State RegulationsNC specificDifficulty 2/5
A North Carolina insurer requested additional information on a health claim, but the claimant never supplied it. What must the insurer do under the prompt-pay statute?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under G.S. 58-3-225(c) and (d), if the requested information is not received within 90 days, the insurer must deny the claim and notify the claimant, and it must reopen the claim if the information is submitted within 1 year of the denial. This keeps the claim loop closed but fair: the claimant gets notice and a full year to cure the missing-information problem.
Why the other options are wrong
- A) The 90-day information window forbids indefinite open claims; silence triggers a mandatory denial with notice.
- B) Missing information does not force payment; the statute authorizes denial once the 90-day window lapses unanswered.
- C) Denial without notice violates the statute — the insurer must both deny and notify, then reopen on a timely cure.
Memory hook
Ninety days silent, then deny-and-notify; one year to reopen.