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State RegulationsTN specificDifficulty 2/5

A Tennessee insured suffers a covered loss and submits written proof of loss. Under the required legal actions provision of an individual accident and health policy, when may the insured bring suit on the policy?

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Answer & full 3-part explanation (select an option above, or peek)

Why D is correct

T.C.A. § 56-26-108(11) bars any legal action for recovery under the policy unless it is brought more than 60 days after written proof of loss has been given, and bars any action brought after 3 years from the time written proof of loss is required by the policy. The double window gives the insurer 60 days to settle before litigation and gives both parties a definitive cut-off date.

Why the other options are wrong

  • A) T.C.A. § 56-26-108(11) imposes a 60-day waiting period after written proof of loss and a 3-year outside limit, so suit can be brought neither immediately nor at any later time without limit.
  • B) 45 days is the reinstatement backstop under T.C.A. § 56-26-108(4); the legal-actions waiting period is 60 days, and a 3-year outside limit does apply.
  • C) The numbers are mismatched: 90 days is the proof-of-loss deadline and 2 years is the time limit on certain defenses, while T.C.A. § 56-26-108(11) uses 60 days and 3 years.

Memory hook

Wait 60 days to sue; 3 years and the door closes.

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