Unum's coterie of insurance companies recently advised policyholders of a new ruling by New York courts which substantially changed the law of preexisting condition when applied to ERISA claimants. All other DI insurers were also ordered by the New York Department of Insurance to so notify their policyholders.

     In the past, the law was thought be that a preexisting injury, illness or disability would permanently bar a claim for long term disability income claims under group and blanket (usually Erisa) disability policies. However, the ruling in Benesowitz v. Metropolitan Life Insurance Company, 8 NYS3d 661 (2007), decided that such preexisting condition would preclude payments only for a waiting period of up to

12 months, after which the insurer would be required to pay the disability claim according to the terms of its policy.

     As a result of this court ruling, the New York State Insurance Department ordered affected insurers to make a good faith effort to review and identify all claims for disability benefits based upon preexisting conditions going back at least 2 years from the date of the decision, June 27, 2007.  (If the insured's policy permits legal action to brought after a 2-year period, the insurer must extend its review for a period at least equal to the period in which the policy says a claim may be brought).

     The Insurance Department then ordered the affected companies to notify all affected insured in writing of the results of such review an to retroactively pay all benefits due, with interest, from the commencement of the period for which the insurer would have been liable had the insurer applied the law pursuant to the Benesowitz court ruling.

     Most importantly, the Department ordered that those who are unable to show proof of loss retroactively may, if still covered being covered by the policy, be entitled to prospective disability payments by providing proof under the terms of the policy.

     If you have any doubts or questions concerning your eligibility to file to file or refile your disability income insurance claim under the Benesowitz ruling, talk it over with Mike Quiat, an aggressive, responsive attorney with long experience in disability income insurance claims.

800-797-5575

(back)