State RegulationsGA specificDifficulty 2/5
A Georgia resident buys an individual accident and sickness policy. Two years after issue, she submits a claim for a condition she had before the policy was issued. The condition was not named or specifically described in the policy's exclusions. What may the insurer do?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under O.C.G.A. § 33-29-3(b)(2)(B), after two years from issue no claim may be denied because of a preexisting condition unless that condition was excluded by name or by specific description in the policy. Because this policy named no such exclusion, the insurer must pay the claim despite the condition predating the policy.
Why the other options are wrong
- A) A blanket preexisting-condition denial after two years violates the standard provision unless the condition was specifically excluded.
- C) The statutory test turns on whether the policy excluded the condition by name or description, not on application disclosures.
- D) The statute provides no authority to reduce benefits for preexisting conditions after the two-year mark.
Memory hook
Two years and no named exclusion means the claim gets paid.