If a claim is not denied within 90 days, the denial can occur later only if what condition applies?

• A. The denial is based on previously known facts
• B. A supervisor approves the denial
• C. The presumption is rebuttable only by evidence discovered subsequent to the 90-day period
• D. The claim is denied immediately upon discovery

Answer: (C)

The key idea is that there’s a 90-day window for denying a claim, and if the insurer doesn’t deny within that window, a presumption arises that the claim is compensable. This presumption isn’t absolute: a denial can occur later only if new evidence is discovered after the 90-day period that rebuts that presumption. So the condition that makes a late denial possible is evidence found after day 90 that shows the claim isn’t compensable. The other notions don’t fit because they don’t address this post‑90‑day evidence required to overcome the initial presumption.