Assembly Bill A6465

                             
                     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:
 
   Section 1. Section 3216 of the insurance law is amended  by  adding  a
 new subsection (n) to read as follows:
   (N) NO INSURER MAY OFFSET OR REDUCE BENEFITS PAYABLE UNDER A POLICY OF
 ACCIDENT  AND HEALTH INSURANCE PROVIDING DISABILITY INSURANCE DUE TO THE
 ACTUAL OR ESTIMATED RECEIPT  OF  SOCIAL  SECURITY  DISABILITY  INSURANCE
 BENEFITS UNLESS:
   (1)  THE  INSURER HAS A REASONABLE, GOOD FAITH BELIEF THAT THE INSURED
 IS ENTITLED TO SUCH BENEFITS AND A MEANS OF  REASONABLY  ESTIMATING  THE
 AMOUNT PAYABLE;
   (2)  THE INSURER NOTIFIES THE INSURED THAT THE INSURED MAY QUALIFY FOR
 SUCH BENEFITS AND TO PURSUE SUCH BENEFITS THROUGH ANY REQUIRED  ADMINIS-
 TRATIVE APPEALS;
   (3)  THE  INSURER  MAKES  A GOOD FAITH EFFORT TO ASSIST THE INSURED IN
 APPLYING FOR SUCH BENEFITS; AND
   (4) THE INSURED FAILS TO APPLY FOR,  OR  PURSUE,  SUCH  BENEFITS  WITH
 REASONABLE  DILIGENCE  DURING  THE  APPLICATION  PROCESS OR ANY REQUIRED
 APPEALS.
   § 2. Section 3221 of the insurance law is  amended  by  adding  a  new
 subsection (v) to read as follows:
   (V) NO INSURER MAY OFFSET OR REDUCE BENEFITS PAYABLE UNDER A POLICY OF
 ACCIDENT  AND HEALTH INSURANCE PROVIDING DISABILITY INSURANCE DUE TO THE
 ACTUAL OR ESTIMATED RECEIPT  OF  SOCIAL  SECURITY  DISABILITY  INSURANCE
 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)  THE  INSURER HAS A REASONABLE, GOOD FAITH BELIEF THAT THE INSURED
 IS ENTITLED TO SUCH BENEFITS AND A MEANS OF  REASONABLY  ESTIMATING  THE
 AMOUNT PAYABLE;
   (2)  THE INSURER NOTIFIES THE INSURED THAT THE INSURED MAY QUALIFY FOR
 SUCH BENEFITS AND TO PURSUE SUCH BENEFITS THROUGH ANY REQUIRED  ADMINIS-
 TRATIVE APPEALS;
   (3)  THE  INSURER  MAKES  A GOOD FAITH EFFORT TO ASSIST THE INSURED IN
 APPLYING FOR SUCH BENEFITS; AND
   (4) THE INSURED FAILS TO APPLY FOR,  OR  PURSUE,  SUCH  BENEFITS  WITH
 REASONABLE  DILIGENCE  DURING  THE  APPLICATION  PROCESS OR ANY REQUIRED
 APPEALS.
   § 3.  This act shall take effect immediately.