumer Services: https://oci.georgia.gov/about-us/contact-us
• OCI Complaint Portal: https://ociapp.oci.ga.gov/ConsumerService/Complaint.aspx
• O.C.G.A. § 33-4-6 (Liability of insurer for damages and attorney's fees): https://law.justia.com/codes/georgia/title-33/chapter-4/section-33-4-6/
• O.C.G.A. § 33-4-7 (Bad-faith failure to settle motor vehicle claims)
• O.C.G.A. § 33-6-30 et seq. (Unfair Trade Practices Act)
• O.C.G.A. § 33-6-34 (Acts constituting unfair claims settlement practices)
• O.C.G.A. § 33-6-37 (No private right of action under UCPA)
• BayRock Mortg. Corp. v. Chicago Title Ins. Co., 286 Ga. App. 18 (2007)
• Thompson v. Homesite Ins. Co. of Ga., 345 Ga. App. 183 (2018)
• Southern Realty Mgmt., Inc. v. Aspen Specialty Ins. Co., 311 Ga. App. 100 (2011)
• Cagle v. State Farm Fire & Cas. Co., 218 Ga. App. 60 (1995)
• NAIC Consumer Insurance Search: https://content.naic.org/cis_consumer_information.htm