State RegulationsNY specificDifficulty 2/5
A New York long-term care insured appeals her insurer's denial of benefits. Under Reg 62, the insurer must decide the appeal within:
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under Reg 62 (11 NYCRR Part 52), when a New York long-term care insured appeals a denied claim, the insurer must decide the appeal within 60 days, and even complex cases may not run past 120 days. The deadline exists because appeal rights are hollow if the insurer can sit on a denial indefinitely - an insured disputing a care benefit needs an answer while the dispute still matters.
Why the other options are wrong
- A) Thirty days is not the decision deadline the regulation sets for long-term care appeals; the standard period is longer.
- B) Six months overstates the outer limit; even the most complex appeal may not stretch that far.
- C) Fifteen business days is the deadline for answering an insured's information request, a separate obligation from deciding an appeal.
Memory hook
Appeal the denial: 60 days to decide, 120 at the outside.