If a claim is not denied within 90 days, it can only be denied later based on what?

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Prepare for the California Self‑Insurance Plans (SIP) Exam with our interactive quiz. Benefit from multiple-choice questions, detailed explanations, and essential tips to enhance your knowledge and succeed in your exam!

Multiple Choice

If a claim is not denied within 90 days, it can only be denied later based on what?

Explanation:
The rule being tested is that claim decisions must be made within 90 days. If no denial or payment decision is issued in that period, the claim is deemed denied by operation of law. Because of that, any later disposition on the claim must be a denial. Accepting the claim, delaying the decision, or simply closing the file would contradict the deemed-denied status, whereas a denial aligns with the automatic consequence of not denying in time.

The rule being tested is that claim decisions must be made within 90 days. If no denial or payment decision is issued in that period, the claim is deemed denied by operation of law. Because of that, any later disposition on the claim must be a denial. Accepting the claim, delaying the decision, or simply closing the file would contradict the deemed-denied status, whereas a denial aligns with the automatic consequence of not denying in time.

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