What can I do if a pet insurer denies a valid claim in Georgia?
Georgia law gives policyholders a specific path when an insurer denies a claim without a reasonable basis: Georgia's bad-faith statute, O.C.G.A. 33-4-6, lets a policyholder make a written demand for payment, and if the insurer still has not paid after 60 days, the policyholder can pursue a penalty of up to 50% of the loss or $5,000, whichever is greater, plus attorney fees.
"Bad faith" in this context means the insurer refused, in whole or in part, to pay a claim it had no reasonable basis to deny. An insurer that reviews a claim, applies a policy exclusion correctly, and denies it in good faith is not acting in bad faith, even if the policyholder disagrees with the outcome. The statute targets refusals that lack a reasonable basis, such as an insurer that denies a claim without reviewing the submitted records or ignores documentation that contradicts its stated reason for denial.
The 60-day clock starts running from the date the written demand is delivered to the insurer, not from the date of the original claim denial. A policyholder who simply calls the insurer to dispute a denial has not started that clock; the demand needs to be in writing and sent to the insurer.
As an example: a dog owner submits a $3,000 claim for emergency surgery, and the insurer denies it, stating the condition was pre-existing, without pointing to any medical record that supports that conclusion. The owner sends a written demand for payment, referencing the vet's records showing the condition first appeared after the policy's effective date. If the insurer still refuses to pay after 60 days, the statute allows the owner to pursue the bad-faith penalty and attorney fees in addition to the original claim amount.
This statute applies to insurance policies issued in Georgia generally, not only to pet insurance. Related reading: how pet insurance premiums are priced in Georgia, coverage rules for older pets, and whether Olive Cover places pet insurance (it does not; Georgia's pet market is direct-to-consumer). For questions about home, auto, or umbrella claims, Olive Insurance Services, LLC, the licensed agency behind the Olive Cover brand, can be reached through Olive Cover's about page.
