New York Child Abuse Identification and Reporting Practice Exam

According to the Time Payment of Claims provision, under what circumstance might payment be delayed?

1. Claims without proof of loss

2. Claims involving periodic payments

3. Claims submitted after a year

4. Claims submitted by third parties

The correct answer is: Claims involving periodic payments

The Time Payment of Claims provision allows for specific conditions under which the payment of claims can be delayed, with periodic payments being one of the recognized circumstances. When claims involve periodic payments, the payment might be postponed until the appropriate amount can be calculated based on the established schedule or terms stipulated in the policy. This often occurs because periodic payments require a more detailed assessment of ongoing situations, such as the length of treatment or the continuity of care, making it necessary to wait for all necessary information to ensure accurate assessment and fair compensation. Claims without proof of loss, those submitted after a year, or those submitted by third parties generally fall under different provisions or standard claim expectations that would typically not include a delay specifically related to periodic payment terms. Therefore, the correct answer reflects the unique nature of periodic payments and the administrative processes required to manage them effectively.