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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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    “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.”

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    “Thank you Glenn for accepting my case. I had all but given up on finding an attorney that was willing to take this case, and although you may not remember, I enclosed a note to you when I sent my [ins. co.] file asking you to please help me. You did that sir, and I can't thank you enough. My thanks to you Corinne for pursuing my case with vigor. I don't know much about how these legal things are handled, but I could tell by your communications with me, making sure I was always informed, that you were on top of it all. Also, you were ALWAYS available to me to answer questions, and your compassion for me and my situation is so much appreciated. I have had limited exposure to the legal system and attorneys, but I have never been able to just call and talk to them, as I could with you. I always had to speak with someone in the office that couldn't really answer my questions. My sincerest thanks and best wishes for you both You have restored my faith in the goodness of people!”

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