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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:

  1. obtain only information that is necessary to evaluate and decide whether to accept or deny a claim for benefits;
  2. 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
  3. 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.

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    “I wanted to thank you again for all of your help. My daughter would not be in treatment without your help. I can never thank you enough, there are no words that can express the feelings of gratitude and relief I have that you helped us, and I believe saved my little girl. Taking her back to Timberline Knolls was very difficult in many ways, I wish UBH could know the damage they have done to her by having her go in and out like this. When she went into Timberline Knolls the first time she was not happy to go exactly, no one wants to go into treatment, but she was open to going in and ready, for the first time, to really look at her issues and work hard to get better. When she had to leave Timberline she expressed that she wished she could have stayed because she felt like she was finally at a place where she was getting better and, though it was hard, she was really opening up and dealing with her issues for the first time, something she has had a hard time doing. I just wanted you to know that she was going down to a really bad place and without you I don't know what would have happened except that she would not be at Timberline Knolls right now getting better and I thought you should know this. With unending gratitude.”

    R.

  • I won the appeal.

    “Hi Glenn- This is a very belated thank you for your generous assistance and advice last summer, when I was appealing UBH's decision for my son. I won the appeal, at least for care at the partial hospitalization level (they wouldn't budge on residential, but the facility was accepting the partial care reimbursement for residential treatment). But the appeal was a great moral victory, and I think it's a great thing to have in the record, just in case he needs to go for treatment again. Thanks again for your generous help, I was very grateful for it. Wishing you a most happy Thanksgiving.”

    Terry S.

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    “Hi Elizabeth - You have been such an important part of my and Jennifer's past year, and I want to send you a note to wish you a wonderful holiday. Thank you for all of your hard work, support and belief in our case. Thank you seems like two small words and not enough, but they are heartfelt and mean so much.”

    J.H.

  • Truly outstanding in every way!

    “Both Glenn Kantor and his associate attorney Brent Brehm are truly experts in the field of disability law. They handled a complex individual disability policy issue for me. Their knowledge of the law, coupled with their experience, resources, and tactical skills, helped me obtain results that exceeded my expectations. Truly outstanding in every way!”

    Anonymous

  • I am a life you have touched. May God bless you richly.

    “After suffering with constant pain for nearly seven months, losing the job I loved and then being denied my long term disability, I was extremely discouraged when I began looking for help. With a few phone calls from Mr. Kantor to my insurance company, my long term disability was reinstated . The financial burden was lifted and I have hope again. I am a life you have touched. May God bless you richly.”

    Susan H.