Rising costs for insurance, with reports of refusals to pay claims, could spur legislation

ATLANTA — Like just about everything, the cost of insurance has been rising, fueling frustration that state leaders say they want to address.

Policy holders complain of expensive insurance that does not pay out as promised. At the same time, insurers see an unattractive market in Georgia.

Georgia ranked 50th in profitability for insurance companies last year among the 50 states and the District of Columbia, said Robert Hoyt of the University of Georgia's Terry College of Business.

Hoyt, speaking at the final hearing last week of a committee of lawmakers concerned about insurance costs, said low profits can drive insurers from the market, reducing competition.

Profits were down 8.7% in the state versus 7.8% average gains nationally, he said. That kind of imbalance encourages companies to take their business elsewhere.

"Less availability can lead to higher prices," he said.

The House of Representatives' Blue-Ribbon Study Committee on Insurance Rates met for a final time in Gwinnett County on Thursday after holding hearings in Atlanta, Savannah and Macon.

Despite the discouraging statistics from last year, the lawmakers heard some positive news.

Three companies recently announced reductions in their auto policy premiums, according to state Insurance Commissioner John King.

Safeco Insurance Company of Illinois is cutting rates 5.1%, Safeco Insurance Company of Indiana is reducing them 4.9% and Liberty Mutual Personal Insurance Company is lowering rates by 5.7%.

King attributed the reductions to the state's anti-fraud efforts and to the "lawsuit abuse reforms" lawmakers adopted earlier this year, a reference to tort law changes that were a priority for Gov. Brian Kemp during the last legislative session.

The legislation passed largely along party lines, with Democrats arguing it shielded insurers from liability and denied claimants adequate legal redress.

Lawmakers on the House committee heard complaints about insurers who refused to pay claims because, the critics said, state laws did not hold them to account.

"Insurance companies expect policyholders to pay their bills on time, every time," said a woman who sued her insurer after months of battling over repair costs from a fallen tree. "When it's their turn to pay, there are often no real consequences for delay or denial."

Auto repair companies talked of insurers who refused to pay the full cost to repair cars to manufacturers' standards.

They shared stories about owners who fought insurers for months and finally paid out of pocket, desperate to get their vehicles back.

"The insurance company will drag their feet," said Frankie Johnson, owner of Styles Auto Care in Cartersville. He said his customers had shared hundreds of their email threads with insurers that illustrated their predicament.

Companies want to delay the repair process, he said, "hoping that everyone will just give up."

Johnson sized up the situation: "The current rights of the consumer are not much."

There were similar stories about tactics in medical care.

Rachael Auyer, of the Georgia Society of Orthotists and Prosthetists, had a client who lost her leg below the knee in an automobile collision. An avid marathoner, the 39-year-old teacher was denied a running prosthesis, Auyer said, because it was not deemed medically necessary. Auyer said the Rome woman, a special education teacher, also had to hop to the bathroom because the insurer did not deem a shower prosthesis to be medically necessary.

"Physicians don't determine medical necessity," Auyer said, "insurance companies do."

Rep. Matt Reeves, R-Duluth, chaired the study committee. He said in an interview that lawmakers will be scrutinizing prices, profits and the way claims are processed.

Reeves, who serves as vice chairman of the House Judiciary Committee, said the state needs to review its fines for insurance companies that act in bad faith to ensure penalties are significant enough to deter misbehavior.

Insurance affordability will likely inspire legislation during the legislative session that starts in January, he said. "I think it'll be a robust session on insurance."