Related provisions for COBS 17.1.3
1 - 1 of 1 items.
1When
an insurer or managing
agent receives a claim under a long-term
care insurance contract, it must respond promptly by providing
the policyholder, or the person acting on the policyholder's behalf,
with:(1) a claim form (if it requires one
to be completed);(2) a summary of its claims handling
procedure; and(3) appropriate information about the
medical criteria that must be met, and any waiting periods that apply, under
the terms of the policy.
As soon as reasonably practicable after
receipt of a claim, the insurer or managing agent must tell the policyholder, or the person acting
on the policyholder's behalf:(1) (for each part of the claim it
accepts), whether the claim will be settled by paying the policyholder,
providing goods or services to the policyholder or
paying another person to provide
those goods or services; and(2) (for each part of the claim it
rejects), why the claim has been rejected and whether any future