If a claim is not denied within 90 days, the claim may be denied later based on what?

• A. Delay and investigate
• B. Deny
• C. Accept
• D. Close the file

Answer: (A)

The main idea is that there is a 90-day window to act on a claim, and if no denial is issued within that period, the claim can later be denied on the basis of delay while the insurer continues to investigate. In California SIP claim handling, the 90-day rule allows for timely decisions, but if more information is needed, the claim may be denied later because of the ongoing investigation and the resulting delay. This makes “delay and investigate” the correct basis for a later denial. Other options don’t fit because denying later without a stated investigative basis isn’t capturing why the denial is permissible, accepting would contradict the premise, and closing the file isn’t the reason a denial would occur.