California Life-Only & Accident and Health AgentAccident and Health InsuranceEasy
A health insurance policy includes a provision that requires the insured to submit a written notice of claim to the insurer within a specified timeframe after a covered loss occurs. Failure to do so may result in the denial of the claim. Which policy provision is being described?
- ANotice of Claim
- BProof of Loss
- CTime of Payment of Claims
- DLegal Actions
Show answer & explanationAnswer & explanation
Correct answer: A. Notice of Claim
The Notice of Claim provision specifies the timeframe within which an insured must notify the insurer of a covered loss. This allows the insurer to initiate the claims process promptly.
Why the other options are wrong
- B. The Proof of Loss provision requires the submission of detailed evidence supporting the claim, which comes after the initial notice.
- C. The Time of Payment of Claims provision specifies when the insurer must pay a claim after receiving proof of loss, not when notification is due.
- D. The Legal Actions provision dictates when legal action can be taken against the insurer, not when to notify of a claim.
Notice of Claim Provision
A standard health insurance policy provision that requires the insured to provide written notice of a claim to the insurer within a specified period after a loss occurs, typically 20 days.
- Mandates timely notification of a loss.
- Usually within 20 days, or as soon as reasonably possible.
- Allows the insurer to begin investigation.
Memory trick: Health policies contain clauses, like a clock for claim notices.