California Life-Only & Accident and Health AgentAccident and Health InsuranceEasy
A health insurance policy includes a provision that specifies the time frame within which an insured must provide written notice of a claim to the insurer. What is this provision called?
- ANotice of Claim
- BProof of Loss
- CClaims Adjudication
- DElimination Period
Show answer & explanationAnswer & explanation
Correct answer: A. Notice of Claim
The Notice of Claim provision requires the insured to inform the insurer of a claim within a specified timeframe, typically 20 days or as soon as reasonably possible. This initial notification allows the insurer to begin the claims process.
Why the other options are wrong
- B. Proof of Loss refers to the formal statement and documentation provided to the insurer to substantiate the claim, which comes after the initial notice.
- C. Claims Adjudication is the process by which the insurer evaluates a claim to determine its validity and the amount of benefit payable, and it occurs after notice and proof of loss.
- D. An Elimination Period is a waiting period before disability income benefits begin, not related to the notification of a claim.
Notice of Claim Provision
A standard health insurance policy provision requiring the insured to notify the insurer of a claim within a specified period, typically 20 days or 'as soon as reasonably possible'.
- Initial step in making a claim.
- Usually requires written notification.
- Timeframe specified in the policy.
Memory trick: Notice of Claim is the 'first knock' on the insurer's door.