California Department of Insurance Reaches Settlement with Hartford in Favor of Insureds
CALIFORNIA DEPARTMENT OF INSURANCE
For Release: July 2, 2007
Media Calls Only: 916-492-3566
California Reaches Settlement on Discretionary Clause in Disability Income Insurance Policies
Hartford agrees to replace controversial provision and to make benefits decisions based on a new policy term
SACRAMENTO - As part of its ongoing efforts to make disability income insurance policies provide greater and more certain benefits to California workers, Insurance Commissioner Steve Poizner announced a settlement with Hartford Life Insurance Company that provides that the policies it sells in California will no longer contain controversial "discretionary clause" language.
"The discretionary clause gives an insurer complete discretion when determining whether an injured worker is entitled to benefits," said Commissioner Poizner. "This settlement means that going forward The Hartford will use the new policy language to determine claim benefits. I want to commend The Hartford for working cooperatively with the Department to resolve this important consumer issue."
The Department intends to apply the terms of the settlement to all disability income insurance policies sold in the State.
The settlement requires that when making benefits decisions, The Hartford will:
- obtain only information that is necessary to evaluate and decide whether to accept or deny a claim for benefits;
- consider and interpret the policy and all information that relates to the claim for benefits and make a determination of the claimant's eligibility for benefits based on the new policy language; and
- if the claim is denied, explain in writing the basis for the adverse decision.
"Californians are entitled to know that insurers will decide their claims based on relevant information using consistent policy language that applies to all California insurers and insureds," Commissioner Poizner said. "We will make sure that policies do not give unlimited discretion to the insurance company."
Please visit the Department of Insurance Web site at www.insurance.ca.gov. Non media inquiries should be directed to the Consumer Hotline at 800.927.HELP. Callers from out of state, please dial 213.897.8921. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.