Question 1

What is the standard timeframe within which an insured must provide written notice of a claim to the insurer after a loss occurs?

Accepted Answer

The insured must provide written notice of a claim within 20 days after a loss occurs, or as soon as reasonably possible.

Question 2

After receiving notice of a claim, within how many days must an insurer furnish claim forms to the insured?

Accepted Answer

The insurer must furnish claim forms within 15 days of receiving notice of a claim.

Question 3

What is the standard deadline for submitting proof of loss to an insurer for a health insurance claim?

Accepted Answer

Proof of loss must typically be submitted within 90 days after the date of loss, or as soon as reasonably possible.

Question 4

If an insurer does not provide claim forms within the required timeframe, what right does the claimant have?

Accepted Answer

The claimant may submit proof of loss in any written form that describes the occurrence, character, and extent of the loss.

Question 5

What is the 'time of payment of claims' provision in health insurance, and how quickly must benefits be paid?

Accepted Answer

The time of payment of claims provision requires that benefits be paid immediately upon receipt of written proof of loss, or periodically (e.g., monthly) for ongoing claims.

Claims & Benefits: Life and Health Insurance License Exam

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