State RegulationsPA specificDifficulty 3/5
An insured submits written proof of loss on an accident and health claim, and the insurer denies the claim. The insured is considering a lawsuit. Under 40 P.S. § 753(A)(11), which timing rules govern the legal action?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
40 P.S. § 753(A)(11) sandwiches a lawsuit between two deadlines: no action may be brought before 60 days after written proof of loss is filed, and no action may be brought after three years from the time written proof of loss is required. Missing either boundary defeats the claim in court, which is why insureds should document the proof-of-loss date and calendar both ends of the window.
Why the other options are wrong
- A) Filing immediately after the loss skips both the proof-of-loss step and the 60-day waiting period the statute requires.
- B) A departmental hearing is not a prerequisite to suit; the statute's own waiting period and outside deadline control.
- C) Pennsylvania imposes both a 60-day floor and a 3-year ceiling on accident and health legal actions; there is no unlimited window.
Memory hook
Suit lives between day 60 and year 3 — arrive too early or too late and the door is shut.