§ 90g.5. Claim provisions.
(a) The form contains the following claim provisions:
(1) Notice of claim. Written notice of claim is to be given to the insurer within 20 days after the occurrence or commencement of a covered loss or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured to the insurer at
(insert the location of the office as the insurer may designate) or to an authorized agent of the insurer, with information sufficient to identify the insured, is deemed notice to the insurer.(2) Claim forms. The insurer upon receipt of a notice of claim, is required to furnish to the claimant forms as are usually furnished by it for filing proofs of loss. If the forms are not furnished within 15 days after the giving of the notice of claim, it is considered that the claimant complied with the requirements of this contract as to proof of loss if the claimant submits, within the time fixed in the contract for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made.
(3) Proofs of loss. Written proof of loss is to be furnished to the insurer at its office, in case of claim for loss for which this contract provides a periodic payment contingent upon continuing loss, within 90 days after the termination of the period for which the insurer is liable, and in case of claim for another loss, within 90 days after the date of the loss. Failure to furnish proof within the time required does not invalidate nor reduce a claim if it was not reasonably possible to give proof within that time, if the proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than 1 year from the time proof is otherwise required.
(4) Time of payment of claims. Indemnities payable under this contract for any loss other than loss for which this contract provides any periodic payment are due immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this contract provides periodic payment are to be paid
(insert period for payment).(5) Payment of claims. Benefits are to be paid to the owner or owner’s estate while the insured is living, unless they have been assigned elsewhere.
(6) Physical examinations. The insurer as its own expense has the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim thereunder.
(b) In lieu of the claim provisions specified in this section, the form contains other appropriate provisions and the submission letter contains a complete justification for the lack of the claim provisions specified in this section.
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
