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On June 27, 2007, the New York Court of Appeals issued a unanimous decision in the case Benesowitz vs. Metropolitan Life Insurance Company, which affects pre-existing condition provisions in group disability policies issued in New York state.
The Court's Decision
The court held that New York Insurance Law Section 3234 establishes that any pre-existing condition provision is a waiting period, and not a complete bar for coverage of those disabilities that arise within the first 12 months of coverage.
Impacts of this Decision
Based on this decision, Guardian is re-examining disability claims denied based upon pre-existing conditions. The re-examination includes claims that were denied within a three year period prior to June 27, 2007.
By April 30, 2008, Guardian plans to:
 | Contact all affected insureds via mail with the results of this review, and |
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| Pay any benefit due with interest (benefits due would correspond to the start of the period for which Guardian would have been liable had the court's decision been applied to the claim when the proof of loss was first submitted) |
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If additional information is required to determine whether benefits are payable, Guardian will attempt to request the information on or before April 30, 2008. Guardian will notify the insured and retroactively pay any benefits due with interest no later than 60 days after receiving all necessary information.
If you believe that your group disability claim was previously denied by Guardian for a pre-existing condition based on the prior interpretation of New York Insurance Law Section 3234, you may contact us at 800-538-4583. As noted above, this re-examination only affects group disability policies issued in New York state.
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