| Topic - Notifying the Health Insurance Company of a Claim | Education Center |
You should give written notice of a claim within 20 days after any covered loss, or as soon as reasonably possible. Extra time is granted if, for example, you're seriously injured and notice cannot be given within the listed time period. Notice may be given directly to the insurance company or to an agent.
When the insurance company receives notice of a claim, it will usually furnish claim forms within 15 days. If it fails to do so, you may comply with the requirement for filing proof of loss by submitting written proof of the occurrence, character and extent of the loss. This can be in the form of an official accident report form or simply an affidavit that you've signed.
Formal proof of loss (on company claim forms) should be submitted within 90 days after any covered loss. Once again, extra time is granted if it's not possible for you to respond within this time period. But proof must be furnished as soon as reasonably possible, and no later than one year from the time proof is otherwise required (unless you're legally incapacitated at that point).
Issues of incapacitation are less important here than simple forgetfulness and inaccuracy. Most disputes over proof of loss reports involve situations in which policyholders only include some of the expenses they've accrued in their reports. Then, when the insurance company only covers some of the bills, accusations start to fly.
A caveat: Insurance companies won't cover costs they can't verify on the proof of loss form. Make sure you include everything. Most doctor's offices and hospitals will help you out in this effort.