On June 27, 2007, the Court of Appeals for the State of New York issued a ruling in the case of Benesowitz v. Metropolitan Life Insurance Co., 8 N.Y.3d 661 (2007). The Court held that New York Insurance Law, Section 3234(a)(2), which specifies the requirements for New York regulated fully-insured group disability policies that include pre-existing condition provisions, must be interpreted as establishing a waiting period, rather than a total exclusion, for coverage of disabilities that are due to a pre-existing condition.
Prior to the Benesowitz ruling, the statute had been applied as permitting a total exclusion for coverage of these conditions. As a result, the State of New York Insurance Department has required all group disability insurers to review certain New York disability claims that were denied on the ground that the insured's disability was due to a pre-existing condition, as defined immediately below.
Unum will review the claim of any insured:
- covered under a fully-insured, group disability policy
- regulated by the state of New York
- that was denied because of a pre-existing condition
- between June 28, 2004 and June 27, 2007.
The claim review will be subject to all other terms and conditions of the policy. In addition, the claim review is being undertaken without any action required on the part of the insured.
Notification to affected insureds:
On or before April 30, 2008, Unum will notify all affected insureds who:
- are entitled to the payment of a disability benefit, or
- need to provide additional information to assist with our benefit review and determination.
As stated above, this review will be conducted without any action required on the part of the insured. However, any person who believes they may have an impacted claim (defined above), may contact us with questions by calling 800-421-0344 and advising that the call is about a previously denied New York pre-existing condition claim.