An insured in Atlanta has held an individual accident and sickness policy for more than two years. The policy never named or specifically described her knee condition. The insurer now denies a claim for knee surgery on the ground that the condition preexisted the policy. Is the denial proper?

Why D is correct

Under O.C.G.A. § 33-29-3(b)(2)(B), after two years from the issue of an individual A&S policy, no claim may be denied on the ground that a condition existed before the policy was issued unless the condition was excluded by name or by specific description in the policy. Because the knee condition was never excluded, the denial is improper and the claim must be evaluated on its merits.

Why the other options are wrong

• A) There is no three-year preexisting-condition window; the statutory limit is two years and it has already run.
• B) A disclosure-based denial is barred after two years unless the condition was excluded by name or specific description, which it was not.
• C) Refund of premiums is not the framework for this rule; the policy simply remains liable for the claim.

Memory hook

Name it or lose it: after two years, unnamed conditions are covered.