Prohibits insurers from reducing disability benefits due to the actual or anticipated receipt of social security disability benefits unless certain conditions are met

S T A T E   O F   N E W   Y O R K
        ________________________________________________________________________

                                          6465

                               2025-2026 Regular Sessions

                                  I N  A S S E M B L Y

                                      March 5, 2025
                                       ___________

        Introduced  by  M.  of A. HUNTER, BERGER, CLARK, WEPRIN -- read once and
          referred to the Committee on Insurance

        AN ACT to amend the insurance law, in relation to  prohibiting  insurers
          from reducing disability benefits unless certain conditions are met

          THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
        BLY, DO ENACT AS FOLLOWS:

     1    Section 1. Section 3216 of the insurance law is amended  by  adding  a
     2  new subsection (n) to read as follows:
     3    (N) NO INSURER MAY OFFSET OR REDUCE BENEFITS PAYABLE UNDER A POLICY OF
     4  ACCIDENT  AND HEALTH INSURANCE PROVIDING DISABILITY INSURANCE DUE TO THE
     5  ACTUAL OR ESTIMATED RECEIPT  OF  SOCIAL  SECURITY  DISABILITY  INSURANCE
     6  BENEFITS UNLESS:
     7    (1)  THE  INSURER HAS A REASONABLE, GOOD FAITH BELIEF THAT THE INSURED
     8  IS ENTITLED TO SUCH BENEFITS AND A MEANS OF  REASONABLY  ESTIMATING  THE
     9  AMOUNT PAYABLE;
    10    (2)  THE INSURER NOTIFIES THE INSURED THAT THE INSURED MAY QUALIFY FOR
    11  SUCH BENEFITS AND TO PURSUE SUCH BENEFITS THROUGH ANY REQUIRED  ADMINIS-
    12  TRATIVE APPEALS;
    13    (3)  THE  INSURER  MAKES  A GOOD FAITH EFFORT TO ASSIST THE INSURED IN
    14  APPLYING FOR SUCH BENEFITS; AND
    15    (4) THE INSURED FAILS TO APPLY FOR,  OR  PURSUE,  SUCH  BENEFITS  WITH
    16  REASONABLE  DILIGENCE  DURING  THE  APPLICATION  PROCESS OR ANY REQUIRED
    17  APPEALS.
    18    § 2. Section 3221 of the insurance law is  amended  by  adding  a  new
    19  subsection (v) to read as follows:
    20    (V) NO INSURER MAY OFFSET OR REDUCE BENEFITS PAYABLE UNDER A POLICY OF
    21  ACCIDENT  AND HEALTH INSURANCE PROVIDING DISABILITY INSURANCE DUE TO THE
    22  ACTUAL OR ESTIMATED RECEIPT  OF  SOCIAL  SECURITY  DISABILITY  INSURANCE
    23  BENEFITS UNLESS:

         EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09624-01-5
        A. 6465                             2

     1    (1)  THE  INSURER HAS A REASONABLE, GOOD FAITH BELIEF THAT THE INSURED
     2  IS ENTITLED TO SUCH BENEFITS AND A MEANS OF  REASONABLY  ESTIMATING  THE
     3  AMOUNT PAYABLE;
     4    (2)  THE INSURER NOTIFIES THE INSURED THAT THE INSURED MAY QUALIFY FOR
     5  SUCH BENEFITS AND TO PURSUE SUCH BENEFITS THROUGH ANY REQUIRED  ADMINIS-
     6  TRATIVE APPEALS;
     7    (3)  THE  INSURER  MAKES  A GOOD FAITH EFFORT TO ASSIST THE INSURED IN
     8  APPLYING FOR SUCH BENEFITS; AND
     9    (4) THE INSURED FAILS TO APPLY FOR,  OR  PURSUE,  SUCH  BENEFITS  WITH
    10  REASONABLE  DILIGENCE  DURING  THE  APPLICATION  PROCESS OR ANY REQUIRED
    11  APPEALS.
    12    § 3.  This act shall take effect immediately.