State RegulationsPA specificDifficulty 1/5
Under an individual accident and health policy, within how many days of a covered loss must the insured generally give notice of claim under 40 P.S. § 753(A)(5)?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
40 P.S. § 753(A)(5) requires written notice of claim within 20 days of the covered loss, or as soon as reasonably possible thereafter. Notice is the trigger that starts the insurer's claim-handling duties, including the duty to furnish claim forms. Weekly-premium policies may require shorter notice for non-hospitalized sickness, and losses expected to produce loss-of-time benefits of two years or longer call for a continuing-disability notice every six months.
Why the other options are wrong
- A) 90 days is the proof-of-loss window under 40 P.S. § 753(A)(7), not the notice-of-claim deadline.
- B) 15 days is the deadline for the insurer to furnish claim forms under 40 P.S. § 753(A)(6), not for the insured to give notice.
- D) 60 days is the legal-action waiting period after written proof of loss under 40 P.S. § 753(A)(11), unrelated to claim notice.
Memory hook
Notice in 20, forms in 15, proof in 90 — the claim clock runs in three beats.