Disclosure Authorization Forms Authorizing Disclosure of Personal or Privileged Information

  1. Law
  2. Georgia Code
  3. Insurance
  4. Collection, Use, and Disclosure of Information Gathered by Insurance Institutions
  5. Disclosure Authorization Forms Authorizing Disclosure of Personal or Privileged Information

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Notwithstanding any other provision of law of this state, no insurance institution, agent, or insurance-support organization may utilize as its disclosure authorization form in connection with insurance transactions a form or statement which authorizes the disclosure of personal or privileged information about an individual to the insurance institution, agent, or insurance-support organization unless the form or statement:

  1. Is written in plain language;
  2. Is dated;
  3. Specifies the types of persons authorized to disclose information about the individual;
  4. Specifies the nature of the information authorized to be disclosed;
  5. Names the insurance institution or agent and identifies by generic reference representatives of the insurance institution to whom the individual is authorizing information to be disclosed;
  6. Specifies the purposes for which the information is collected;
  7. Specifies the length of time such authorization shall remain valid, which shall be no longer than:
    1. In the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits:
      1. Thirty months from the date the authorization is signed if the application or request involves life, health, or disability insurance;
      2. One year from the date the authorization is signed if the application or request involves property or casualty insurance; or
    2. In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy:
      1. The term of coverage of the policy if the claim is for a health insurance benefit;
      2. The duration of the claim if the claim is not for a health insurance benefit; and
  8. Advises the individual or person authorized to act on behalf of the individual that the individual or the individual's authorized representative is entitled to receive a copy of the authorization form.

(Code 1981, §33-39-7, enacted by Ga. L. 1982, p. 615, § 1.)


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