What Do You Mean It's Not Covered: Filling Out the Proper Forms
Claim Forms: Upon receipt of a notice of claim, we will furnish forms to the claimant for filing proof of the loss. If we do not furnish the forms within 15 days after we have been given the notice, we will consider the claimant to have complied with the requirements for filing proof of loss, provided we have received, within the time fixed in the policy for filing proof of loss, written proof of the occurrence, the character and the extent of the loss for which the claim is made.
When the insurance company receives notice of a claim, it will usually furnish claim forms within 15 days. If it fails to do so, you may comply with the requirement for filing proof of loss by submitting written proof of the occurrence, character and extent of the loss. This can be in the form of an official accident report form or simply a affidavit that you've signed.
Proof of Loss: We must be furnished written proof of loss within 90 days after the date of loss. We will not reject or reduce any claim because we are not furnished proof in the time required if it is not possible for you to do so. However, proof must be furnished as soon as reasonably possible, and in no event, later than one year from the time proof is required, unless it is legally impossible to do so.
Formal proof of loss (on company claim forms) should be submitted within 90 days after any covered loss. Once again, extra time is granted if it's not possible for you to respond within this time period. But proof must be furnished as soon as reasonably possible, and no later than one year from the time proof is otherwise required (unless you're legally incapacitated at that point). Issues of incapacitation are less important here than simple forgetfulness and inaccuracy. Most disputes over proof of loss reports involve situations in which policyholders only include some of the expenses they've accrued in their reports. Then, when the insurance company only covers some of the bills, accusations start to fly. A caveat: Insurance companies won't cover costs they can't verify on the proof of loss form. Make sure you include everything. Most doctors offices and hospitals will help you out in this effort.
