State RegulationsNC specificDifficulty 2/5
An insurer receives a health claim but does not pay it, deny it, or request additional information within the time permitted by law, and later pays the claim late. What does North Carolina law require on the late payment?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under G.S. 58-3-225(b) and (e), an insurer must pay, deny, or request information on a health claim within 30 calendar days after the claim is received (a claim is presumed received 5 business days after mailing or electronic transmission). A payment made after that window bears interest at 18% per annum. The deposit-rate standard in option C belongs to the life prompt-payment provision for death benefits, G.S. 58-58-110(a) — a different rule for a different line.
Why the other options are wrong
- A: G.S. 58-3-225(e) makes 18% per annum interest mandatory for late payment; paying the claim late without interest does not cure the delay.
- C: Interest tied to the rate paid on death proceeds left on deposit comes from the life death-benefit prompt-payment rule, G.S. 58-58-110(a), not from the health claim prompt-pay statute.
- D: There is no demand requirement — the 18% per annum interest applies automatically to late payments under G.S. 58-3-225(e).
Memory hook
Late health claim? 18% per annum, automatic.