Insurance Claim Denied in Georgia (Country)? Rights Under the National Bank of Georgia

Georgia — located at the crossroads of Eastern Europe and Western Asia — has a rapidly developing insurance market with meaningful rights for policyholders who face claim denials. Whether your denial involves private health insurance, motor insurance, or life coverage, you have formal channels to challenge the decision through Georgia's insurance supervisor.

Why Insurers Deny Claims in Georgia

Insurance in Georgia is regulated by the Insurance State Supervision Service of Georgia (ISSS), operating under the Ministry of Economy and Sustainable Development. The ISSS licenses insurers, sets conduct standards, and protects policyholders under the Law of Georgia on Insurance (1997, as significantly amended) and the Law on Insurance Supervision (2014).

Common denial reasons include:

• Policy exclusions: Pre-existing medical conditions, self-inflicted injury, or losses occurring outside the policy's territorial scope are frequently invoked
• Non-disclosure: The insurer claims material facts were concealed at the application stage, allowing them to void the contract or decline the claim
• Late claim notification: Georgian insurance policies typically impose strict deadlines for reporting incidents — failure to comply is a common basis for denial
• Documentation gaps: Particularly in health insurance, insurers may require documentation from approved facilities or in specific formats
• Disputed valuation: In motor and property insurance, the insurer may accept partial liability but dispute the quantum of the loss

How to Appeal

Step 1: Request a written denial with specific grounds

If you have not received a written denial citing the specific policy provision, request one immediately in writing. Under Georgian insurance law, insurers must provide written denial reasons. A documented paper trail is essential before any escalation.

Step 2: Review the policy language carefully

Read the specific clause the insurer cited. Under Georgian contract law, ambiguous terms in insurance contracts can be interpreted in the policyholder's favour — a doctrine known as contra proferentem. Compare the denial language against the actual policy text.

Step 3: Gather your supporting evidence

Compile your complete policy document, premium payment receipts confirming active coverage, original claim submission with all supporting documents, medical records or expert assessments, the denial letter, and all prior correspondence with your insurer or broker. Independent expert opinions or medical certificates strengthen an appeal significantly.

Step 4: Submit a formal internal complaint

Write a formal appeal to your insurer's customer complaints office. Georgian insurers are required to have formal complaints handling procedures under the Law on Insurance Supervision. Your letter should identify the policy and claim reference numbers, address each denial reason with specific counter-arguments and evidence, specify the remedy you are seeking, and set a deadline of 15 to 20 working days for a response.

Step 5: Escalate to the Insurance State Supervision Service of Georgia (ISSS)

If the internal appeal does not resolve the matter, file a formal complaint with the ISSS:

• Address: 2 Sanapiro Street, Tbilisi 0102, Georgia
• Phone: +995 32 291 05 06
• Website: isss.gov.ge
• Email: info@isss.gov.ge

The ISSS reviews complaints against licensed insurers and can compel insurers to provide their full claims file and reasoning. Where the ISSS finds a violation, it can direct the insurer to pay the claim and impose financial penalties.

Step 6: Consider the Georgian courts

For disputes not resolved through the regulatory channel, Georgia's common courts (civil jurisdiction) handle insurance contract disputes. Tbilisi City Court is the appropriate first instance court for most insurance disputes. Legal representation by a Georgian attorney is advisable.

What to Include in Your Appeal

• Your complete policy document and any riders or endorsements
• Premium payment receipts confirming coverage was active at the time of loss
• Medical records, police reports, invoices, or expert assessments relevant to your claim
• The denial letter citing the specific policy provision relied upon
• Any correspondence with your insurer or broker
• Independent expert opinions or medical certificates if applicable

Fight Back With ClaimBack

A denied insurance claim in Georgia is not the final word. The Insurance State Supervision Service has genuine authority to hold insurers accountable under the Law on Insurance Supervision (2014), and policyholders who submit well-documented appeals backed by contra proferentem arguments regularly succeed in reversing unjustified decisions. ClaimBack generates a professional appeal letter in 3 minutes.

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Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal