Under an Individual Health policy, when can a policyowner sue for nonpayment?

• A. 60 days after submitting written proof of loss or 3 years from filing the proof of loss
• B. Immediately after submitting proof of loss
• C. After insurer denies the claim, and not before
• D. Only after 3 years have passed

Answer: (A)

In this topic, you learn that there’s a specific period before you can sue for unpaid benefits under an Individual Health policy. The insured must first file written proof of loss, which is the documentation showing what was claimed and why. After that submission, the insurer has a 60-day window to pay or deny the claim. Only after that 60-day period can a lawsuit be pursued if the benefits remain unpaid. There’s also a deadline to sue: the action must be filed within 3 years from when the proof of loss was filed. This combination—a 60-day waiting period plus a 3-year limit—lets the insurer handle and resolve claims, while protecting the policyowner’s right to seek legal recourse within a finite timeframe.