How long does the insurer have to pay or issue a full/partial denial of a claim once evaluated?

The insurer is required to pay or issue a full or partial denial of a claim within 45 calendar days after the claim has been evaluated. This timeframe is established to ensure that claims are processed in a timely manner, which is essential for maintaining customer trust and satisfaction. By adhering to this 45-day rule, insurers help ensure that claimants have a clear understanding of their claim status and can plan accordingly based on the outcome.

This duration reflects the regulatory standards set to protect consumers and support fair practices within the insurance industry. A more extended period could lead to uncertainty for the claimant, while a shorter period might not allow sufficient time for thorough evaluation of complex claims. Understanding these timeframes is crucial for both insurance professionals and consumers navigating the claims process.