Notice of Claim: in individual health policies, what is the notice of claim requirement?

• A. It is not required to inform the insurer about a pending claim at the start of a covered loss.
• B. It is a requirement to inform the insurer about a pending claim within 15 days of loss.
• C. It is a requirement in individual health policies for the policyowner to inform the insurer about a pending claim at the start of a covered loss.
• D. It is required only for group policies.

Answer: (C)

Notice of claim is about informing the insurer promptly when a loss begins and a claim might be filed. In individual health policies, the policyowner is required to notify the insurer about a pending claim at the start of a covered loss. This early notice allows the insurer to begin claim processing, verify coverage, and coordinate benefits without unnecessary delay. The idea that no notice is required conflicts with how claims are handled, while a fixed 15-day window isn’t universal across all individual policies, and saying the rule only applies to group policies isn’t accurate since individual policies also require notice.