If the insurer delays denial after 90 days but later presents new evidence discovered after 90 days, what can the denial be based on?

• A. Previously known facts only
• B. Any evidence discovered before 90 days
• C. Evidence discovered after 90 days
• D. A new hearing

Answer: (C)

The key idea is that the 90-day window governs when the insurer must issue a denial, but it doesn’t freeze the basis for denial to information available only up to that point. If the insurer delays past 90 days and later uncovers evidence discovered after that period, the denial can rely on that post‑90‑day evidence because it reflects new, material information that justifies denying the claim. This preserves the integrity of the denial when new facts come to light, rather than forcing acceptance based on information known only at the initial stage.

Note that evidence known before the 90-day deadline would have to be considered at the time the denial is issued; post‑90‑day evidence is the type that can justify a late denial. A hearing isn’t the basis for denial itself, so it isn’t the correct foundation here.