Question

"What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision? 1.File a lawsuit 2.Submit the claim in any form 3.Wait for the claim form to arrive 4.Resubmit the request for a claim form"

Answer 1

If the insurer does not send claims forms within the stated time period, the insured should contact the insurer to inquire about the delay. They may need to file a lawsuit, submit the claim in any form, or resubmit their request for a claim form if the insurer does not respond.

Step-by-step explanation:

If the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision, the insured should first contact the insurer to inquire about the delay. They may need to provide additional information or request the forms directly. If the insurer continues to fail to send the forms, the insured can consider filing a lawsuit against the insurer for breach of contract.

Option 1: File a lawsuit: This is a possible course of action if the insurer consistently fails to send the claims forms.

Option 2: Submit the claim in any form: In some cases, the insured may be able to submit the claim using alternative means, such as online claim submission or through a written statement.

Option 3: Resubmit the request for a claim form: The insured can try reaching out to the insurer again and request the claim forms.

Answer 2

If an insurer fails to send claims forms on time, the insured should submit the claim in any written form, per the 'proof of loss' provision in the policy, ensuring the process is not delayed.

Step-by-step explanation:

If an insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision, the insured should submit the claim in any form. According to the 'proof of loss' provision in many health insurance policies, if the insurer does not provide forms in a timely manner, the insured is allowed to submit a written proof of the occurrence, character, and extent of the loss for which claim is made. This submission should be made within the time limit stated in the policy for filing claims (usually within 90 days of the loss). This ensures that the claim process is not delayed due to the lack of a specific form.