Sec. 1251.112. DEADLINE FOR CLAIM. (a) A group accident and health insurance policy must provide that:
(1) in the case of a claim for a loss other than a claim for a loss of time for disability, written proof of the loss must be provided to the insurer not later than the 90th day after the date of the loss; and
(2) in the case of a claim for loss of time for disability:
(A) written proof of the loss must be provided to the insurer not later than the 90th day after the beginning of the period for which the insurer is liable; and
(B) subsequent written proofs of the continuance of the disability must be provided to the insurer at intervals as reasonably required by the insurer.
(b) Failure to provide written proof of a loss within the time prescribed by Subsection (a) does not invalidate or reduce a claim if:
(1) it was not reasonably possible to provide written proof of the loss within that time;
(2) written proof of the loss is provided as soon as reasonably possible; and
(3) unless the claimant does not have the legal capacity to provide proof of loss, proof of loss is provided not later than the first anniversary of the date the proof of loss is otherwise required.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle B - Group Health Coverage
Chapter 1251 - Group and Blanket Health Insurance
Subchapter C. Group Accident and Health Insurance: Required Provisions
Section 1251.101. Required Provisions
Section 1251.102. Payment of Premiums
Section 1251.103. Incontestability of Policy
Section 1251.104. Entire Contract
Section 1251.105. Statement Made by Policyholder or Insured
Section 1251.106. Distinction Based on Marital Status Prohibited
Section 1251.107. Evidence of Insurability
Section 1251.108. Exclusion or Limitation of Coverage for Preexisting Conditions
Section 1251.109. Adjustment of Premiums or Benefits if Age of Insured Is Misstated
Section 1251.110. Deadline for Notice of Claim
Section 1251.112. Deadline for Claim
Section 1251.113. Prompt Payment of Benefits Required
Section 1251.114. Payment of Benefits
Section 1251.115. Right to Conduct Physical Examination or Autopsy