State RegulationsIL specificDifficulty 2/5
An Illinois individual A&H policy's legal-actions provision allows the policyowner to sue the insurer immediately after any claim dispute arises. Under the Illinois Insurance Code minimum standard enforced for individual A&H policies, when may a legal action against the insurer be brought?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
215 ILCS 5/357.12 provides that no legal action may be brought against an insurer to recover on an individual accident and health policy until 60 days after written proof of loss has been furnished, and no action may be brought later than 3 years from the time written proof of loss is required to be furnished. An immediate-suit provision is more restrictive than the Illinois minimum that individual A&H policies must honor under the minimum-standards framework of 50 Ill. Adm. Code 2007. The waiting period also gives the insurer its statutory window to pay the claim.
Why the other options are wrong
- A) 20 days is the notice-of-claim figure under 215 ILCS 5/357.6 and 1 year is the extended proof-of-loss figure under 215 ILCS 5/357.8; neither defines the legal-actions window.
- B) The statutory thresholds are 60 days and 3 years under 215 ILCS 5/357.12, not 30 days and 2 years.
- D) Illinois law imposes both a 60-day waiting period after proof of loss and a 3-year outer limit, so the policyowner cannot sue at any time.
Memory hook
Sixty days to wait, three years at the gate.