A North Carolina health insurer receives a clean claim and pays it 45 calendar days later, having neither denied the claim nor requested additional information. Because payment was late, what does G.S. 58-3-225 require the insurer to do?

Why A 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 of receipt — a claim is presumed received 5 business days after mailing or electronic transmission. Payment made after that window bears interest at 18% per annum, so the insurer here owes interest for the period beyond 30 days.

Why the other options are wrong

• B) The $100 to $1,000 civil penalty under G.S. 58-2-70 is a regulatory sanction the Commissioner may order for violations of Chapter 58 — it is not the automatic per-day consequence for late claim payment, which is 18% interest.
• C) The 180-day filing window under G.S. 58-3-225(f) is untouched by the insurer's late payment; nothing in the prompt-pay statute extends it.
• D) Late payment triggers statutory interest, not premium refund; no North Carolina statute requires rescission-by-refund for slow claims.

Memory hook

Miss the 30-day mark on a health claim? Pay 18% a year.