California Life-Only & Accident and Health AgentAccident and Health InsuranceHard
A health insurance policy includes a provision that requires the insured to submit written proof of loss to the insurer within 90 days after the date of loss. If it is not reasonably possible to provide proof within this timeframe, the provision typically allows for an extension, but not beyond which maximum period from the date of loss?
- A1 year
- B6 months
- C2 years
- D3 years
Show answer & explanationAnswer & explanation
Correct answer: A. 1 year
The Proof of Loss provision typically requires submission within 90 days of the loss. However, if it's not reasonably possible, the policy usually allows for an extension, but generally not later than one year from the date the proof is otherwise required. This one-year limit is common in standard health insurance provisions.
Why the other options are wrong
- B. 6 months is typically too short for the maximum extension period if 90 days was not reasonably possible.
- C. 2 years is generally related to the contestable period or time limit on certain defenses, not the proof of loss extension.
- D. 3 years is typically too long for the maximum extension period for proof of loss.
Proof of Loss Provision (Extension)
A standard health insurance policy provision requiring written proof of loss within a specified period (e.g., 90 days), with an allowance for extension if not reasonably possible, but generally not beyond one year from the due date.
- Initial deadline often 90 days.
- Extension allowed if not reasonably possible.
- Maximum extension typically one year from original due date.
- Does not apply if insured is legally incapacitated.
Memory trick: Proof of Loss: 90 days short, 1 year max, or you're out of luck.