An insurance claim is the policyholder's written demand to the insurer for compensation of damage caused by an insured event — and the composition, timing and consequences of that demand are defined by the Civil Code of Georgia. The entire life cycle of a claim in Georgia, from notification to payment, is reflected in Articles 814, 820, 821, 826, 829 and 830 of the Code. Specialised ombudsman or agency procedural models characteristic of foreign insurance markets do not exist in the Georgian system — the page is carried entirely by the Georgian Civil Code.
The notification duty and the required records
The claim cycle begins with notification. Under Article 814 of the Civil Code, as soon as the policyholder learns of the occurrence of the insured event, the policyholder is obliged to notify the insurer. Thereafter the insurer may, after the insured event has occurred, demand from the policyholder any records that are necessary for establishing the insured event or the scope of the obligation. In practical terms this means that document preparation should begin at once: medical conclusions, invoices, payment documents and acts describing the event are precisely the material the insurer is legally entitled to request.
An important protection also exists. The insurer cannot rely on an agreement by which it is released from its obligation on the ground that the policyholder failed to perform the notification duty, where the insurer's interests are not thereby materially violated. Such a clause is effectively neutralised where a late or defective notification causes the insurer no real harm — for instance, where complete information about the event was available to it by another route. Drafting the claim therefore includes demonstrating that any notification defect was immaterial.
The form, scope and amount of compensation
Three fundamental parameters of compensation are fixed by the Code. Under Article 820, in damage insurance the insurer must compensate the damage in money — compensation by natural replacement or by provision of services is not envisaged by this norm. Under Article 821 the insurer compensates damage only within the limits of the insured sum — this is the ceiling defined in the contract, up to which the insurer's exposure runs. Finally, under Article 826 the insurer is not obliged to pay the policyholder an amount exceeding the damage incurred, even where the insured sum exceeds the insured value at the moment of the insured event. Damage is compensated according to its actual scope, and over-insurance brings the policyholder no additional recovery.