State RegulationsPA specificDifficulty 2/5
An insured notifies the insurer of an accident and health claim, but the insurer never furnishes the required claim forms. Under 40 P.S. § 753(A)(6) and 40 P.S. § 753(A)(7), what may the insured do?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
40 P.S. § 753(A)(6) obliges the insurer to furnish claim forms within 15 days of receiving notice; if it fails, the insured may send written proof of the particulars instead. The proof of loss is then due within 90 days under 40 P.S. § 753(A)(7). The design prevents an insurer from stalling a claim simply by withholding paperwork, and grace to one year protects an insured who lacks legal capacity.
Why the other options are wrong
- B) The deadline is not suspended; the statute expressly substitutes written proof when the insurer withholds the forms.
- C) Failure to furnish forms is not a denial; the legal-action provision of 40 P.S. § 753(A)(11) imposes its own timing rules instead.
- D) Repeated notices accomplish nothing; once notice is given, the remedy is written proof of loss within the 90-day window.
Memory hook
No forms? Write it yourself — proof still lands within 90 days.